First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives.

PubMed

Arch, Joanna J; Craske, Michelle G

2009-09-01

In this article, the authors assess the successes, remaining challenges, and new developments in cognitive behavioral therapy (CBT) for anxiety disorders. They define CBT, examine treatment components, review treatment efficacy, and discuss the challenges of attrition, long-term follow-up, co-occurring/comorbid disorders, limited treatment comparisons, treatment mediators, and broader implementation. In addition, they present recent developments in cognitive behavioral therapy for anxiety disorders, including linking exposure therapy to basic science, mindfulness and acceptance-based treatments, and unified or transdiagnostic treatment protocols.

Investigating the Effectiveness, Acceptability and Impact on Healthcare Usage of Providing a Cognitive-Behavioural Based Psychological Therapy Service for Patients with Primary Antibody Deficiency.

PubMed

Campbell, Mari; Clarke, Alex; Symes, Andrew; Workman, Sarita; Stauss, Hans; Webster, A David

2018-02-01

Patients with primary antibody deficiency report poorer quality of life and higher rates of anxiety and depression than the general population. Cognitive-behavioral therapy has been shown to be a valuable treatment for patients with other long-term physical health conditions, improving well-being and enabling them to manage their symptoms more effectively. The aim of this project was to establish the feasibility and effectiveness of providing cognitive-behavioral based therapy to patients with primary antibody deficiency. Forty-four patients completed a course of psychological therapy. Participants completed a series of self-report measures examining psychological and physical health, and service usage, prior to starting treatment and following their final session. They also provided feedback on their experience of treatment. Patients showed improvements in anxiety, depression, insomnia and fatigue. There was a high level of acceptability of the service and the potential for long-term cost savings to the NHS. Psychological therapy based on the cognitive-behavioral model of treatment appears to be a valuable treatment for patients with primary antibody deficiency and comorbid mental health difficulties.

Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change.

PubMed

Huestis, Samantha E; Kao, Grace; Dunn, Ashley; Hilliard, Austin T; Yoon, Isabel A; Golianu, Brenda; Bhandari, Rashmi P

2017-12-07

Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

The value of mindfulness meditation in the treatment of insomnia.

PubMed

Martires, Joanne; Zeidler, Michelle

2015-11-01

Insomnia is the most common reported sleep disorder with limited treatment options including pharmacotherapy and cognitive behavioral therapy for insomnia. Pharmacotherapy can be complicated by tolerance and significant side-effects and cognitive behavioral therapy for insomnia providers are limited in number. This article reviews mindfulness meditation as an additional therapy for insomnia. Both mindfulness-based stress reduction (MBSR) and mindfulness-based therapy for insomnia (MBTI) have been studied in the treatment of insomnia. Randomized controlled studies of MBSR and MBTI have shown overall reduction in sleep latency and total wake time and increase in total sleep time after mindfulness therapy using both patient reported outcome and quantitative measures of sleep. Mindfulness techniques have been shown to be well accepted by patients with long-lasting effects. A three-arm randomized study with MBSR, MBTI, and self-monitoring showed similar improvement in insomnia between the MBSR and MBTI groups, with possibly longer duration of efficacy in the MBTI group. Recent data show that MBTI is also an effective and accepted treatment for insomnia in older patients. Increasing evidence shows that mindfulness meditation, delivered either via MBSR or MBTI, can be successfully used for the treatment of insomnia with good patient acceptance and durable results.

Open Trial of an Acceptance-Based Behavior Therapy Intervention to Engage Newly Diagnosed HIV Patients in Care: Rationale and Evidence of Feasibility and Acceptability.

PubMed

Moitra, Ethan; Chan, Philip A; Stein, Michael D

2015-09-01

Successful linkage and retention in care of newly diagnosed individuals in the United States remains a significant gap in the HIV care continuum. This study assessed the acceptability and feasibility of an acceptance-based behavior therapy (ABBT) intervention to engage patients newly diagnosed with HIV in medical care. Nine patients were recruited over 4 months for this brief ABBT intervention, which consisted of two brief sessions, each lasting less than 20 min. The intervention was developed to promote psychological acceptance of the HIV diagnosis, thereby increasing patients' willingness to make informed disclosure of their status. Eight patients completed a 1-month follow-up assessment, and all approved of the intervention and its components. Over the 1-month period, participants showed increased acceptance, reduced perceptions of HIV stigmatization, and increased disclosure of HIV status to social supports. This pilot study provided support for the continued investigation of ABBT as an adjunctive intervention for newly diagnosed HIV patients who are at high-risk of dropping out of HIV care. © The Author(s) 2015.

Investigating the Similarities and Differences between Practitioners of Second and Third Wave Cognitive-Behavioral Therapies

PubMed Central

Brown, Lily A.; Gaudiano, Brandon A.; Miller, Ivan W.

2013-01-01

There has been much discussion in the literature recently regarding the conceptual and techniual differences between so-called second (e.g., Beckian cognitive therapy) and third “wave” (e.g., acceptance and commitment therapy) behavior therapies. Previous research has not addressed the potential similarities and differences among the practitioners of these types of approaches. The current study examined possible differences in the characteristics of second wave (n=55) and third wave cognitive-behavioral therapists (n=33) using an internet-based survey. There were differences found at the technique level between the two groups. As expected, third wave therapists reported greater use of mindfulness/acceptance techniques. Also, third wave therapists reported greater use of exposure techniques and second wave therapists reported greater use of cognitive restructuring and relaxation techniques. In general, third wave clinicians were more eclectic at the technique level, and demonstrated significantly greater use of family systems techniques, existential/humanistic techniques, and the total number of techniques used. No significant differences were found on the attitudinal measures administered, including reliance on an intuitive thinking style, acceptance of complementary and alternative therapies and related health beliefs, or most attitudes toward evidence-based practices. We did not identify many differences between second wave and third wave therapists other than in terms of the techniques they employ. The clinical and research implications for these findings are discussed. PMID:21324946

Acceptance and Commitment Therapy as a Unified Model of Behavior Change

ERIC Educational Resources Information Center

Hayes, Steven C.; Pistorello, Jacqueline; Levin, Michael E.

2012-01-01

The present article summarizes the assumptions, model, techniques, evidence, and diversity/social justice commitments of Acceptance and Commitment Therapy (ACT). ACT focused on six processes (acceptance, defusion, self, now, values, and action) that bear on a single overall target (psychological flexibility). The ACT model of behavior change has…

Acceptance and Commitment Therapy: Introduction

ERIC Educational Resources Information Center

Twohig, Michael P.

2012-01-01

This is the introductory article to a special series in Cognitive and Behavioral Practice on Acceptance and Commitment Therapy (ACT). Instead of each article herein reviewing the basics of ACT, this article contains that review. This article provides a description of where ACT fits within the larger category of cognitive behavior therapy (CBT):…

A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus

ERIC Educational Resources Information Center

Hesser, Hugo; Gustafsson, Tore; Lunden, Charlotte; Henrikson, Oskar; Fattahi, Kidjan; Johnsson, Erik; Westin, Vendela Zetterqvist; Carlbring, Per; Maki-Torkko, Elina; Kaldo, Viktor; Andersson, Gerhard

2012-01-01

Objective: Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format. Method: Ninety-nine participants (mean age = 48.5 years; 43% female) who were…

Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy as Treatments for Academic Procrastination: A Randomized Controlled Group Session

ERIC Educational Resources Information Center

Wang, Shuo; Zhou, Ya; Yu, Shi; Ran, Li-Wen; Liu, Xiang-Ping; Chen, Yu-Fei

2017-01-01

Objective: This study tested the efficacy of Acceptance and Commitment Therapy (ACT), compared with Cognitive-Behavioral Therapy (CBT), in alleviating academic procrastination. Method: A total of 60 (53.3% male) undergraduates suffering from academic procrastination were randomly assigned to two treatment groups (ACT and CBT) and a control group.…

Clinical processes in behavioral couples therapy.

PubMed

Fischer, Daniel J; Fink, Brandi C

2014-03-01

Behavioral couples therapy is a broad term for couples therapies that use behavioral techniques based on principles of operant conditioning, such as reinforcement. Behavioral shaping and rehearsal and acceptance are clinical processes found across contemporary behavioral couples therapies. These clinical processes are useful for assessment and case formulation, as well as teaching couples new methods of conflict resolution. Although these clinical processes assist therapists in achieving efficient and effective therapeutic change with distressed couples by rapidly stemming couples' corrosive affective exchanges, they also address the thoughts, emotions, and issues of trust and intimacy that are important aspects of the human experience in the context of a couple. Vignettes are provided to illustrate the clinical processes described. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Building capacity for cognitive behavioral therapy delivery for depression in disaster-impacted contexts.

PubMed

Ngo, Victoria K; Centanni, Angela; Wong, Eunice; Wennerstrom, Ashley; Miranda, Jeanne

2011-01-01

Numerous challenges exist in implementing evidence-based practices, such as cognitive behavioral therapy, in resource poor, ethnic minority, and/or disaster-affected communities with disparities in mental health. Community-academic participatory partnerships are a promising approach to addressing disparities by implementing community-appropriate, evidence-based depression care. A community-academic collaborative was formed in New Orleans after Hurricane Katrina to expand resources for effective depression care, including cognitive behavioral therapy. In this article, we: 1) describe our model of building capacity to deliver cognitive behavioral therapy for depression in post-disaster community-based settings; 2) discuss the impact of this training program on therapist reported practice; and 3) share lessons learned regarding disseminating and sustaining evidence-based interventions in the context of a disaster impacted community. Using a mixed methods approach, we found that this model was feasible, acceptable, and disseminated knowledge about cognitive behavioral therapy in community settings. Over the course of two years, community providers demonstrated the feasibility of implementing evidence-based practice and potential for local community leadership. The lessons learned from this model of implementation may help address barriers to disseminating evidence-based interventions in other low-resource, disaster-impacted community settings.

Integrative Behavioral Couple Therapy: Theoretical Background, Empirical Research, and Dissemination.

PubMed

Roddy, McKenzie K; Nowlan, Kathryn M; Doss, Brian D; Christensen, Andrew

2016-09-01

Integrative Behavioral Couple Therapy (IBCT), developed by Drs. Andrew Christensen and Neil Jacobson, builds off the tradition of behavioral couple therapy by including acceptance strategies as key components of treatment. Results from a large randomized clinical trial of IBCT indicate that it yields large and significant gains in relationship satisfaction. Furthermore, these benefits have been shown to persist for at least 5 years after treatment for the average couple. Not only does IBCT positively impact relationship constructs such as satisfaction and communication, but the benefits of therapy extend to individual, co-parenting, and child functioning. Moreover, IBCT has been shown to operate through the putative mechanisms of improvements in emotional acceptance, behavior change, and communication. IBCT was chosen for nationwide training and dissemination through the Veteran Affairs Medical Centers. Furthermore, the principles of IBCT have been translated into a web-based intervention for distressed couples, OurRelationship.com. IBCT is continuing to evolve and grow as research and technologies allow for continued evaluation and dissemination of this well-supported theoretical model. © 2016 Family Process Institute.

Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability.

PubMed

Stanley, Barbara; Brown, Gregory; Brent, David A; Wells, Karen; Poling, Kim; Curry, John; Kennard, Betsy D; Wagner, Ann; Cwik, Mary F; Klomek, Anat Brunstein; Goldstein, Tina; Vitiello, Benedetto; Barnett, Shannon; Daniel, Stephanie; Hughes, Jennifer

2009-10-01

To describe the elements of a manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide. The CBT-SP was developed using a risk reduction and relapse prevention approach and theoretically grounded in principles of cognitive-behavioral therapy, dialectical behavioral therapy, and targeted therapies for suicidal youths with depression. The CBT-SP consists of acute and continuation phases, each lasting about 12 sessions, and includes a chain analysis of the suicidal event, safety plan development, skill building, psychoeducation, family intervention, and relapse prevention. The CBT-SP was administered to 110 recent suicide attempters with depression aged 13 to 19 years (mean 15.8 years, SD 1.6) across five academic sites. Twelve or more sessions were completed by 72.4% of the sample. A specific intervention for adolescents at high risk for repeated suicide attempts has been developed and manual based, and further testing of its efficacy seems feasible.

Developing a Safer Conception Intervention for Men Living with HIV in South Africa.

PubMed

Khidir, Hazar; Psaros, Christina; Greener, Letitia; O'Neil, Kasey; Mathenjwa, Mxolisi; Mosery, F N; Moore, Lizzie; Harrison, Abigail; Bangsberg, David R; Smit, Jennifer A; Safren, Steven A; Matthews, Lynn T

2018-06-01

Within sexual partnerships, men make many decisions about sexual behavior, reproductive goals, and HIV prevention. There are increasing calls to involve men in reproductive health and HIV prevention. This paper describes the process of creating and evaluating the acceptability of a safer conception intervention for men living with HIV who want to have children with partners at risk for acquiring HIV in KwaZulu-Natal, South Africa. Based on formative work conducted with men and women living with HIV, their partners, and providers, we developed an intervention based on principles of cognitive-behavioral therapy to support men in the adoption of HIV risk-reduction behaviors such as HIV-serostatus disclosure and uptake of and adherence to antiretroviral therapy. Structured group discussions were used to explore intervention acceptability and feasibility. Our work demonstrates that men are eager for reproductive health services, but face unique barriers to accessing them.

The tailored activity program (TAP) to address behavioral disturbances in frontotemporal dementia: a feasibility and pilot study.

PubMed

O'Connor, Claire M; Clemson, Lindy; Brodaty, Henry; Low, Lee-Fay; Jeon, Yun-Hee; Gitlin, Laura N; Piguet, Olivier; Mioshi, Eneida

2017-10-15

To explore the feasibility of implementing the Tailored Activity Program with a cohort of people with frontotemporal dementia and their carers (dyads). The Tailored Activity Program is an occupational therapy based intervention that involves working collaboratively with family carers and prescribes personalized activities for behavioral management in people with dementia. Twenty dyads randomized into the study (Tailored Activity Program: n = 9; Control: n = 11) were assessed at baseline and 4-months. Qualitative analyzes evaluated feasibility and acceptability of the program for the frontotemporal dementia cohort, and quantitative analyzes (linear mixed model analyzes, Spearman's rho correlations) measured the impact of the program on the dyads. The Tailored Activity Program was an acceptable intervention for the frontotemporal dementia dyads. Qualitative analyses identified five themes: "carer perceived benefits", "carer readiness to change", "strategies used by carer to engage person with dementia", "barriers to the Tailored Activity Program uptake/implementation", and "person with dementia engagement". Quantitative outcomes showed an overall reduction of behavioral symptoms (F 18.34  = 8.073, p = 0.011) and maintenance of functional performance in the person with dementia (F 18.03  = 0.375, p = 0.548). This study demonstrates the potential for using an activity-based intervention such as the Tailored Activity Program in frontotemporal dementia. Service providers should recognize that while people with frontotemporal dementia present with challenging issues, tailored therapies may support their function and reduce their behavioral symptoms. Implications for rehabilitation The Tailored Activity Program is an occupational therapy based intervention that involves prescribing personalized activities for behavioral management in dementia. The Tailored Activity Program is an acceptable and feasible intervention approach to address some of the unique behavioral and functional impairments inherent in frontotemporal dementia.

Comparison of motivational interviewing with acceptance and commitment therapy: a conceptual and clinical review.

PubMed

Bricker, Jonathan; Tollison, Sean

2011-10-01

Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) are two emerging therapies that focus on commitment to behavior change. The aim was to provide the first systematic comparison of MI with ACT. A systematic comparison was undertaken of MI and ACT at the conceptual level, with a focus on their philosophical and theoretical bases, and at the clinical level, with a focus on the therapeutic relationship, use of language in therapy, and use of values in therapy. Conceptually, MI and ACT have distinct philosophical bases. MI's theoretical basis focuses on language content, whereas ACT's theoretical basis focuses on language process. Clinically, ACT and MI have distinct approaches to the therapeutic relationship, fundamentally different foci on client language, and different uses of client values to motivate behavior change. ACT, but not MI, directly targets the willingness to experience thoughts, feelings, and sensations. Despite their conceptual and clinical differences, MI and ACT are complementary interventions. Collaborations between MI and ACT researchers may yield fruitful cross-fertilization research on core processes and clinical outcomes.

Comparison of Motivational Interviewing with Acceptance and Commitment Therapy: A conceptual and clinical review

PubMed Central

Bricker, J.B.; Tollison, S.J.

2011-01-01

Background Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) are two emerging therapies that focus on commitment to behavior change. Aim Provide the first systematic comparison of MI with ACT. Methods A systematic comparison of MI and ACT at the conceptual level, with a focus on their philosophical and theoretical bases, and at the clinical level, with a focus on the therapeutic relationship, use of language in therapy, and use of values in therapy. Results Conceptually, MI & ACT have distinct philosophical bases. MI’s theoretical basis focuses on language content, whereas ACT’s theoretical basis focuses on language process. Clinically, ACT and MI have distinct approaches to the therapeutic relationship, fundamentally different foci on client language, and different uses of client values to motivate behavior change. ACT, but not MI, directly targets the willingness to experience thoughts, feelings, and sensations. Conclusions Despite their conceptual and clinical differences, MI and ACT are complementary interventions. Collaborations between MI and ACT researchers may yield fruitful cross-fertilization research on core processes and clinical outcomes. PMID:21338532

Trauma-related emotions and radical acceptance in dialectical behavior therapy for posttraumatic stress disorder after childhood sexual abuse.

PubMed

Görg, Nora; Priebe, Kathlen; Böhnke, Jan R; Steil, Regina; Dyer, Anne S; Kleindienst, Nikolaus

2017-01-01

Posttraumatic Stress Disorder (PTSD) related to childhood sexual abuse (CSA) is often associated with a wide range of trauma-related aversive emotions such as fear, disgust, sadness, shame, guilt, and anger. Intense experience of aversive emotions in particular has been linked to higher psychopathology in trauma survivors. Most established psychosocial treatments aim to reduce avoidance of trauma-related memories and associated emotions. Interventions based on Dialectical Behavior Therapy (DBT) also foster radical acceptance of the traumatic event. This study compares individual ratings of trauma-related emotions and radical acceptance between the start and the end of DBT for PTSD (DBT-PTSD) related to CSA. We expected a decrease in trauma-related emotions and an increase in acceptance. In addition, we tested whether therapy response according to the Clinician Administered PTSD-Scale (CAPS) for the DSM-IV was associated with changes in trauma-related emotions and acceptance. The data was collected within a randomized controlled trial testing the efficacy of DBT-PTSD, and a subsample of 23 women was included in this secondary data analysis. In a multilevel model, shame, guilt, disgust, distress, and fear decreased significantly from the start to the end of the therapy whereas radical acceptance increased. Therapy response measured with the CAPS was associated with change in trauma-related emotions. Trauma-related emotions and radical acceptance showed significant changes from the start to the end of DBT-PTSD. Future studies with larger sample sizes and control group designs are needed to test whether these changes are due to the treatment. ClinicalTrials.gov, number NCT00481000.

Treatment of social anxiety disorder using online virtual environments in second life.

PubMed

Yuen, Erica K; Herbert, James D; Forman, Evan M; Goetter, Elizabeth M; Comer, Ronald; Bradley, Jean-Claude

2013-03-01

Over 80% of people with social anxiety disorder (SAD) do not receive any type of treatment, despite the existence of effective evidence-based treatments. Barriers to treatment include lack of trained therapists (particularly in nonmetropolitan areas), logistical difficulties (e.g., cost, time, transportation), concerns regarding social stigma, and fear of negative evaluation from health care providers. Interventions conducted through electronic communication media, such as the Internet, have the potential to reach individuals who otherwise would not have access to evidence-based treatments. Second Life is an online virtual world that holds great promise in the widespread delivery of evidence-based treatments. We assessed the feasibility, acceptability, and initial efficacy of an acceptance-based behavior therapy in Second Life to treat adults with generalized SAD. Participants (n=14) received 12 sessions of weekly therapy and were assessed at pretreatment, midtreatment, posttreatment, and follow-up. Participants and therapists rated the treatment program as acceptable and feasible, despite frequently encountered technical difficulties. Analyses showed significant pretreatment to follow-up improvements in social anxiety symptoms, depression, disability, and quality of life, with effect sizes comparable to previously published results of studies delivering in-person cognitive behavior therapy for SAD. Implications and future directions are discussed. Copyright © 2012. Published by Elsevier Ltd.

Internet-Based Acceptance and Commitment Therapy for Psychological Distress Experienced by People With Hearing Problems: Study Protocol for a Randomized Controlled Trial.

PubMed

Molander, Peter; Hesser, Hugo; Weineland, Sandra; Bergwall, Kajsa; Buck, Sonia; Hansson-Malmlöf, Johan; Lantz, Henning; Lunner, Thomas; Andersson, Gerhard

2015-09-01

Psychological distress and psychiatric symptoms are prevalent among people with hearing loss or other audiological conditions, but psychological interventions for these groups are rare. This article describes the study protocol for a randomized controlled trial for evaluating the effect of a psychological treatment delivered over the Internet for individuals with hearing problems and concurrent psychological distress. Participants who are significantly distressed will be randomized to either an 8-week Internet-delivered acceptance-based cognitive behavioral therapy (i.e., acceptance and commitment therapy [ACT]), or wa it-list control. We aim to include measures of distress associated with hearing difficulties, anxiety, and depression. In addition, we aim to measure acceptance associated with hearing difficulties as well as quality of life. The results of the trial may further our understanding of how to best treat people who present problems with both psychological distress and hearing in using the Internet.

Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia.

PubMed

Scales, Kezia; Zimmerman, Sheryl; Miller, Stephanie J

2018-01-18

To draw from systematic and other literature reviews to identify, describe, and critique nonpharmacological practices to address behavioral and psychological symptoms of dementia (BPSDs) and provide evidence-based recommendations for dementia care especially useful for potential adopters. A search of systematic and other literature reviews published from January 2010 through January 2017. Nonpharmacological practices were summarized to describe the overall conceptual basis related to effectiveness, the practice itself, and the size and main conclusions of the evidence base. Each practice was also critically reviewed to determine acceptability, harmful effects, elements of effectiveness, and level of investment required, based on time needed for training/implementation, specialized care provider requirements, and equipment/capital requirements. Nonpharmacological practices to address BPSDs include sensory practices (aromatherapy, massage, multi-sensory stimulation, bright light therapy), psychosocial practices (validation therapy, reminiscence therapy, music therapy, pet therapy, meaningful activities), and structured care protocols (bathing, mouth care). Most practices are acceptable, have no harmful effects, and require minimal to moderate investment. Nonpharmacological practices are person-centered, and their selection can be informed by considering the cause and meaning of the individual's behavioral and psychological symptoms. Family caregivers and paid care providers can implement evidence-based practices in home or residential care settings, although some practices require the development of more specific protocols if they are to become widely used in an efficacious manner. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A pilot study of a nurse-delivered cognitive behavioral therapy intervention (Ziphamandla) for adherence and depression in HIV in South Africa.

PubMed

Andersen, Lena S; Magidson, Jessica F; O'Cleirigh, Conall; Remmert, Jessica E; Kagee, Ashraf; Leaver, Matthew; Stein, Dan J; Safren, Steven A; Joska, John

2018-05-01

Depression is prevalent among people living with HIV in South Africa and interferes with adherence to antiretroviral therapy. This study evaluated a nurse-delivered, cognitive behavioral therapy intervention for adherence and depression among antiretroviral therapy users with depression in South Africa ( n = 14). Primary outcomes were depression, antiretroviral therapy adherence, feasibility, and acceptability. Findings support robust improvements in mood through a 3-month follow up. Antiretroviral therapy adherence was maintained during the intervention period. Participant retention supports acceptability; however, modest provider fidelity despite intensive supervision warrants additional attention to feasibility. Future effectiveness research is needed to evaluate this nurse-delivered cognitive behavioral therapy intervention for adherence and depression in this context.

Acceptance-Enhanced Behavior Therapy for Trichotillomania in Adolescents

ERIC Educational Resources Information Center

Fine, Kathi M.; Walther, Michael R.; Joseph, Jessica M.; Robinson, Jordan; Ricketts, Emily J.; Bowe, William E.; Woods, Douglas W.

2012-01-01

Although several studies have examined the efficacy of Acceptance Enhanced Behavior Therapy (AEBT) for the treatment of trichotillomania (TTM) in adults, data are limited with respect to the treatment of adolescents. Our case series illustrates the use of AEBT for TTM in the treatment of two adolescents. The AEBT protocol (Woods & Twohig, 2008) is…

"Knowing That You're Not the Only One": Perspectives on Group-Based Cognitive-Behavioral Therapy for Adherence and Depression (CBT-AD) in Adults With Type 1 Diabetes.

PubMed

Esbitt, Sabrina A; Batchelder, Abigail W; Tanenbaum, Molly L; Shreck, Erica; Gonzalez, Jeffrey S

2015-08-01

Depression and illness-specific distress are more common among adults with Type 1 diabetes (T1DM) than the general population and have been associated with poorer control of blood glucose and increased risk for serious diabetes-related complications. Treatment nonadherence has also been associated with depressive symptoms and diabetes-related distress, and has repeatedly been suggested as an important modifiable behavioral pathway linking depression and diabetes outcomes. The present study reports on the feasibility and acceptability of a pilot intervention using group-based cognitive-behavioral therapy to improve treatment adherence among adults with T1DM and elevated levels of diabetes-related distress or depressive symptoms. We describe the components of the intervention and utilize qualitative data along with descriptive outcome data. Our findings suggest that participation in the group was acceptable and associated with reductions in depressive symptoms and diabetes-specific distress. Challenges to feasibility and future directions are discussed.

An Open Trial of a New Acceptance-Based Behavioral Treatment for Major Depression with Psychotic Features

ERIC Educational Resources Information Center

Gaudiano, Brandon A.; Nowlan, Kathryn; Brown, Lily A.; Epstein-Lubow, Gary; Miller, Ivan W.

2013-01-01

Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In…

Moderators and Non-Specific Predictors of Treatment Outcome for Anxiety Disorders : A Comparison of Cognitive Behavioral Therapy to Acceptance and Commitment Therapy

ERIC Educational Resources Information Center

Wolitzky-Taylor, Kate B.; Arch, Joanna J.; Rosenfield, David; Craske, Michelle G.

2012-01-01

Objective: Understanding for whom, and under what conditions, treatments exert their greatest effects is essential for developing personalized medicine. Research investigating moderators of outcome among evidence-based treatments for anxiety disorders is lacking. The current study examined several theory-driven and atheoretical putative moderators…

Self-focused attention and safety behaviors across group therapies for social anxiety disorder.

PubMed

Desnoyers, Amanda J; Kocovski, Nancy L; Fleming, Jan E; Antony, Martin M

2017-07-01

Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD). The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT). Participants with symptoms meeting criteria for SAD (N = 137) were randomly assigned to the 12-week-treatment groups (n = 53 for each condition) or a waitlist control (n = 31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up. Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups. Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.

The Valued Living Questionnaire: Defining and Measuring Valued Action within a Behavioral Framework

ERIC Educational Resources Information Center

Wilson, Kelly G.; Sandoz, Emily K.; Kitchens, Jennifer; Roberts, Miguel

2010-01-01

A number of cognitive-behavior therapies now strongly emphasize particular behavioral processes as mediators of clinical change specific to that therapy. This shift in emphasis calls for the development of measures sensitive to changes in the therapies' processes. Among these is acceptance and commitment therapy (ACT), which posits valued living…

Acceptance and Commitment Therapy and Contextual Behavioral Science: Examining the Progress of a Distinctive Model of Behavioral and Cognitive Therapy

PubMed Central

Hayes, Steven C.; Levin, Michael E.; Plumb-Vilardaga, Jennifer; Villatte, Jennifer L.; Pistorello, Jacqueline

2012-01-01

A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term “contextual behavioral science.” We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy. PMID:23611068

Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy.

PubMed

Hayes, Steven C; Levin, Michael E; Plumb-Vilardaga, Jennifer; Villatte, Jennifer L; Pistorello, Jacqueline

2013-06-01

A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term "contextual behavioral science." We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy. Copyright © 2011. Published by Elsevier Ltd.

Acceptance-Enhanced Behavior Therapy (AEBT) for Trichotillomania and Chronic Skin Picking: Exploring the Effects of Component Sequencing

ERIC Educational Resources Information Center

Flessner, Christopher A.; Busch, Andrew M.; Heideman, Paul W.; Woods, Douglas W.

2008-01-01

This pilot study examined the utility of acceptance-enhanced behavior therapy (AEBT) for trichotillomania (TTM) and chronic skin picking (CSP) and the impact of altering treatment sequence on overall treatment efficacy. Participants referred to a TTM and CSP specialty clinic were assessed by an independent evaluator within separate, nonconcurrent,…

Acceptability of Alternative Treatments for Deviant Child Behavior.

ERIC Educational Resources Information Center

Kazdin, Alan E.

1980-01-01

Cases of deviant child behavior were described to 88 undergraduate students along with four different treatments (reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock). Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from…

Cognitive-Behavioral Therapy.

PubMed

An, Hong; He, Ri-Hui; Zheng, Yun-Rong; Tao, Ran

2017-01-01

Cognitive-behavioral therapy (CBT) is the main method of psychotherapy generally accepted in the field of substance addiction and non-substance addiction. This chapter mainly introduces the methods and technology of cognitive-behavior therapy of substance addiction, especially in order to prevent relapse. In the cognitive-behavior treatment of non-substance addiction, this chapter mainly introduces gambling addiction and food addiction.

[Evaluation of an intensive therapy program for treatment of severe behavioral disorders in mentally handicapped patients with autistic or psychotic behavior].

PubMed

Elbing, U; Rohmann, U H

1993-09-01

The development of severely disturbed and socially accepted behavior in mentally handicapped persons with autistic or psychotic symptoms is documented before, during and after an intensive therapy program conducted in a residential institution for mentally handicapped persons. Seven single case studies were made as long term observation with a duration between 18 and 33 weeks, mostly with a multiple baseline design. One or two follow ups with at least four weeks length were conducted in six out of seven cases up to four years after the end of the intensive therapy. The main results show (1) the decrease of disturbed behavior and the increase of socially accepted behavior during the therapy program, and (2) the significant reduction of the disturbed behavior patterns taking place during the baseline phase before the beginning of the therapy in all cases but one. The results are discussed under the aspects of a possible explanation for the findings and their impact on the discussion about psychotherapy research.

Evaluating Acceptance and Commitment Therapy: An Analysis of a Recent Critique

ERIC Educational Resources Information Center

Gaudiano, Brandon A.

2011-01-01

Acceptance and commitment therapy (ACT) is a newer psychotherapy that has generated much clinical and research interest in recent years. However, the approach has begun to receive strong criticism from proponents of traditional cognitive-behavioral therapy (CBT). Hofmann and Asmundson (2008) recently compared and contrasted ACT and traditional…

Evaluating Acceptance and Commitment Therapy: An Analysis of a Recent Critique

ERIC Educational Resources Information Center

Gaudiano, Brandon A.

2009-01-01

Acceptance and commitment therapy (ACT) is a newer psychotherapy that has generated much clinical and research interest in recent years. However, the approach has begun to receive strong criticism from proponents of traditional cognitive-behavioral therapy (CBT). Hofmann and Asmundson (2008) recently compared and contrasted ACT and traditional…

Addressing Behavioral Health Disparities for Somali Immigrants Through Group Cognitive Behavioral Therapy Led by Community Health Workers.

PubMed

Pratt, Rebekah; Ahmed, Nimo; Noor, Sahra; Sharif, Hiba; Raymond, Nancy; Williams, Chris

2017-02-01

To test the feasibility and acceptability of implementing an evidence-based, peer-delivered mental health intervention for Somali women in Minnesota, and to assess the impact of the intervention on the mental health of those who received the training. In a feasibility study, 11 Somali female community health workers were trained to deliver an 8-session cognitive behavioral therapy intervention. Each of the trainers recruited 5 participants through community outreach, resulting in 55 participants in the intervention. Self-assessed measures of mood were collected from study participants throughout the intervention, and focus groups were conducted. The 55 Somali women who participated recorded significant improvements in mood, with self-reported decreases in anxiety and increases in happiness. Focus group data showed the intervention was well received, particularly because it was delivered by a fellow community member. Participants reported gaining skills in problem solving, stress reduction, and anger management. Participants also felt that the intervention helped to address some of the stigma around mental health in their community. Delivery of cognitive behavioral therapy by a community health workers offered an acceptable way to build positive mental health in the Somali community.

The Humanism of Rational Emotive Behavior Therapy and Other Cognitive Behavior Therapies.

ERIC Educational Resources Information Center

Ellis, Albert

1996-01-01

Describes aspects of rational emotive behavior therapy (REBT). REBT shows how people can both create and uncreate many of their emotional disturbances. It is a theory of personality which avoids devotion to any kind of magic and supernaturalism and emphasizes unconditional self-acceptance, antiabsolutism, uncertainty, and human fallibility. (RJM)

How to Handle Anxiety: The Effects of Reappraisal, Acceptance, and Suppression Strategies on Anxious Arousal

PubMed Central

Hofmann, Stefan G.; Heering, Sanna; Sawyer, Alice T.; Asnaani, Anu

2009-01-01

It has been suggested that reappraisal strategies are more effective than suppression strategies for regulating emotions. Recently, proponents of the acceptance-based behavior therapy movement have further emphasized the importance of acceptance-based emotion regulation techniques. In order to directly compare these different emotion regulation strategies, 202 volunteers were asked to give an impromptu speech in front of a video camera. Participants were randomly assigned to one of three groups. The Reappraisal group was instructed to regulate their anxious arousal by reappraising the situation; the Suppression group was asked to suppress their anxious behaviors; and the Acceptance group was instructed to accept their anxiety. As expected, the Suppression group showed a greater increase in heart rate from baseline than the Reappraisal and Acceptance groups. Moreover, the Suppression group reported more anxiety than the Reappraisal group. However, the Acceptance and Suppression groups did not differ in their subjective anxiety response. These results suggest that both reappraising and accepting anxiety is more effective for moderating the physiological arousal than suppressing anxiety. However, reappraising is more effective for moderating the subjective feeling of anxiety than attempts to suppress or accept it. PMID:19281966

A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

PubMed Central

Addison, Laura R; Piazza, Cathleen C; Patel, Meeta R; Bachmeyer, Melanie H; Rivas, Kristi M; Milnes, Suzanne M; Oddo, Jackie

2012-01-01

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory-integration-based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important. PMID:23060661

A Stage I Pilot Study of Acceptance and Commitment Therapy for Methadone Detoxification

PubMed Central

Stotts, Angela L.; Green, Charles; Masuda, Akihiko; Grabowski, John; Wilson, Kelly; Northrup, Thomas; Moeller, F. Gerard; Schmitz, Joy

2012-01-01

BACKGROUND While agonist replacement therapies are effective for managing opioid dependence, community treatment programs are increasingly choosing detoxification. Unfortunately, success rates for opioid detoxification are very low, in part, due to physical and psychological symptoms associated with opioid withdrawal. Few behavior therapies specifically address the distressing experiences specific to opioid withdrawal. A novel behavioral treatment, Acceptance and Commitment Therapy (ACT), works from the premise that the avoidance of unpleasant private experiences (thoughts, feelings, bodily sensations) is ubiquitous yet may be pathogenic, resulting in treatment drop-out and further drug use. METHODS This Stage I pilot study developed and tested an ACT-based opioid detoxification behavioral therapy. Opioid dependent patients (N = 56) who were attending a licensed methadone clinic were randomized to receive either 24 individual therapy sessions of ACT or Drug Counseling (DC) in the context of a 6-month methadone dose reduction program. RESULTS While no difference was found on opioid use during treatment, 37% of participants in the ACT condition were successfully detoxified at the end of treatment compared to 19% of those who received DC. Fear of detoxification was also reduced across time in the ACT condition relative to DC. CONCLUSION This first study of ACT to assist opioid detoxification indicates promise. Research is needed to refine specific treatment strategies for this population to further strengthen effects. PMID:22425411

Men Who Have Sex With Men in Peru: Acceptability of Medication-Assisted Therapy for Treating Alcohol Use Disorders

PubMed Central

Brown, Shan-Estelle; Vagenas, Panagiotis; Konda, Kelika A.; Clark, Jesse L.; Lama, Javier R.; Gonzales, Pedro; Sanchez, Jorge; Duerr, Ann C.; Altice, Frederick L.

2015-01-01

In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW (n = 26) with AUDs (AUDIT ≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves “social” drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, medication-assisted therapies using naltrexone may be a beneficial strategy for MSM with AUDs. PMID:25787988

Men Who Have Sex With Men in Peru: Acceptability of Medication-Assisted Therapy for Treating Alcohol Use Disorders.

PubMed

Brown, Shan-Estelle; Vagenas, Panagiotis; Konda, Kelika A; Clark, Jesse L; Lama, Javier R; Gonzales, Pedro; Sanchez, Jorge; Duerr, Ann C; Altice, Frederick L

2017-07-01

In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW ( n = 26) with AUDs (AUDIT ≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves "social" drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, medication-assisted therapies using naltrexone may be a beneficial strategy for MSM with AUDs.

Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders

PubMed Central

Arch, Joanna; Eifert, Georg H.; Davies, Carolyn; Plumb Vilardaga, Jennifer C.; Rose, Raphael D.; Craske, Michelle G.

2016-01-01

Objective Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this research gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. Method One hundred twenty eight individuals (52% female, mean age = 38, 33% minority) with one or more DSM-IV anxiety disorders began treatment following randomization to 12 sessions of CBT or ACT; both treatments included behavioral exposure. Assessments at pre-treatment, post-treatment, 6-month, and 12-month follow-up measured anxiety specific (principal disorder Clinical Severity Ratings [CSR], Anxiety Sensitivity Index, Penn State Worry Questionnaire, Fear Questionnaire avoidance) and non-anxiety specific (Quality of Life Index [QOLI], Acceptance and Action Questionnaire-16 [AAQ]) outcomes. Treatment adherence and therapist competency ratings, treatment credibility, and co-occurring mood and anxiety disorders were investigated. Results CBT and ACT improved similarly across all outcomes from pre- to post-treatment. During follow-up, ACT showed steeper CSR improvements than CBT (p < .05, d = 1.33) and at 12-month follow-up, ACT showed lower CSRs than CBT among completers (p < .05, d = 1.05). At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = .42; Completers: p < .05, d = .59) whereas CBT reported higher QOLI than ACT (p < .05, d = .43). Attrition and comorbidity improvements were similar, although ACT utilized more non-study psychotherapy at 6-month follow-up. Therapist adherence and competency were good; treatment credibility was higher in CBT. Conclusions Overall improvement was similar between ACT and CBT, indicating that ACT is a highly viable treatment for anxiety disorders. PMID:22563639

Strategies to manage patients with dental anxiety and dental phobia: literature review

PubMed Central

Appukuttan, Deva Priya

2016-01-01

Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, “tell-show-do”, and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought. PMID:27022303

Investigating the Similarities and Differences between Practitioners of Second- and Third-Wave Cognitive-Behavioral Therapies

ERIC Educational Resources Information Center

Brown, Lily A.; Gaudiano, Brandon A.; Miller, Ivan W.

2011-01-01

There has been much discussion in the literature recently regarding the conceptual and technical differences between so-called second- (e.g., Beckian cognitive therapy) and third-wave (e.g., acceptance and commitment therapy) behavioral therapies. Previous research has not addressed the potential similarities and differences among the…

The effectiveness of mindfulness-based interventions for supporting people with intellectual disabilities: a narrative review.

PubMed

Harper, Sarah K; Webb, Thomas L; Rayner, Kelly

2013-05-01

A number of studies have used mindfulness-based interventions to influence the behavior of people with intellectual disabilities, to improve their quality of life, and to reduce challenging behavior. The present review critically evaluates 18 studies and assesses the clinical and academic impact of their findings. Strengths identified included replicable methodological approaches, use of multiple baseline designs, strong construct and criterion validity, and consideration of the mechanisms by which mindfulness influences behavior change. Limitations included a lack of randomized controlled trials, inclusion of qualitative data without structured analysis, limited use of statistical analyses, and problems with sampling leading to difficulties generalizing findings. There was also a paucity of research investigating the impact of "Dialectical Behavior Therapy" and "Acceptance and Commitment Therapy" and the role of mindfulness within these approaches. Further research is warranted in this regard.

Behavior change, acceptance, and coping flexibility in highly distressed patients with rheumatic diseases: feasibility of a cognitive-behavioral therapy in multimodal rehabilitation.

PubMed

Vriezekolk, Johanna E; Geenen, Rinie; van den Ende, Cornelia H M; Slot, Helma; van Lankveld, Wim G J M; van Helmond, Toon

2012-05-01

To describe the development and feasibility of the integration of a cognitive-behavioral therapy (CBT) within a multimodal rehabilitation program for highly distressed patients with rheumatic diseases. Development included the detailed specification of the theoretical and empirical-based underpinnings of the CBT and the comprehensive description of its design and content. Feasibility was assessed by percentage of eligible patients, attrition and attendance rates, and patient satisfaction. The developed CBT component seeks to decrease psychological distress and improve activities and participation across multiple life domains by accomplishing behavior change, acceptance, and coping flexibility. Motivational interviewing was applied to endorse patients' own reasons to change. Forty percent (35/87) of the eligible patients were admitted to the program. Attendance rate (>95%) was high. Patient satisfaction ranged from 6.8 to 8.0 (10-point scale). Integrating CBT within a multimodal rehabilitation program is feasible. An acceptable proportion of the intended patient sample is eligible and patient's attendance and satisfaction is high. Patients with impaired physical and psychosocial functioning despite adequate medical treatment pose a great challenge. Their treatment outcome may be improved by screening and selecting highly distressed patients and offering them a CBT embedded in multimodal rehabilitation program. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Using Acceptance and Commitment Therapy in the Rehabilitation of an Adolescent Female with Chronic Pain: A Case Example

ERIC Educational Resources Information Center

Wicksell, Rikard K.; Dahl, JoAnne; Magnusson, Bo; Olsson, Gunnar L.

2005-01-01

This case example illustrates how Acceptance and Commitment Therapy (ACT) within a behavior medicine approach was used in the rehabilitation of an adolescent with debilitating chronic pain. For chronic pain with unclear etiology (idiopathic pain), pharmacological therapy alone is often insufficient. Psychological treatment strategies have been…

Assessing Treatment Integrity in Acceptance and Commitment Therapy: Strategies and Suggestions

ERIC Educational Resources Information Center

Plumb, Jennifer C.; Vilardaga, Roger

2010-01-01

In this paper, we briefly review the current literature on treatment integrity and discuss the relevance of this procedure for detecting, measuring and ensuring that the proposed mechanisms of change in cognitive behavior therapy, in this case of acceptance and commitment therapy (ACT; S.C. Hayes, Strosahl, & Wilson, 1999), take place. We discuss…

Cognitive-behavioral therapy and hypnotic relaxation to treat sleep problems in an adolescent with diabetes.

PubMed

Perfect, Michelle M; Elkins, Gary R

2010-11-01

Inadequate sleep among adolescents frequently contributes to obesity and reduced academic performance, along with symptoms of anxiety, depression, fatigue, and attention deficits. The etiological bases of sleep quality has been associated with both stress and sleep habits. These problems tend to be especially important for adolescents with diabetes as the effects of poor sleep complicate health outcomes. This case example concerns a 14-year-old adolescent girl with a history of type I diabetes and stress-related sleep difficulties. Treatment included cognitive-behavioral methods and hypnotic relaxation therapy. Results of this case example and other controlled research suggest that hypnotic relaxation therapy is well accepted, results in good compliance, and serves as a useful adjunctive to cognitive-behavioral intervention for sleep problems. © 2010 Wiley Periodicals, Inc.

Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability.

PubMed

Landes, Sara J; Chalker, Samantha A; Comtois, Katherine Anne

2016-01-01

Rates of treatment dropout in outpatient Dialectical Behavior Therapy (DBT) in the community can be as high as 24 % to 58 %, making dropout a great concern. The primary purpose of this article was to examine predictors of dropout from DBT in a community mental health setting. Participants were 56 consumers with borderline personality disorder (BPD) who were psychiatrically disabled participating in a larger feasibility trial of Dialectical Behavior Therapy- Accepting the Challenges of Exiting the System. The following variables were examined to see whether they predicted dropout in DBT: age, education level, baseline level of distress, baseline level of non-acceptance of emotional responses, and skills module in which a consumer started DBT skills group. These variables were chosen based on known predictors of dropout in consumers with BPD and in DBT, as well as an interest in what naturally occurring variables might impact dropout. The dropout rate in this sample was 51.8 %. Results of the logistic regression show that younger age, higher levels of baseline distress, and a higher level of baseline non-acceptance of emotional responses were significantly associated with dropout. The DBT skills module in which an individual started group did not predict dropout. The implications of these findings are that knowledge of consumer age and pretreatment levels of distress and non-acceptance of emotional responses can impact providers' choice of commitment and treatment strategies to reduce dropout. Future research should examine these strategies, as well as the impact of predictor variables on outcome and reasons for dropout.

Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

ERIC Educational Resources Information Center

Woo, Stephanie M.; Hepner, Kimberly A.; Gilbert, Elizabeth A.; Osilla, Karen Chan; Hunter, Sarah B.; Munoz, Ricardo F.; Watkins, Katherine E.

2013-01-01

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT)…

Mindfulness and Acceptance-Based Group Therapy for Social Anxiety Disorder: An Open Trial

ERIC Educational Resources Information Center

Kocovski, Nancy L.; Fleming, Jan E.; Rector, Neil A.

2009-01-01

Mindfulness and Acceptance-Based Group Therapy (MAGT) for Social Anxiety Disorder (SAD) is based largely on Acceptance and Commitment Therapy (ACT; Hayes et al., 1999), with enhanced mindfulness mostly from Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002). The purpose of this study was to assess the feasibility and initial…

Feasibility, Acceptability and Preliminary Treatment Outcomes in a School-Based CBT Intervention Program for Adolescents with ASD and Anxiety in Singapore

ERIC Educational Resources Information Center

Drmic, Irene E.; Aljunied, Mariam; Reaven, Judy

2017-01-01

Adolescents with autism spectrum disorder (ASD) are at high risk for anxiety difficulties and disorders. Clinic-based cognitive behavioral therapy (CBT) is effective; however, few published school-based CBT programs for youth with ASD exist. In this study, the Facing Your Fears CBT protocol was adapted for delivery and piloted within a school…

A commentary on the status of the behavioral approach in the healthcare marketplace.

PubMed

Moss, G R

1993-12-01

Clinically applied behavioral technology (e.g., integrated, systems-based hospital programs) and specific behavior therapies (e.g., systematic desensitization) have a long record of documented and powerful efficacy yet have failed to penetrate successfully the healthcare marketplace and to receive adequate public recognition. Many behavioral techniques are utilized widely without acknowledgement of their true origins. The current position of the behavioral approach in the healthcare marketplace is examined, and factors making for resistance to its acceptance are identified. Recommendations are offered for the more effective promotion of behavioral methods and services.

“I have remained strong because of that food”: Acceptability and use of lipid-based nutrient supplements among pregnant HIV-infected Ugandan women receiving combination antiretroviral therapy

PubMed Central

Young, Sera; Natamba, Barnabas; Luwedde, Flavia; Nyafwono, Dorcas; Okia, Ben; Osterbauer, Beth; Natureeba, Paul; Johnson, Lynn; Michel, Chloe; Zheng, Amy; Robine, Marion; Achan, Jane; Charlebois, Edwin; Cohan, Deb; Havlir, Diane

2015-01-01

We evaluated the acceptability and use of macronutrient supplementation among HIV-infected pregnant Ugandan women receiving antiretroviral therapy in a clinical study (NCT 00993031). We first conducted formative research among 56 pregnant and lactating women to select a supplement regimen. Acceptability and use of the supplementation regimen [35 sachets of lipid-based nutrient supplements (LNS) and 4 or 6 kg of instant soy porridge for the household provided monthly] were evaluated among 87 pregnant women. Organoleptic assessments of LNS were favorable. Participants reported consuming LNS a mean of 6.1 days per week, and adherence to recommended consumption behaviors (e.g. frequency, quantity, not sharing) was >80%. Few women reported negative social consequences of supplementation. The majority of participants also consumed most of the porridge intended for the household. In sum, LNS was acceptable and used regularly. Larger studies to evaluate physical and psychosocial consequences of LNS during pregnancy among HIV-infected women are warranted. PMID:25416075

A meta-analysis of the relationship between rational beliefs and psychological distress.

PubMed

Oltean, Horea-Radu; David, Daniel Ovidiu

2018-06-01

 Rational emotive behavior therapy (REBT) model of psychological health assumes that rational beliefs cause functional emotions and adaptive behavior, but the presumed role of rational beliefs as protective factor against psychological distress/disorders is still in debate. An important step in validating an evidence-based therapy is to investigate the underling theoretical assumptions. Thus, the aim of the present meta-analysis is to investigate the direction and magnitude of the relationship between rational beliefs and psychological distress.  Our search identified 26 studies that met our criteria. We evaluated the effect size using the random-effects model and we tested the moderator role of several variables. The overall results revealed a medium negative association between rational beliefs and psychological distress, r = -0.31. The strongest association was found for unconditional acceptance beliefs (r = -0.41). The results add empirical evidence for the underling theory of REBT and revealed that the strength of the association between rational beliefs and distress is robust for a wide range of emotional problems. Therefore, rational beliefs could be a trans-diagnostic protective factor against distress. Moreover, results emphasized that rational beliefs type is an important factor, suggesting an increased focus in therapy on the developing of unconditional acceptance and self-acceptance beliefs. © 2017 Wiley Periodicals, Inc.

Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder

ERIC Educational Resources Information Center

Orsillo, Susan M.; Batten, Sonja V.

2005-01-01

The current article describes the application of a behavioral psychotherapy, acceptance and commitment therapy (ACT), to the treatment of post-traumatic stress disorder (PTSD). It is argued that PTSD can be conceptualized as a disorder that is developed and maintained in traumatized individuals as a result of excessive, ineffective attempts to…

A randomized controlled pilot study of CBT-I Coach: Feasibility, acceptability, and potential impact of a mobile phone application for patients in cognitive behavioral therapy for insomnia.

PubMed

Koffel, Erin; Kuhn, Eric; Petsoulis, Napoleon; Erbes, Christopher R; Anders, Samantha; Hoffman, Julia E; Ruzek, Josef I; Polusny, Melissa A

2018-03-01

There has been growing interest in utilizing mobile phone applications (apps) to enhance traditional psychotherapy. Previous research has suggested that apps may facilitate patients' completion of cognitive behavioral therapy for insomnia (CBT-I) tasks and potentially increase adherence. This randomized clinical trial pilot study ( n = 18) sought to examine the feasibility, acceptability, and potential impact on adherence and sleep outcomes related to CBT-I Coach use. All participants were engaged in CBT-I, with one group receiving the app as a supplement and one non-app group. We found that patients consistently used the app as intended, particularly the sleep diary and reminder functions. They reported that it was highly acceptable to use. Importantly, the app did not compromise or undermine benefits of cognitive behavioral therapy for insomnia and patients in both groups had significantly improved sleep outcomes following treatment.

Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review.

PubMed

Veehof, M M; Trompetter, H R; Bohlmeijer, E T; Schreurs, K M G

2016-01-01

The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies' quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.

Acceptance and Commitment Therapy and Behavioral Activation for the Treatment of Depression: Description and Comparison

ERIC Educational Resources Information Center

Kanter, Jonathan W.; Baruch, David E.; Gaynor, Scott T.

2006-01-01

The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the "common cold" of outpatient populations. Two treatments for depression have emerged:…

Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial.

PubMed

Turner, Judith A; Anderson, Melissa L; Balderson, Benjamin H; Cook, Andrea J; Sherman, Karen J; Cherkin, Daniel C

2016-11-01

Cognitive behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with chronic low back pain (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (nonreactivity, nonjudging, and acting with awareness; all P values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P values <0.05) measures. Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the subsample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain.

Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial

PubMed Central

Turner, Judith A.; Anderson, Melissa L.; Balderson, Benjamin H.; Cook, Andrea J.; Sherman, Karen J.; Cherkin, Daniel C.

2016-01-01

Cognitive-behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit chronic pain patients by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR versus CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20-70 years with chronic low back pain (CLBP) (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness; and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (non-reactivity, non-judging, and acting with awareness; all P-values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P-values < 0.05) measures. Catastrophizing decreased slightly more post-treatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the sub-sample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness, and similar effects of MBSR and CBT on these measures among individuals with CLBP. PMID:27257859

Targeting Acceptance, Mindfulness, and Values-Based Action in Chronic Pain: Findings of Two Preliminary Trials of an Outpatient Group-Based Intervention

ERIC Educational Resources Information Center

Vowles, Kevin E.; Wetherell, Julie Loebach; Sorrell, John T.

2009-01-01

Cognitive behavior therapy (CBT) for chronic pain is effective, although a number of issues in need of clarification remain, including the processes by which CBT works, the role of cognitive changes in the achievement of outcomes, and the formulation of a coherent theoretical model. Recent developments in psychology have attempted to address these…

Modular Cognitive-Behavioral Therapy for Body Dysmorphic Disorder

ERIC Educational Resources Information Center

Wilhelm, Sabine; Phillips, Katharine A.; Fama, Jeanne M.; Greenberg, Jennifer L.; Steketee, Gail

2011-01-01

This study pilot tested a newly developed modular cognitive-behavioral therapy (CBT) treatment manual for body dysmorphic disorder (BDD). We tested feasibility, acceptability, and treatment outcome in a sample of 12 adults with primary BDD. Treatment was delivered in weekly individual sessions over 18 or 22 weeks. Standardized clinician ratings…

The Evolution of "Enhanced" Cognitive Behavior Therapy for Eating Disorders: Learning from Treatment Nonresponse

ERIC Educational Resources Information Center

Cooper, Zafra; Fairburn, Christopher G.

2011-01-01

In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has…

The Use of Acceptance to Promote Positive Change by Decreasing Shame and Guilt: A Practice Exemplar.

PubMed

Meltzer, Mary-Ellen

2015-01-01

The use of acceptance by mental health clinicians in the clinical setting is an effective method for providing a safe environment for clients to make positive changes. Acceptance means that mental health clinicians are non-judgmental and acknowledge the clients' situations as they are. When actively used by clinicians, acceptance decreases clients' anxiety and the intensity of their feelings of guilt and shame. Clients are then able to begin to accept themselves as they are. The purpose of this article is to discuss the ways in which mental health clinicians promote clients' acceptance of themselves using the tools of acceptance and commitment therapy and dialectical behavioral therapy.

The Effects of a Brief Acceptance-based Behavior Therapy vs. Traditional Cognitive Behavior Therapy for Public Speaking Anxiety: Differential Effects on Performance and Verbal Working Memory

NASA Astrophysics Data System (ADS)

Glassman, Lisa Hayley

Individuals with public speaking phobia experience fear and avoidance that can cause extreme distress, impaired speaking performance, and associated problems in psychosocial functioning. Most extant interventions for public speaking phobia focus on the reduction of anxiety and avoidance, but neglect performance. Additionally, very little is known about the relationship between verbal working memory and social performance under conditions of high anxiety. The current study compared the efficacy of two cognitive behavioral treatments, traditional Cognitive Behavioral Therapy (tCBT) and acceptance-based behavior therapy (ABBT), in enhancing public speaking performance via coping with anxiety. Verbal working memory performance, as measured by the backwards digit span (BDS), was measured to explore the relationships between treatment type, anxiety, performance, and verbal working memory. We randomized 30 individuals with high public speaking anxiety to a 90-minute ABBT or tCBT intervention. As this pilot study was underpowered, results are examined in terms of effect sizes as well as statistical significance. Assessments took place at pre and post-intervention and included self-rated and objective anxiety measurements, a behavioral assessment, ABBT and tCBT process measures, and backwards digit span verbal working memory tests. In order to examine verbal working memory during different levels of anxiety and performance pressure, we gave each participant a backwards digit span task three times during each assessment: once under calm conditions, then again while experiencing anticipatory anxiety, and finally under conditions of acute social performance anxiety in front of an audience. Participants were asked to give a video-recorded speech in front of the audience at pre- and post-intervention to examine speech performance. Results indicated that all participants experienced a very large and statistically significant decrease in anxiety (both during the speech and BDS), as well as an improvement in speech performance regardless of intervention received. While not statistically significant, participants who received an acceptance-based intervention exhibited larger improvements in observer-rated speech performance at post-treatment in comparison to tCBT (F (1,21) = 1.91, p =.18, etap2 = .08) such that individuals in the ABBT condition exhibited a considerably greater improvement in observer-rated speech performance than those in the tCBT condition. There was no differential impact of treatment condition on subjective speech anxiety or working memory task performance. Potential mediators and moderators of treatment were also examined. Results provide support for a brief 90-minute intervention for public speaking anxiety, but more research is needed in a study with a larger sample to fully understand the relationship between ABBT strategies and improvements in behavioral performance.

Pilot study of a brief dialectical behavior therapy skills group for jail inmates.

PubMed

Moore, Kelly E; Folk, Johanna B; Boren, Emily A; Tangney, June P; Fischer, Sarah; Schrader, Shannon W

2018-02-01

Regulating emotions, refraining from impulsive, maladaptive behavior, and communicating effectively are considered primary treatment needs among jail inmates. Dialectical behavior therapy (DBT; Linehan, 1993a) skills address these deficits and have been implemented in long-term correctional settings, but have yet to be adapted for general population inmates in short-term jail settings. This study assessed the feasibility and acceptability of a DBT skills group in a jail setting, as well as its utility in improving coping skills and emotional/behavioral dysregulation. Male jail inmates participated in an 8-week DBT skills group and completed pre- and posttest assessments of coping skills, emotional/behavioral dysregulation, and measures of treatment acceptability. Out of 27 who started therapy, 16 completed it, primarily due to involuntary attrition such as transfer to another correctional facility. Although several logistical issues arose during this pilot study, preliminary results suggest that a brief DBT skills group is feasible and acceptable in a jail setting, and may improve coping skills and reduce externalization of blame among general population jail inmates. This study lays the groundwork for larger, controlled trials of abbreviated DBT skills groups for general population inmates in short-term jail settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[Psychological assessment and psychotherapy for chronic pain in the elderly].

PubMed

Mattenklodt, P; Leonhardt, C

2015-08-01

Systematic reviews of psychosocial assessment and effectiveness of psychotherapy for chronic pain syndromes in older patients are rare. However, it is of particular importance to consider the psychosocial aspects of elderly people with chronic pain. This narrative review describes recommended German-language assessments of the psychosocial dimensions of pain and summarizes existing studies of psychological therapy approaches for chronic pain in old age. Effective psychometric instruments are available for the assessment of cognitive function, pain-specific attitudes, depression, fear of falling, interpersonal processes and social activities, pain management, pain acceptance, disability, psychological well-being, and quality of life. Further experience with the use of these instruments with cognitively impaired or geriatric patients is required. The efficacy of age-adapted cognitive behavioral therapy and multimodal therapy for older patients has been documented. However, there is often a lack of supporting documentation about important result parameters (e.g., quality of life, functioning in everyday life, or pain acceptance). Overall, chronic pain in elderly people requires a biopsychosocial-spiritual model of pain. More attention should be given in research and daily practice to religiosity/spirituality as a possible means of coping, while mindfulness- and acceptance-based therapies should be further explored.

An acceptance-oriented cognitive-behavioral therapy in multimodal rehabilitation: a pre-post test evaluation in highly distressed patients with rheumatic diseases.

PubMed

Vriezekolk, Johanna E; Eijsbouts, Agnes M M; van Lankveld, Wim G J M; Beenackers, Hanneke; Geenen, Rinie; van den Ende, Cornelia H M

2013-06-01

To examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases. An observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen's effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters. Significant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d ≥ 0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients. The patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment. A randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented cognitive-behavioral therapy for highly distressed patients in rehabilitation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder.

PubMed

Hayes-Skelton, Sarah A; Roemer, Lizabeth; Orsillo, Susan M

2013-10-01

To examine whether an empirically and theoretically derived treatment combining mindfulness- and acceptance-based strategies with behavioral approaches would improve outcomes in generalized anxiety disorder (GAD) over an empirically supported treatment. This trial randomized 81 individuals (65.4% female, 80.2% identified as White, average age 32.92) diagnosed with GAD to receive 16 sessions of either an acceptance-based behavior therapy (ABBT) or applied relaxation (AR). Assessments at pretreatment, posttreatment, and 6-month follow-up included the following primary outcome measures: GAD clinician severity rating, Structured Interview Guide for the Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, Depression Anxiety Stress Scale, and the State-Trait Anxiety Inventory. Secondary outcomes included the Beck Depression Inventory-II, Quality of Life Inventory, and number of comorbid diagnoses. Mixed effect regression models showed significant, large effects for time for all primary outcome measures (ds = 1.27 to 1.61) but nonsignificant, small effects for condition and Condition × Time (ds = 0.002 to 0.20), indicating that clients in the 2 treatments improved comparably over treatment. For secondary outcomes, time was significant (ds = 0.74 to 1.38), but condition and Condition × Time effects were not (ds = 0.004 to 0.31). No significant differences emerged over follow-up (ds = 0.03 to 0.39), indicating maintenance of gains. Between 63.3 and 80.0% of clients in ABBT and 60.6 and 78.8% of clients in AR experienced clinically significant change across 5 calculations of change at posttreatment and follow-up. ABBT is a viable alternative for treating GAD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

A Comparison of Sensory Integrative and Behavioral Therapies as Treatment for Pediatric Feeding Disorders

ERIC Educational Resources Information Center

Addison, Laura R.; Piazza, Cathleen C.; Patel, Meeta R.; Bachmeyer, Melanie H.; Rivas, Kristi M.; Milnes, Suzanne M.; Oddo, Jackie

2012-01-01

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory…

The "RAPID" Cognitive-Behavioral Therapy Program for Inattentive Children: Preliminary Findings

ERIC Educational Resources Information Center

Young, Susan

2013-01-01

Objective: The objectives of the current study were to ascertain feasibility and acceptability of directly delivering a cognitive-behavioral therapy (CBT) group intervention for inattentive children in a school setting, to examine the reliability of the RATE-C Questionnaires that accompany the program, and to determine whether they can be used to…

Dialectical Behavior Therapy for Adolescents With Bipolar Disorder: A 1-Year Open Trial

PubMed Central

GOLDSTEIN, TINA R.; AXELSON, DAVID A.; BIRMAHER, BORIS; BRENT, DAVID A.

2010-01-01

Objective To describe an adapted version of dialectical behavior therapy for adolescents with bipolar disorder. Method The dialectical behavior therapy intervention is delivered over 1 year and consists of two modalities: family skills training (conducted with individual family units) and individual therapy. The acute treatment period (6 months) includes 24 weekly sessions; sessions alternate between the two treatment modalities. Continuation treatment consists of 12 additional sessions tapering in frequency through 1 year. We conducted an open pilot trial of the treatment, designed as an adjunct to pharmacological management, to establish feasibility and acceptability of the treatment for this population. Participants included 10 patients (mean age 15.8 ± 1.5 years, range 14–18) receiving treatment in an outpatient pediatric bipolar specialty clinic. Symptom severity and functioning were assessed quarterly by an independent evaluator. Consumer satisfaction was also assessed posttreatment. Results Feasibility and acceptability of the intervention were high, with 9 of 10 patients completing treatment, 90% of scheduled sessions attended, and high treatment satisfaction ratings. Patients exhibited significant improvement from pre- to posttreatment in suicidality, nonsuicidal self-injurious behavior, emotional dysregulation, and depressive symptoms. Conclusions Dialectical behavior therapy may offer promise as an approach to the psychosocial treatment of adolescent bipolar disorder. PMID:17581446

Rationale and design of a pilot study examining Acceptance and Commitment Therapy for persistent pain in an integrated primary care clinic.

PubMed

Kanzler, Kathryn E; Robinson, Patricia J; McGeary, Donald D; Mintz, Jim; Potter, Jennifer Sharpe; Muñante, Mariana; Lopez, Eliot J; Dougherty, Donald M; Hale, Willie J; Velligan, Dawn I

2018-03-01

Most of the 100 million Americans with persistent pain are treated in primary care clinics, but evidence-based psychosocial approaches targeting pain-related disability are not usually provided in these settings. This manuscript describes the rationale and methods for a protocol to pilot test the feasibility and effectiveness of Acceptance and Commitment Therapy (ACT), an evidence-based psychological treatment for persistent pain, delivered by a Behavioral Health Consultant in primary care. Eligible patients are identified through electronic health record registries and invited to participate via secure messaging, letters and a follow-up phone call. Participants are also recruited with advertising and clinician referral. Patients agreeing to participate are consented and complete initial assessments, with a target of 60 participants. Randomization is stratified based on pain severity with participants assigned to either ACT or Enhanced Treatment as Usual (E-TAU). ACT participants receive one standardized Behavioral Health Consultation visit followed by three ACT-based group visits and one group booster visit. All patients attend six assessment visits, during which the E-TAU patients are provided with educational pain management handouts based on standard cognitive behavioral treatment of pain. The study aims to determine feasibility and effectiveness of brief ACT for persistent pain delivered by an integrated behavioral health clinician in primary care from pre- to post-treatment, and to examine mechanisms of change in ACT participants. This study, in a "real-world" setting, will lay groundwork for a larger trial. If effective, it could improve treatment methods and quality of life for patients with persistent pain using a scalable approach. Copyright © 2018 Elsevier Inc. All rights reserved.

The ethical foundations of behavior therapy.

PubMed

Kitchener, Richard F

1991-01-01

In this article, I am concerned with the ethical foundations of behavior therapy, that is, with the normative ethics and the meta-ethics underlying behavior therapy. In particular, I am concerned with questions concerning the very possibilty of providing an ethical justification for things done in the context of therapy. Because behavior therapists must be able to provide an ethical justification for various actions (if the need arises), certain meta-ethical views widely accepted by behavior therapists must be abandoned; in particular, one must give up ethical subjectivism, ethical skepticism, and ethical relativism. An additional task is to show how it is possible to provide a nonsubjective, nonskeptical, and nonrelativistic moral justification for an ethical statement. Although this is a monumental task, I provide a rough sketch of such a model, one that is congenial to the value judgments underlying behavior therapy.

Staying well during pregnancy and the postpartum: A pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence.

PubMed

Dimidjian, Sona; Goodman, Sherryl H; Felder, Jennifer N; Gallop, Robert; Brown, Amanda P; Beck, Arne

2016-02-01

Clinical decision-making regarding the prevention of depression is complex for pregnant women with histories of depression and their health care providers. Pregnant women with histories of depression report preference for nonpharmacological care, but few evidence-based options exist. Mindfulness-based cognitive therapy has strong evidence in the prevention of depressive relapse/recurrence among general populations and indications of promise as adapted for perinatal depression (MBCT-PD). With a pilot randomized clinical trial, our aim was to evaluate treatment acceptability and efficacy of MBCT-PD relative to treatment as usual (TAU). Pregnant adult women with depression histories were recruited from obstetric clinics at 2 sites and randomized to MBCT-PD (N = 43) or TAU (N = 43). Treatment acceptability was measured by assessing completion of sessions, at-home practice, and satisfaction. Clinical outcomes were interview-based depression relapse/recurrence status and self-reported depressive symptoms through 6 months postpartum. Consistent with predictions, MBCT-PD for at-risk pregnant women was acceptable based on rates of completion of sessions and at-home practice assignments, and satisfaction with services was significantly higher for MBCT-PD than TAU. Moreover, at-risk women randomly assigned to MBCT-PD reported significantly improved depressive outcomes compared with participants receiving TAU, including significantly lower rates of depressive relapse/recurrence and lower depressive symptom severity during the course of the study. MBCT-PD is an acceptable and clinically beneficial program for pregnant women with histories of depression; teaching the skills and practices of mindfulness meditation and cognitive-behavioral therapy during pregnancy may help to reduce the risk of depression during an important transition in many women's lives. (c) 2016 APA, all rights reserved).

New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT).

PubMed

Sebastián Sánchez, Beatriz; Gil Roales-Nieto, Jesús; Ferreira, Nuno Bravo; Gil Luciano, Bárbara; Sebastián Domingo, Juan José

2017-09-01

The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than placebo attention control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.

Contemporary Cognitive Behavior Therapy: A Review of Theory, History, and Evidence.

PubMed

Thoma, Nathan; Pilecki, Brian; McKay, Dean

2015-09-01

Cognitive behavior therapy (CBT) has come to be a widely practiced psychotherapy throughout the world. The present article reviews theory, history, and evidence for CBT. It is meant as an effort to summarize the forms and scope of CBT to date for the uninitiated. Elements of CBT such as cognitive therapy, behavior therapy, and so-called "third wave" CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) are covered. The evidence for the efficacy of CBT for various disorders is reviewed, including depression, anxiety disorders, personality disorders, eating disorders, substance abuse, schizophrenia, chronic pain, insomnia, and child/adolescent disorders. The relative efficacy of medication and CBT, or their combination, is also briefly considered. Future directions for research and treatment development are proposed.

Mindfulness-based group therapy for systemic lupus erythematosus: A first exploration of a promising mind-body intervention.

PubMed

Horesh, Danny; Glick, Ittai; Taub, Renen; Agmon-Levin, Nancy; Shoenfeld, Yehuda

2017-02-01

Psychological effects related to systemic lupus erythematosus (SLE) are tremendous. While a variety of psychological treatments have been applied to assist SLE patients, the effects of mindfulness practice were never documented in SLE. Mindfulness-based psychotherapy includes several techniques, including body-scan, breathing exercises, and full awareness during daily activities. In this case report, we present a first attempt at conducting mindfulness-based group therapy among SLE patients. Six female SLE patients participated in an 8-week program. Improvement was observed in several areas: patients' increased ability to differentiate between themselves and the disease; increased ability to accept, rather than to actively fight the fact that one must live with the disease; and decreased behavioral avoidance. These observations speak to the significant therapeutic potential of mindfulness practice among SLE patients. With its emphasis on acceptance of negative physical and emotional states, mindfulness practice is a promising treatment option, which needs to be further studied. Copyright © 2016. Published by Elsevier Ltd.

Acceptance and Commitment Therapy for Inpatients with Psychosis (the REACH Study): Protocol for Treatment Development and Pilot Testing

PubMed Central

Gaudiano, Brandon A.; Davis, Carter H.; Epstein-Lubow, Gary; Johnson, Jennifer E.; Mueser, Kim T.; Miller, Ivan W.

2017-01-01

Patients with schizophrenia-spectrum disorders frequently require treatment at inpatient hospitals during periods of acute illness for crisis management and stabilization. Acceptance and Commitment Therapy (ACT), a “third wave” cognitive-behavioral intervention that employs innovative mindfulness-based strategies, has shown initial efficacy in randomized controlled trials for improving acute and post-discharge outcomes in patients with psychosis when studied in acute-care psychiatric hospitals in the U.S. However, the intervention has not been widely adopted in its current form because of its use of an individual-only format and delivery by doctoral-level research therapists with extensive prior experience using ACT. The aim of the Researching the Effectiveness of Acceptance-based Coping during Hospitalization (REACH) Study is to adapt a promising acute-care psychosocial treatment for inpatients with psychosis, and to pilot test its effectiveness in a routine inpatient setting. More specifically, we describe our plans to: (a) further develop and refine the treatment and training protocols, (b) conduct an open trial and make further modifications based on the experience gained, and (c) conduct a pilot randomized controlled trial in preparation for a future fully-powered clinical trial testing the effectiveness of ACT. PMID:28475123

Parents' perceptions of pharmacological and cognitive-behavioral treatments for childhood anxiety disorders.

PubMed

Brown, Amy M; Deacon, Brett J; Abramowitz, Jonathan S; Dammann, Julie; Whiteside, Stephen P

2007-04-01

Cognitive-behavioral therapy (CBT) and pharmacotherapy are the most well-established treatments for childhood anxiety disorders. This study examined how parents (N=71) seeking treatment for their child's anxiety disorder perceive the acceptability, believability, and effectiveness of these treatments. While both treatments were perceived favorably, CBT was rated as more acceptable, believable, and effective in the short- and long-term. Children's treatment history influenced parents' perceptions of pharmacotherapy, with parents of children with no treatment history perceiving medication treatment as less acceptable and believable than parents of children with a history of medication alone or in combination with behavior therapy. No effect of treatment history was found for perceptions of CBT. Significant positive correlations emerged between parents' perceived acceptance and believability for pharmacotherapy and child age and level of dysfunction due to their child's anxiety, respectively. The level of the child's anxiety was not significantly correlated with parents' perceptions of either CBT or pharmacotherapy. Our results suggest that parents of anxious children prefer CBT to medication for the treatment of their child's anxiety disorder. Directions for future research are discussed.

Outcomes of an Acceptance and Commitment Therapy-Based Skills Training Group for Students with High-Functioning Autism Spectrum Disorder: A Quasi-Experimental Pilot Study

ERIC Educational Resources Information Center

Pahnke, Johan; Lundgren, Tobias; Hursti, Timo; Hirvikoski, Tatja

2014-01-01

Autism spectrum disorder is characterized by social impairments and behavioural inflexibility. In this pilot study, the feasibility and outcomes of a 6-week acceptance and commitment therapy-based skills training group were evaluated in a special school setting using a quasi-experimental design (acceptance and commitment therapy/school classes as…

Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.

PubMed

Darnell, Doyanne; O'Connor, Stephen; Wagner, Amy; Russo, Joan; Wang, Jin; Ingraham, Leah; Sandgren, Kirsten; Zatzick, Douglas

2017-03-01

Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction. This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version. Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms. Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.

Computer-Assisted Cognitive Behavioral Therapy for Child Anxiety: Results of a Randomized Clinical Trial

ERIC Educational Resources Information Center

Khanna, Muniya S.; Kendall, Philip C.

2010-01-01

Objective: This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Method: Children (49; 33 males) ages 7-13 (M = 10.1 [plus or minus] 1.6; 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were…

Do we need to challenge thoughts in cognitive behavior therapy?

PubMed

Longmore, Richard J; Worrell, Michael

2007-03-01

Cognitive behavior therapy (CBT) emphasizes the primacy of cognition in mediating psychological disorder. It aims to alleviate distress by modifying cognitive content and process, realigning thinking with reality. Recently, various authors have questioned the need for CBT therapists to use logico-rational strategies to directly challenge maladaptive thoughts. Hayes [Hayes, S.C. (2004). Acceptance and commitment therapy and the new behavior therapies. In S.C. Hayes, V.M. Follette, & M.M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition. (pp. 1-29). New York: Guilford] has identified three empirical anomalies in the research literature. Firstly, treatment component analyzes have failed to show that cognitive interventions provide significant added value to the therapy. Secondly, CBT treatments have been associated with a rapid symptomatic improvement prior to the introduction of specific cognitive interventions. Thirdly, there is a paucity of data that changes in cognitive mediators instigate symptomatic change. This paper critically reviews the empirical literature that addresses these significant challenges to CBT. A comprehensive review of component studies finds little evidence that specific cognitive interventions significantly increase the effectiveness of the therapy. Although evidence for the early rapid response phenomenon is lacking, there is little empirical support for the role of cognitive change as causal in the symptomatic improvements achieved in CBT. These findings are discussed with reference to the key question: Do we need to challenge thoughts in CBT?

Emerging Approaches to Counseling Intervention: Theory, Research, Practice, and Training

ERIC Educational Resources Information Center

Murdock, Nancy L.; Duan, Changming; Nilsson, Johanna E.

2012-01-01

This article provides an overview of the major contribution that presents three emerging approaches to counseling: narrative therapy, dialectical behavior therapy, and acceptance and commitment therapy. The three theoretical systems were chosen because they are current, for the most part not addressed in the mainstream counseling psychology…

Moderators and non-specific predictors of treatment outcome for anxiety disorders: a comparison of cognitive behavioral therapy to acceptance and commitment therapy.

PubMed

Wolitzky-Taylor, Kate B; Arch, Joanna J; Rosenfield, David; Craske, Michelle G

2012-10-01

Understanding for whom, and under what conditions, treatments exert their greatest effects is essential for developing personalized medicine. Research investigating moderators of outcome among evidence-based treatments for anxiety disorders is lacking. The current study examined several theory-driven and atheoretical putative moderators of outcome in cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Eighty-seven patients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) anxiety disorder completed 12 sessions of ACT or CBT and were assessed with a self-report measure of anxiety at baseline, post-treatment, and 6- and 12-month follow-up assessments. CBT outperformed ACT among those at moderate levels of baseline anxiety sensitivity, and among those with no comorbid mood disorder. ACT outperformed CBT among those with comorbid mood disorders. Higher baseline neuroticism was associated with poorer outcome across treatment conditions. Neither moderation nor general prediction was observed for baseline anxiety disorder comorbidity, race/ethnicity, gender, age, or baseline severity of the principal anxiety disorder. When including all randomized participants who completed the pre-treatment assessment (N = 121), a similar pattern was observed. Prescriptive recommendations for clinical practice and directions for future research are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety.

PubMed

Davies, Carolyn D; Niles, Andrea N; Pittig, Andre; Arch, Joanna J; Craske, Michelle G

2015-03-01

Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome. Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables. Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts. Copyright © 2014 Elsevier Ltd. All rights reserved.

iACT - An interactive mHealth monitoring system to enhance psychotherapy for adolescents with sickle cell disease

PubMed Central

Cheng, Chihwen; Brown, R. Clark; Cohen, Lindsey L.; Venugopalan, Janani; Stokes, Todd H.

2016-01-01

Sickle cell disease (SCD) is the most common inherited disease, and SCD symptoms impact functioning and well-being. For example, adolescents with SCD have a higher tendency of psychological problems than the general population. Acceptance and Commitment Therapy (ACT), a cognitive-behavioral therapy, is an effective intervention to promote quality of life and functioning in adolescents with chronic illness. However, traditional visit-based therapy sessions are restrained by challenges, such as limited follow-up, insufficient data collection, low treatment adherence, and delayed intervention. In this paper, we present Instant Acceptance and Commitment Therapy (iACT), a system designed to enhance the quality of pediatric ACT. iACT utilizes text messaging technology, which is the most popular cell phone activity among adolescents, to conduct real-time psychotherapy interventions. The system is built on cloud computing technologies, which provides a convenient and cost-effective monitoring environment. To evaluate iACT, a trial with 60 adolescents with SCD is being conducted in conjunction with the Georgia Institute of Technology, Children’s Healthcare of Atlanta, and Georgia State University. PMID:24110179

iACT--an interactive mHealth monitoring system to enhance psychotherapy for adolescents with sickle cell disease.

PubMed

Cheng, Chihwen; Brown, R Clark; Cohen, Lindsey L; Venugopalan, Janani; Stokes, Todd H; Wang, May D

2013-01-01

Sickle cell disease (SCD) is the most common inherited disease, and SCD symptoms impact functioning and well-being. For example, adolescents with SCD have a higher tendency of psychological problems than the general population. Acceptance and Commitment Therapy (ACT), a cognitive-behavioral therapy, is an effective intervention to promote quality of life and functioning in adolescents with chronic illness. However, traditional visit-based therapy sessions are restrained by challenges, such as limited follow-up, insufficient data collection, low treatment adherence, and delayed intervention. In this paper, we present Instant Acceptance and Commitment Therapy (iACT), a system designed to enhance the quality of pediatric ACT. iACT utilizes text messaging technology, which is the most popular cell phone activity among adolescents, to conduct real-time psychotherapy interventions. The system is built on cloud computing technologies, which provides a convenient and cost-effective monitoring environment. To evaluate iACT, a trial with 60 adolescents with SCD is being conducted in conjunction with the Georgia Institute of Technology, Children's Healthcare of Atlanta, and Georgia State University.

Managing Loss and Change: Grief Interventions for Dementia Caregivers in a CBT-Based Trial.

PubMed

Meichsner, Franziska; Schinköthe, Denise; Wilz, Gabriele

2016-05-01

Dementia caregivers often experience loss and grief related to general caregiver burden, physical, and mental health problems. Through qualitative content analysis, this study analyzed intervention strategies applied by therapists in a randomized-controlled trial in Germany to assist caregivers in managing losses and associated emotions. Sequences from 61 therapy sessions that included interventions targeting grief, loss, and change were transcribed and analyzed. A category system was developed deductively, and the intercoder reliability was satisfactory. The identified grief intervention strategies were recognition and acceptance of loss and change,addressing future losses,normalization of grief, and redefinition of the relationship Therapists focused on identifying experienced losses, managing associated feelings, and fostering acceptance of these losses. A variety of cognitive-behavioral therapy-based techniques was applied with each strategy. The findings contribute to understanding how dementia caregivers can be supported in their experience of grief and facilitate the development of a manualized grief intervention. © The Author(s) 2015.

Acceptance and Commitment Therapy: Western adoption of Buddhist tenets?

PubMed

Fung, Kenneth

2015-08-01

Acceptance and Commitment Therapy (ACT) is a psychological intervention that has wide clinical applications with emerging empirical support. It is based on Functional Contextualism and is derived as a clinical application of the Relational Frame Theory, a behavioral account of the development of human thought and cognition. The six core ACT therapeutic processes include: Acceptance, Defusion, Present Moment, Self-as-Context, Values, and Committed Action. In addition to its explicit use of the concept of mindfulness, the therapeutic techniques of ACT implicitly incorporate other aspects of Buddhism. This article describes the basic principles and processes of ACT, explores the similarities and differences between ACT processes and some of the common tenets in Buddhism such as the Four Noble Truths and No-Self, and reports on the experience of running a pilot intervention ACT group for the Cambodian community in Toronto in partnership with the community's Buddhist Holy Monk. Based on this preliminary exploration in theory and the reflections of the group experience, ACT appears to be consistent with some of the core tenets of Buddhism in the approach towards alleviating suffering, with notable differences in scope reflecting their different aims and objectives. Further development of integrative therapies that can incorporate psychological and spiritual as well as diverse cultural perspectives may help the continued advancement and evolution of more effective psychotherapies that can benefit diverse populations. © The Author(s) 2014.

Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis.

PubMed

Zhang, Yingshi; Cai, Jiayi; An, Li; Hui, Fuhai; Ren, Tianshu; Ma, Hongda; Zhao, Qingchun

2017-05-01

Demographic aging is a worldwide phenomenon, cognitive and behavioral impairment is becoming global burden of nerve damage. However, the effect of pharmacological treatment is not satisfying. Therefore, we analyzed the efficacy of music therapy in elderly dementia patients, and if so, whether music therapy can be used as first-line non-pharmacological treatment. A comprehensive literature search was performed on PubMed, EMbase and the Cochrane Library from inception to September 2016. A total of 34 studies (42 analyses, 1757 subjects) were included; all of them had an acceptable quality based on the PEDro and CASP scale scores. Studies based on any type of dementia patient were combined and analyzed by subgroup. The standardized mean difference was -0.42 (-0.74 to -0.11) for disruptive behavior and 0.20 (-0.09 to 0.49) for cognitive function as primary outcomes in random effect models using controls as the comparator; the secondary outcomes were depressive score, anxiety and quality of life. No evidence of publication bias was found based on Begg's and Egger's test. The meta-analysis confirmed that the baseline differences between the two groups were balanced. Subgroup analyses showed that disease sub-type, intervention method, comparator, subject location, trial design, trial period and outcome measure instrument made little difference in outcomes. The meta-regression may have identified the causes of heterogeneity as the intervention method, comparator and trial design. Music therapy was effective when patients received interactive therapy with a compared group. There was positive evidence to support the use of music therapy to treat disruptive behavior and anxiety; there were positive trends supporting the use of music therapy for the treatment of cognitive function, depression and quality of life. This study is registered with PROSPERO, number CRD42016036153. Copyright © 2016 Elsevier B.V. All rights reserved.

Key constructs in "classical" and "new wave" cognitive behavioral psychotherapies: relationships among each other and with emotional distress.

PubMed

Cristea, Ioana A; Montgomery, Guy H; Szamoskozi, Stefan; David, Daniel

2013-06-01

We aimed to relate key constructs from three forms of cognitive behavioral therapy that are often placed in competition: rational emotive behavior therapy, cognitive therapy, and acceptance and commitment therapy. The key constructs of the underlying theories (i.e., irrational beliefs/unconditional self-acceptance, dysfunctional cognitions, experiential avoidance/psychological inflexibility) of these therapies have not been explicitly studied in their relationships to each other and with emotional distress. We used a cross-sectional design. The variables were selected to indicate key constructs of the three major forms of therapy considered. Study 1 used a sample of 152 students, who were assessed during a stressful period of their semester (mean age = 21.71; 118 females), while Study 2 used a clinical sample of 28 patients with generalized anxiety disorder (mean age = 26.67; 26 females). Results showed that these constructs, central in the therapies considered, had medium to high associations to each other and to distress. Experiential avoidance was found to mediate the relationship between the other, schema-type cognitive constructs and emotional distress. Moreover, multiple mediation analysis in Study 2 seemed to indicate that the influence of the more general constructs on distress was mediated by experiential avoidance, whose effect seemed to be carried on further by automatic thoughts that were the most proximal to distress. Although each of the cognitive constructs considered comes with its underlying theory, the relationships between them can no longer be ignored and cognitive behavioral therapy theoretical models reliably accounting for these relationships should be proposed and tested. © 2013 Wiley Periodicals, Inc.

Fifty Strategies for Counseling Defiant, Aggressive Adolescents: Reaching, Accepting, and Relating.

ERIC Educational Resources Information Center

Hanna, Fred J.; Hanna, Constance A.; Keys, Susan G.

1999-01-01

Takes a transtheoretical approach using ideas from cognitive behavioral, existential, Gestalt, psychodynamic, and multicultural therapies to describe both new and established strategies for relationships building with defiant youth. Arranges strategies in three categories: reaching, accepting, and relating. Suggestions for counselors when working…

Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety.

PubMed

Porritt, J; Rodd, H; Morgan, A; Williams, C; Gupta, E; Kirby, J; Creswell, C; Newton, T; Stevens, K; Baker, S; Prasad, S; Marshman, Z

2017-01-01

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.

Mindfulness-based interventions for binge eating: a systematic review and meta-analysis.

PubMed

Godfrey, Kathryn M; Gallo, Linda C; Afari, Niloofar

2015-04-01

Mindfulness-based interventions are increasingly used to treat binge eating. The effects of these interventions have not been reviewed comprehensively. This systematic review and meta-analysis sought to summarize the literature on mindfulness-based interventions and determine their impact on binge eating behavior. PubMED, Web of Science, and PsycINFO were searched using keywords binge eating, overeating, objective bulimic episodes, acceptance and commitment therapy, dialectical behavior therapy, mindfulness, meditation, mindful eating. Of 151 records screened, 19 studies met inclusion criteria. Most studies showed effects of large magnitude. Results of random effects meta-analyses supported large or medium-large effects of these interventions on binge eating (within-group random effects mean Hedge's g = -1.12, 95 % CI -1.67, -0.80, k = 18; between-group mean Hedge's g = -0.70, 95 % CI -1.16, -0.24, k = 7). However, there was high statistical heterogeneity among the studies (within-group I(2) = 93 %; between-group I(2) = 90 %). Limitations and future research directions are discussed.

Acceptance and expressed emotion in Mexican American caregivers of relatives with schizophrenia.

PubMed

Dorian, Marina; Ramírez García, Jorge I; López, Steven R; Hernández, Brenda

2008-06-01

The relation between Expressed Emotion (EE) and caregiver acceptance was tested with the use of video-recorded interactions between 31 Mexican American family caregivers and their relatives with schizophrenia. Borrowing the concept from Integrative Behavioral Couple Therapy, acceptance was defined as caregiver's engagement with the ill relative along with low levels of expectations for behavioral change. Three aspects of caregiver acceptance were measured: global acceptance of the patient, unified detachment (i.e., nonblaming but engaged problem discussion), and low aversive responses to patient behavior (e.g., criticisms and demanding change). Relative to high EE caregivers, low EE caregivers were consistently more accepting of their ill relatives across the three measures of acceptance. Unified detachment was negatively associated with emotional overinvolvement and aversive responses were positively related to criticism. Warmth was not related to acceptance. The findings suggest that the study of acceptance in family caregivers is a heuristic avenue for future research due to its potential to shed light on specifically what family members do in caring for their ill relatives with schizophrenia.

Acceptance and Commitment Training: A Brief Intervention to Reduce Procrastination among College Students

ERIC Educational Resources Information Center

Scent, Camille L.; Boes, Susan R.

2014-01-01

Academic procrastination is a multifaceted problem with cognitive, behavioral, and motivational correlates. Considered from an acceptance and commitment therapy (ACT) point of view, these correlates relate to experiential avoidance and cognitive fusion. This article describes a brief ACT intervention for reducing procrastination.

Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial.

PubMed

Shahnavaz, Shervin; Hedman-Lagerlöf, Erik; Hasselblad, Tove; Reuterskiöld, Lena; Kaldo, Viktor; Dahllöf, Göran

2018-01-22

Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects. The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children's and adolescents' ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups' self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment. This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability. The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment. ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies. ©Shervin Shahnavaz, Erik Hedman-Lagerlöf, Tove Hasselblad, Lena Reuterskiöld, Viktor Kaldo, Göran Dahllöf. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.01.2018.

The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial.

PubMed

Järvelä-Reijonen, Elina; Karhunen, Leila; Sairanen, Essi; Muotka, Joona; Lindroos, Sanni; Laitinen, Jaana; Puttonen, Sampsa; Peuhkuri, Katri; Hallikainen, Maarit; Pihlajamäki, Jussi; Korpela, Riitta; Ermes, Miikka; Lappalainen, Raimo; Kolehmainen, Marjukka

2018-02-27

Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects. Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants' (n = 219, 85% females) mean body mass index was 31.3 kg/m 2 (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups. Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures. ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted. ClinicalTrials.gov ( NCT01738256 ), registered 17 August, 2012.

Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial.

PubMed

Dahlin, Mats; Andersson, Gerhard; Magnusson, Kristoffer; Johansson, Tomas; Sjögren, Johan; Håkansson, Andreas; Pettersson, Magnus; Kadowaki, Åsa; Cuijpers, Pim; Carlbring, Per

2016-02-01

Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen's d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen's d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD. Copyright © 2015 Elsevier Ltd. All rights reserved.

Acceptance and Commitment Therapy and Habit Reversal Training for the Treatment of Trichotillomania

ERIC Educational Resources Information Center

Crosby, Jesse M.; Dehlin, John P.; Mitchell, P. R.; Twohig, Michael P.

2012-01-01

Trichotillomania is a behavioral problem, and is often referred to as a habit disorder, but it is important to consider the cognitive and emotional components of the behavior. Current treatment recommendations include a traditional behavioral approach (Habit Reversal Training; HRT) combined with an approach that addresses the cognitive and…

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach.

PubMed

Wikman, Anna; Kukkola, Laura; Börjesson, Helene; Cernvall, Martin; Woodford, Joanne; Grönqvist, Helena; von Essen, Louise

2018-04-18

Parenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child's cancer disease after end of treatment. One aim of this study was to develop an internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention. Participatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection. A 10-week, internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in future studies testing and evaluating the intervention were discussed; consensus was not reached for all aspects. To the best of our knowledge, this study is the first use of a participatory action research approach to develop a psychological intervention for parents of children previously treated for cancer and to identify acceptable study procedures. Involvement of parents with lived experience was vital in the development of a potentially relevant and acceptable intervention for this population. ©Anna Wikman, Laura Kukkola, Helene Börjesson, Martin Cernvall, Joanne Woodford, Helena Grönqvist, Louise von Essen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.04.2018.

Outcomes of an acceptance and commitment therapy-based skills training group for students with high-functioning autism spectrum disorder: a quasi-experimental pilot study.

PubMed

Pahnke, Johan; Lundgren, Tobias; Hursti, Timo; Hirvikoski, Tatja

2014-11-01

Autism spectrum disorder is characterized by social impairments and behavioural inflexibility. In this pilot study, the feasibility and outcomes of a 6-week acceptance and commitment therapy-based skills training group were evaluated in a special school setting using a quasi-experimental design (acceptance and commitment therapy/school classes as usual). A total of 28 high-functioning students with autism spectrum disorder (aged 13-21 years) were assessed using self- and teacher-ratings at pre- and post-assessment and 2-month follow-up. All participants completed the skills training, and treatment satisfaction was high. Levels of stress, hyperactivity and emotional distress were reduced in the treatment group. The acceptance and commitment therapy group also reported increased prosocial behaviour. These changes were stable or further improved at the 2-month follow-up. Larger studies are needed to further evaluate the benefits of acceptance and commitment therapy for autism spectrum disorder. © The Author(s) 2013.

Feasibility, Acceptability and Preliminary Treatment Outcomes in a School-Based CBT Intervention Program for Adolescents with ASD and Anxiety in Singapore.

PubMed

Drmic, Irene E; Aljunied, Mariam; Reaven, Judy

2017-12-01

Adolescents with autism spectrum disorder (ASD) are at high risk for anxiety difficulties and disorders. Clinic-based cognitive behavioral therapy (CBT) is effective; however, few published school-based CBT programs for youth with ASD exist. In this study, the Facing Your Fears CBT protocol was adapted for delivery and piloted within a school setting by non-clinicians, with culturally appropriate adaptations. 44 13-15 aged youth with ASD from 22 mainstream schools in Singapore participated. Feasibility, acceptability and preliminary treatment outcomes were examined. Decreases in youth and parent reported anxiety symptoms were reported. Staff and parents found the program useful. Stakeholder support was important for implementation. Initial findings reflect the importance of carefully bridging research-to-practice for youth with ASD and anxiety.

Psychological Flexibility as a Buffer against Caregiver Distress in Families with Psychosis.

PubMed

Jansen, Jens E; Haahr, Ulrik H; Lyse, Hanne-Grethe; Pedersen, Marlene B; Trauelsen, Anne M; Simonsen, Erik

2017-01-01

Background: Research has shown that caregivers of persons with psychosis play an invaluable role in recovery, but unfortunately, often report high levels of distress. While cognitive models of caregiver distress have been well-supported, there is still limited knowledge of the psychological factors involved. Recent advances in cognitive behavioral therapy seem to converge on the importance of acceptance- and mindfulness based processes. Aim: To examine the impact of psychological flexibility on caregiver distress in the early phases of psychosis, while controlling for known predictors of caregiver distress. Method: Within a cross-sectional design, 101 caregivers of 38 persons with first-episode psychosis in a clinical epidemiological sample completed a series of self-report measures. Results: A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service user symptoms, drug use and global functioning, psychological flexibility was a significant predictor of caregiver distress. Conclusion: Greater level of psychological flexibility in caregivers, seems to be related to lower levels of caregiver distress. This finding corresponds to studies within a broad range of emotional disorders. There may be important clinical implications in terms of facilitating the process of acceptance through interventions from the 'third-wave' or contextual cognitive behavioral therapies.

Age-related perception of stature, acceptance of therapy, and psychosocial functioning in human growth hormone-treated girls with Turner's syndrome.

PubMed

Lagrou, K; Xhrouet-Heinrichs, D; Heinrichs, C; Craen, M; Chanoine, J P; Malvaux, P; Bourguignon, J P

1998-05-01

This study evaluated the perception of stature, acceptance of therapy, and psychosocial functioning in relation to age at onset and time on treatment during 2 yr of GH therapy in 31 girls with Turner's syndrome grouped by age (group A: 3.7-5.8 yr, n = 9; group B: 7.2-11.8 yr, n = 13; group C: 12.5-16.4 yr, n = 9). The growth response after 2 yr was significant in the 3 groups when calculated in terms of growth norms for untreated Turner girls (mean increase in height SD score: +1.2, +1.5, and +1.1, respectively). The effect was less marked in terms of growth norms for normal girls, particularly in group B (+0.5 SD score). Height was perceived as a problem by most patients, except in the youngest girls at the start of treatment (group A) and in the majority of the adolescents after 2 yr of GH therapy (group C), without evidence of relation to growth response during therapy. The GH injections were fairly well accepted by all patients, except those younger than 6 yr. In all patients, expected adult height was unrealistic and became more realistic with age, whereas no consistent changes were observed in relation to growth response to GH therapy. The Child Behavior Checklist revealed elevated mean scores at the behavioral subscales of attention problems (group A and B), social problems, withdrawal, and anxiety-depression (most obviously in group B). No significant changes were seen during GH therapy. In group C, an elevated mean social problem score at the Youth Self Report and a low mean social self-esteem score at the Self-Esteem Inventory were observed before therapy and showed a significant improvement during 2 yr of GH treatment. These results, however, might be biased due to an increase in social desirability during therapy. We conclude that the perception of height, acceptance of GH therapy, and psychosocial functioning in girls with Turner's syndrome show important differences between age groups, with only slight changes observed during GH therapy.

Telephone-Delivered Cognitive-Behavioral Therapy for Older, Rural Veterans with Depression and Anxiety in Home-Based Primary Care.

PubMed

Barrera, Terri L; Cummings, Jeremy P; Armento, Maria; Cully, Jeffrey A; Bush Amspoker, Amber; Wilson, Nancy L; Mallen, Michael J; Shrestha, Srijana; Kunik, Mark E; Stanley, Melinda A

2017-01-01

Rural, homebound older adults are at increased risk for anxiety and depression and have limited access to mental health services. These individuals face many barriers to receiving evidence-based mental health treatment and would benefit from interventions that increase access to and efficiency of care. The aim of this study was to evaluate use of a telephone-delivered, modular, cognitive behavioral therapy (CBT) intervention for both late-life depression and anxiety delivered to rural, homebound Veterans. Three cases are presented to illustrate the flexible adaptation of the intervention for use among older Veterans enrolled in home-based primary care, with varying symptom presentations and functional limitations. The Veterans received 7 to 9 sessions of the CBT intervention, with ordering of skill modules based on symptom presentation and determined collaboratively between patient and therapist. The three Veterans showed improvement in depression and/or anxiety symptoms following treatment and provided positive feedback regarding their experiences in this program. These results suggest that telephone-delivered CBT is acceptable to older adults and can be tailored to individual patient needs. Clinicians should consider telephone-delivered CBT as an alternate mode of therapy to increase access to mental health care for rural, homebound individuals with depression and anxiety.

Outpatient Treatment of Child Molesters: Motivational Factors and Outcome.

ERIC Educational Resources Information Center

Jenkins-Hall, Katurah

1994-01-01

Four motivational factors were examined as predictors of treatment effectiveness for 48 male child molesters seen in outpatient therapy using multimodal cognitive behavior therapy for 1 year. Motivation was related to successful outcome. Acceptance of responsibility for sexual deviancy consistently proved to be an effective predictor of favorable…

Cognitive-Behavioral Group Therapy for Latino youth with Type 1 Diabetes and depression: A case study.

PubMed

Cumba-Avilés, Eduardo

2017-02-01

This group case study describes the course of a 14-session Cognitive Behavioral Therapy (CBT) for Latino adolescents with Type 1 Diabetes Mellitus (T1DM) and depressive symptoms. The intervention, known as CBT-DM, is an adaptation of an efficacious group intervention for adolescent depression. The treatment rationale and cultural adaption model are described as well as procedures used to achieve sensitivity to the characteristics of the T1DM culture as experienced by Latino youth from Puerto Rico. Session-by-session protocol is reviewed and treatment gains on the group as a whole and on its individual members are presented, providing quantitative and qualitative data. Treatment feasibility, clients' acceptance and satisfaction with treatment, and follow-up data up to 6 months post-treatment are also examined, considering cognitive, behavioral, emotional, relational, medical, and functional outcomes. Complicating factors, barriers to care, and treatment implications are discussed in the context of treating clients with comorbid chronic physical illness and emotional problems also embedded in a Latino culture. Translation of evidence-based treatments for depression into primary care settings and adapting protocols to youth populations with other medical illnesses is proposed. Recommendations for clinicians are provided, emphasizing the establishment of collaborative relationships with clients, assessing their stage in the process of accepting their chronic illness, as well as understanding their overall context to avoid unnecessary attributions of pathology to their thoughts, behaviors, and feelings.

Cognitive-Behavioral Group Therapy for Latino youth with Type 1 Diabetes and depression: A case study

PubMed Central

Cumba-Avilés, Eduardo

2018-01-01

This group case study describes the course of a 14-session Cognitive Behavioral Therapy (CBT) for Latino adolescents with Type 1 Diabetes Mellitus (T1DM) and depressive symptoms. The intervention, known as CBT-DM, is an adaptation of an efficacious group intervention for adolescent depression. The treatment rationale and cultural adaption model are described as well as procedures used to achieve sensitivity to the characteristics of the T1DM culture as experienced by Latino youth from Puerto Rico. Session-by-session protocol is reviewed and treatment gains on the group as a whole and on its individual members are presented, providing quantitative and qualitative data. Treatment feasibility, clients’ acceptance and satisfaction with treatment, and follow-up data up to 6 months post-treatment are also examined, considering cognitive, behavioral, emotional, relational, medical, and functional outcomes. Complicating factors, barriers to care, and treatment implications are discussed in the context of treating clients with comorbid chronic physical illness and emotional problems also embedded in a Latino culture. Translation of evidence-based treatments for depression into primary care settings and adapting protocols to youth populations with other medical illnesses is proposed. Recommendations for clinicians are provided, emphasizing the establishment of collaborative relationships with clients, assessing their stage in the process of accepting their chronic illness, as well as understanding their overall context to avoid unnecessary attributions of pathology to their thoughts, behaviors, and feelings. PMID:29568241

Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior.

PubMed

Williams, J Mark G; Duggan, Danielle S; Crane, Catherine; Fennell, Melanie J V

2006-02-01

Once suicidal thoughts have emerged as a feature of depression they are likely to be reactivated as part of a suicidal mode of mind whenever sad mood reappears. This article reviews the methods and the usefulness of mindfulness-based cognitive therapy (MBCT) as a treatment for the prevention of the reactivation of the suicidal mode. MBCT integrates mindfulness meditation practices and cognitive therapy techniques. It teaches participants to develop moment-by-moment awareness, approaching ongoing experience with an attitude of nonjudgment and acceptance. Participants are increasingly able to see their thoughts as mental events rather than facts (metacognitive awareness). A case example illustrates how mindfulness skills develop with MBCT and how they relate to the cognitive processes that fuel suicidal crises. An ongoing controlled trial will provide further evidence, but pilot work suggests that MBCT is a promising intervention for those who have experienced suicidal ideation in the past. (c) 2005 Wiley Periodicals, Inc.

User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review

PubMed Central

Rost, Theresia; Stein, Janine; Löbner, Margrit; Kersting, Anette; Luck-Sikorski, Claudia

2017-01-01

Background Computerized cognitive behavioral therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance. Objective The aim of this study was to update and expand on earlier work on user acceptance of cCBT for depression. Methods This paper systematically reviewed quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library, and PsycINFO. Studies were retained if they described the explicit examination of the user acceptance, experiences, or satisfaction related to a cCBT intervention, if they reported depression as a primary outcome, and if they were published in German or English from July 2007 onward. Results A total of 1736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalized and analyzed very heterogeneously. Eight studies reported a very high level of acceptance, 17 indicated a high level of acceptance, and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negative aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings. Conclusions In general, people experience cCBT for depression as predominantly positive, which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalization of concepts, and measurement. PMID:28903893

Targeting emotion dysregulation in the treatment of self-injury.

PubMed

Gratz, Kim L

2007-11-01

Clinically useful definitions of emotion regulation with respect to deliberate self-harm (referred to here as self-injury) focus on adaptive ways of responding to emotional distress rather than on the control of emotions or dampening of emotional arousal. According to one such definition, emotion regulation is a multifaceted construct involving a) the awareness, understanding, and acceptance of emotions; b) ability to engage in goal-directed behaviors, and inhibit impulsive behaviors, when experiencing negative emotions; c) the flexible use of situationally appropriate strategies to modulate the intensity and/or duration of emotional responses rather than to eliminate emotions entirely; and d) willingness to experience negative emotions as part of pursuing meaningful activities in life (Gratz & Roemer, 2004). This article addresses the role of emotion dysregulation in self-injury and discusses two treatments for self-injury that explicitly focus on increasing emotion regulation. These treatments are based on the premise that the reduction of emotion dysregulation will decrease the need for maladaptive behaviors that function to regulate emotions, such as self-injury. A case illustration describing how one of these treatments (an acceptance-based, emotion regulation group therapy) is used to treat self-injury is provided.

Therapeutic Self-Disclosure within DBT, Schema Therapy, and CBASP: Opportunities and Challenges.

PubMed

Köhler, Stephan; Guhn, Anne; Betzler, Felix; Stiglmayr, Christian; Brakemeier, Eva-Lotta; Sterzer, Philipp

2017-01-01

In recent years, various therapeutic interventions have been established that extended behavior and cognitive behavior therapy (CBT) by so-called "third-wave" strategies. In order to address specific therapeutic challenges in certain subgroups of patients who do not sufficiently respond to "classical CBT," some of these third-wave strategies put particular emphasis on therapist self-disclosure. This article highlights therapeutic self-disclosure as a means to address interpersonal problems by comparing three third-wave strategies: (a) acceptance and change strategies as used in Dialectical Behavioral Therapy (DBT), (b) the concept of "limited reparenting" as used in Schema Therapy (ST), and (c) disciplined personal involvement as used in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). On the basis of a critical discussion on opportunities and challenges within these three concepts, self-disclosure is proposed to be a promising therapeutic tool that is worth to be investigated in more depth in future studies.

Conventional Cognitive Behavioral Therapy Facilitated by an Internet-Based Support System: Feasibility Study at a Psychiatric Outpatient Clinic.

PubMed

Månsson, Kristoffer Nt; Klintmalm, Hugo; Nordqvist, Ragnar; Andersson, Gerhard

2017-08-24

Cognitive behavioral therapies have been shown to be effective for a variety of psychiatric and somatic disorders, but some obstacles can be noted in regular psychiatric care; for example, low adherence to treatment protocols may undermine effects. Treatments delivered via the Internet have shown promising results, and it is an open question if the blend of Internet-delivered and conventional face-to-face cognitive behavioral therapies may help to overcome some of the barriers of evidence-based treatments in psychiatric care. We evaluated the feasibility of an Internet-based support system at an outpatient psychiatric clinic in Sweden. For instance, the support system made it possible to send messages and share information between the therapist and the patient before and after therapy sessions at the clinic. Nine clinical psychologists participated and 33 patients were enrolled in the current study. We evaluated the usability and technology acceptance after 12 weeks of access. Moreover, clinical data on common psychiatric symptoms were assessed before and after the presentation of the support system. In line with our previous study in a university setting, the Internet-based support system has the potential to be feasible also when delivered in a regular psychiatric setting. Notably, some components in the system were less frequently used. We also found that patients improved on common outcome measures for depressive and anxious symptoms (effect sizes, as determined by Cohen d, ranged from 0.20-0.69). This study adds to the literature suggesting that modern information technology could be aligned with conventional face-to-face services. ©Kristoffer NT Månsson, Hugo Klintmalm, Ragnar Nordqvist, Gerhard Andersson. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 24.08.2017.

A Cultural Adaptation of Dialectical Behavior Therapy in Nepal

PubMed Central

Ramaiya, Megan K.; Fiorillo, Devika; Regmi, Upasana; Robins, Clive J.; Kohrt, Brandon A.

2017-01-01

Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia. PMID:29056846

The "RAPID" cognitive-behavioral therapy program for inattentive children: preliminary findings.

PubMed

Young, Susan

2013-08-01

The objectives of the current study were to ascertain feasibility and acceptability of directly delivering a cognitive-behavioral therapy (CBT) group intervention for inattentive children in a school setting, to examine the reliability of the RATE-CQuestionnaires that accompany the program, and to determine whether they can be used to measure outcome. Eighty-eight parents/carers, their children (age 8-11), and teachers at mainstream primary schools in London participated by completing the RATE-C Questionnaires; 48 participated in the group treatment following which the Questionnaires were readministered together with a semistructured interview. The intervention had a completion rate of 92%. Postgroup interviews supported the acceptability of a direct intervention with young children. Reliability of the RATE-C Total scores was excellent for parent/carer, child, and teacher ratings; postintervention parent/carer ratings indicated significant improvement on scales of attention, emotion, and conduct with medium to large effect. The results support the reliability of the RATE-C Scales, and feasibility and acceptability of the RAPID intervention.

Mental Health Promotion as a New Goal in Public Mental Health Care: A Randomized Controlled Trial of an Intervention Enhancing Psychological Flexibility

PubMed Central

Bohlmeijer, Ernst T.; Smit, Filip; Westerhof, Gerben J.

2010-01-01

Objectives. We assessed whether an intervention based on acceptance and commitment therapy (ACT) and mindfulness was successful in promoting positive mental health by enhancing psychological flexibility. Methods. Participants were 93 adults with mild to moderate psychological distress. They were randomly assigned to the group intervention (n = 49) or to a waiting-list control group (n = 44). Participants completed measures before and after the intervention as well as 3 months later at follow-up to assess mental health in terms of emotional, psychological, and social well-being (Mental Health Continuum–Short Form) as well as psychological flexibility (i.e., acceptance of present experiences and value-based behavior, Acceptance and Action Questionnaire-II). Results. Regression analyses showed that compared with the participants on the waiting list, participants in the ACT and mindfulness intervention had greater emotional and psychological well-being after the intervention and also greater psychological flexibility at follow-up. Mediational analyses showed that the enhancement of psychological flexibility during the intervention mediated the effects of the intervention on positive mental health. Conclusions. The intervention is effective in improving positive mental health by stimulating skills of acceptance and value-based action. PMID:20966360

Mental health promotion as a new goal in public mental health care: a randomized controlled trial of an intervention enhancing psychological flexibility.

PubMed

Fledderus, Martine; Bohlmeijer, Ernst T; Smit, Filip; Westerhof, Gerben J

2010-12-01

We assessed whether an intervention based on acceptance and commitment therapy (ACT) and mindfulness was successful in promoting positive mental health by enhancing psychological flexibility. Participants were 93 adults with mild to moderate psychological distress. They were randomly assigned to the group intervention (n = 49) or to a waiting-list control group (n = 44). Participants completed measures before and after the intervention as well as 3 months later at follow-up to assess mental health in terms of emotional, psychological, and social well-being (Mental Health Continuum-Short Form) as well as psychological flexibility (i.e., acceptance of present experiences and value-based behavior, Acceptance and Action Questionnaire-II). Regression analyses showed that compared with the participants on the waiting list, participants in the ACT and mindfulness intervention had greater emotional and psychological well-being after the intervention and also greater psychological flexibility at follow-up. Mediational analyses showed that the enhancement of psychological flexibility during the intervention mediated the effects of the intervention on positive mental health. The intervention is effective in improving positive mental health by stimulating skills of acceptance and value-based action.

Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators.

PubMed

Craske, Michelle G; Niles, Andrea N; Burklund, Lisa J; Wolitzky-Taylor, Kate B; Vilardaga, Jennifer C Plumb; Arch, Joanna J; Saxbe, Darby E; Lieberman, Matthew D

2014-12-01

Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. The current study (N = 87) was a 3-arm randomized clinical trial comparing CBT, acceptance and commitment therapy (ACT), and a wait-list control group (WL) in participants with a diagnosis of social phobia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and posttreatment, and participants assigned to CBT and ACT also completed assessments 6 and 12 months following baseline. Assessments consisted of self-report measures, a public-speaking task, and clinician ratings. Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public-speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-month follow-up in CBT compared with ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes. Implications for clinical practice and future research are discussed.

Brief Acceptance and Commitment Therapy and Exposure for Panic Disorder: A Pilot Study

ERIC Educational Resources Information Center

Meuret, Alicia E.; Twohig, Michael P.; Rosenfield, David; Hayes, Steven C.; Craske, Michelle G.

2012-01-01

Cognitive and biobehavioral coping skills are central to psychosocial therapies and are taught to facilitate and improve exposure therapy. While traditional coping skills are aimed at controlling maladaptive thoughts or dysregulations in physiology, newer approaches that explore acceptance, defusion, and values-based direction have been gaining…

Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience

PubMed Central

Sullivan, Marlysa B.; Erb, Matt; Schmalzl, Laura; Moonaz, Steffany; Noggle Taylor, Jessica; Porges, Stephen W.

2018-01-01

Yoga therapy is a newly emerging, self-regulating complementary and integrative healthcare (CIH) practice. It is growing in its professionalization, recognition and utilization with a demonstrated commitment to setting practice standards, educational and accreditation standards, and promoting research to support its efficacy for various populations and conditions. However, heterogeneity of practice, poor reporting standards, and lack of a broadly accepted understanding of the neurophysiological mechanisms involved in yoga therapy limits the structuring of testable hypotheses and clinical applications. Current proposed frameworks of yoga-based practices focus on the integration of bottom-up neurophysiological and top-down neurocognitive mechanisms. In addition, it has been proposed that phenomenology and first person ethical inquiry can provide a lens through which yoga therapy is viewed as a process that contributes towards eudaimonic well-being in the experience of pain, illness or disability. In this article we build on these frameworks, and propose a model of yoga therapy that converges with Polyvagal Theory (PVT). PVT links the evolution of the autonomic nervous system to the emergence of prosocial behaviors and posits that the neural platforms supporting social behavior are involved in maintaining health, growth and restoration. This explanatory model which connects neurophysiological patterns of autonomic regulation and expression of emotional and social behavior, is increasingly utilized as a framework for understanding human behavior, stress and illness. Specifically, we describe how PVT can be conceptualized as a neurophysiological counterpart to the yogic concept of the gunas, or qualities of nature. Similar to the neural platforms described in PVT, the gunas provide the foundation from which behavioral, emotional and physical attributes emerge. We describe how these two different yet analogous frameworks—one based in neurophysiology and the other in an ancient wisdom tradition—highlight yoga therapy’s promotion of physical, mental and social wellbeing for self-regulation and resilience. This parallel between the neural platforms of PVT and the gunas of yoga is instrumental in creating a translational framework for yoga therapy to align with its philosophical foundations. Consequently, yoga therapy can operate as a distinct practice rather than fitting into an outside model for its utilization in research and clinical contexts. PMID:29535617

Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility and Acceptability

PubMed Central

Stanley, Barbara; Brown, Gregory; Brent, David; Wells, Karen; Poling, Kim; Curry, John; Kennard, Betsy D.; Wagner, Ann; Cwik, Mary; Klomek, Anat Brunstein; Goldstein, Tina; Vitiello, Benedetto; Barnett, Shannon; Daniel, Stephanie; Hughes, Jennifer

2009-01-01

Objective To describe the elements of a manualized cognitive behavior psychotherapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide. Method CBT-SP was developed using a risk reduction, relapse prevention approach and theoretically grounded in principles of cognitive behavior therapy, dialectical behavioral therapy and targeted therapies for suicidal, depressed youth. CBT-SP consists of acute and continuation phases, each lasting about 12 sessions, and includes a chain analysis of the suicidal event, safety plan development, skill building, psychoeducation, family intervention, and relapse prevention. Results CBT-SP was administered to 110 depressed, recent suicide attempters aged 13–19 years (mean 15.8±1.6) across five academic sites. Twelve or more sessions were completed by 72.4% of the sample. Conclusions A specific intervention for adolescents at high risk for repeated suicide attempts has been developed and manualized, and further testing of its efficacy appears feasible. PMID:19730273

Web-based therapist training on cognitive behavior therapy for anxiety disorders: a pilot study.

PubMed

Kobak, Kenneth A; Craske, Michelle G; Rose, Raphael D; Wolitsky-Taylor, Kate

2013-06-01

The need for clinicians to use evidence-based practices (such as cognitive behavior therapy [CBT]) is now well recognized. However, a gap exists between the need for empirically based treatments and their availability. This is due, in part, to a shortage of clinicians formally trained on CBT. To address this problem, we developed a Web-based therapist CBT training program, to increase accessibility to this training. The program uses a two-step approach: an interactive multimedia online tutorial for didactic training on CBT concepts, followed by live remote observation through a videoconference of trainees conducting CBT, with immediate feedback in real time during critical moments to enhance learning through iterative guidance and practice. Thirty-nine clinicians from around the county completed the online didactic training and 22 completed the live remote training. Results found a significant increase in knowledge of CBT concepts and a significant increase in clinical skills, as judged by a blind rater. User satisfaction was high for both the online tutorial and the videoconference training. Utilization of CBT by trainees increased after training. Results support the acceptability and effectiveness of this Web-based approach to training.

Cognitive mediators of treatment for social anxiety disorder: comparing acceptance and commitment therapy and cognitive-behavioral therapy.

PubMed

Niles, Andrea N; Burklund, Lisa J; Arch, Joanna J; Lieberman, Matthew D; Saxbe, Darby; Craske, Michelle G

2014-09-01

To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder. Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n=25) or ACT (n=25) for DSM-IV social anxiety disorder. Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms. Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT. Copyright © 2014. Published by Elsevier Ltd.

Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

PubMed Central

Niles, Andrea N.; Burklund, Lisa J.; Arch, Joanna J.; Lieberman, Matthew D.; Saxbe, Darby; Craske, Michelle G.

2016-01-01

Objective To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder. Method Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n = 25) for DSM-IV social anxiety disorder. Results Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms. Conclusions Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT. PMID:25022777

Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy for Young Children: A Pilot Study

PubMed Central

Robst, John; Scheeringa, Michael S.; Cohen, Judith A.; Wang, Wei; Murphy, Tanya K.; Tolin, David F.; Storch, Eric A.

2013-01-01

This pilot study explored the preliminary efficacy, parent acceptability and economic cost of delivering Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT). Nine young children ages 3–6 years and their parents participated in SC-TF-CBT. Eighty-three percent (5/6) of the children who completed Step One treatment and 55.6 % (5/9) of the intent-to-treat sample responded to Step One. One case relapsed at post-assessment. Treatment gains were maintained at 3-month follow-up. Generally, parents found Step One to be acceptable and were satisfied with treatment. At 3-month follow-up, the cost per unit improvement for posttraumatic stress symptoms and severity ranged from $27.65 to $131.33 for the responders and from $36.12 to $208.11 for the intent-to-treat sample. Further research on stepped care for young children is warranted to examine if this approach is more efficient, accessible and cost-effective than traditional therapy. PMID:23584728

Step one within stepped care trauma-focused cognitive behavioral therapy for young children: a pilot study.

PubMed

Salloum, Alison; Robst, John; Scheeringa, Michael S; Cohen, Judith A; Wang, Wei; Murphy, Tanya K; Tolin, David F; Storch, Eric A

2014-02-01

This pilot study explored the preliminary efficacy, parent acceptability and economic cost of delivering Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT). Nine young children ages 3-6 years and their parents participated in SC-TF-CBT. Eighty-three percent (5/6) of the children who completed Step One treatment and 55.6 % (5/9) of the intent-to-treat sample responded to Step One. One case relapsed at post-assessment. Treatment gains were maintained at 3-month follow-up. Generally, parents found Step One to be acceptable and were satisfied with treatment. At 3-month follow-up, the cost per unit improvement for posttraumatic stress symptoms and severity ranged from $27.65 to $131.33 for the responders and from $36.12 to $208.11 for the intent-to-treat sample. Further research on stepped care for young children is warranted to examine if this approach is more efficient, accessible and cost-effective than traditional therapy.

Feasibility of a Prototype Web-Based Acceptance and Commitment Therapy Prevention Program for College Students

ERIC Educational Resources Information Center

Levin, Michael E.; Pistorello, Jacqueline; Seeley, John R.; Hayes, Steven C.

2014-01-01

Objective: This study examined the feasibility of a prototype Web-based acceptance and commitment therapy (ACT) program for preventing mental health problems among college students. Participants: Undergraduate first-year students ("N" = 76) participated between May and November 2011. Methods: Participants were randomized to ACT or a…

Feasibility and Acceptability of Internet-delivered Cognitive Behavioral Therapy for Chronic Pain in Adolescents With Sickle Cell Disease and Their Parents.

PubMed

Palermo, Tonya M; Dudeney, Joanne; Santanelli, James P; Carletti, Alexie; Zempsky, William T

2018-03-01

Pain is a clinical hallmark of sickle cell disease (SCD), and is rarely optimally managed. Cognitive-behavioral therapy (CBT) for pain has been effectively delivered through the Internet in other pediatric populations. We tested feasibility and acceptability of an Internet-delivered CBT intervention in 25 adolescents with SCD (64% female, mean age=14.8 y) and their parents randomized to Internet CBT (n=15) or Internet Pain Education (n=10). Participants completed pretreatment/posttreatment measures. Eight dyads completed semistructured interviews to evaluate treatment acceptability. Feasibility indicators included recruitment and participation rates, engagement and adherence to intervention, and completion of outcome measures. In total, 87 referrals were received from 9 study sites; our recruitment rate was 60% from those families approached for screening. Among participants, high levels of initial intervention engagement (>90%), and adherence (>70%) were demonstrated. Most participants completed posttreatment outcome and diary measures (>75%). Retention at posttreatment was 80%. High treatment acceptability was reported in interviews. Our findings suggest that Internet-delivered CBT for SCD pain is feasible and acceptable to adolescents with SCD and their parents. Engagement and adherence were good. Next steps are to modify recruitment plans to enhance enrollment and determine efficacy of Internet CBT for SCD pain in a large multisite randomized controlled trial.

User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review.

PubMed

Rost, Theresia; Stein, Janine; Löbner, Margrit; Kersting, Anette; Luck-Sikorski, Claudia; Riedel-Heller, Steffi G

2017-09-13

Computerized cognitive behavioral therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance. The aim of this study was to update and expand on earlier work on user acceptance of cCBT for depression. This paper systematically reviewed quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library, and PsycINFO. Studies were retained if they described the explicit examination of the user acceptance, experiences, or satisfaction related to a cCBT intervention, if they reported depression as a primary outcome, and if they were published in German or English from July 2007 onward. A total of 1736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalized and analyzed very heterogeneously. Eight studies reported a very high level of acceptance, 17 indicated a high level of acceptance, and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negative aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings. In general, people experience cCBT for depression as predominantly positive, which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalization of concepts, and measurement. ©Theresia Rost, Janine Stein, Margrit Löbner, Anette Kersting, Claudia Luck-Sikorski, Steffi G Riedel-Heller. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.09.2017.

Acceptance and Commitment Therapy with Older Adults: Rationale and Considerations

PubMed Central

Petkus, Andrew J; M.A; Wetherell, Julie Loebach

2015-01-01

Older adults are the fastest growing segment of the population. With these changing demographics, mental health professionals will be seeing more older clients. Additionally, older adults are an underserved population in that most older adults in need of mental health services do not receive treatment. Thus, it is essential that treatments for mental and behavioral health problems are empirically supported with older adults and that mental health professionals are aware of the special needs of older adult populations. Acceptance and Commitment Therapy (ACT) is an emerging approach to the treatment of distress. The purpose of this article is to provide a rationale for using ACT with older adults based on gerontological theory and research. We also review research on ACT-related processes in later life. We present a case example of an older man with depression and anxiety whom we treated with ACT. Finally, we describe treatment recommendations and important adaptations that need to be considered when using ACT with older adults and discuss important areas for future research. PMID:26997859

Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations.

PubMed

Adler-Neal, Adrienne L; Zeidan, Fadel

2017-09-01

Fibromyalgia is a disorder characterized by widespread pain and a spectrum of psychological comorbidities, rendering treatment difficult and often a financial burden. Fibromyalgia is a complicated chronic pain condition that requires a multimodal therapeutic approach to optimize treatment efficacy. Thus, it has been postulated that mind-body techniques may prove fruitful in treating fibromyalgia. Mindfulness meditation, a behavioral technique premised on non-reactive sensory awareness, attenuates pain and improves mental health outcomes. However, the impact of mindfulness meditation on fibromyalgia-related outcomes has not been comprehensively characterized. The present review delineates the existing evidence supporting the effectiveness and hypothesized mechanisms of mindfulness meditation in treating fibromyalgia-related outcomes. Mindfulness-based interventions premised on cultivating acceptance, non-attachment, and social engagement may be most effective in decreasing fibromyalgia-related pain and psychological symptoms. Mindfulness-based therapies may alleviate fibromyalgia-related outcomes through multiple neural, psychological, and physiological processes. Mindfulness meditation may provide an effective complementary treatment approach for fibromyalgia patients, especially when combined with other reliable techniques (exercise; cognitive behavioral therapy). However, characterizing the specific analgesic mechanisms supporting mindfulness meditation is a critical step to fostering the clinical validity of this technique. Identification of the specific analgesic mechanisms supporting mindfulness-based pain relief could be utilized to better design behavioral interventions to specifically target fibromyalgia-related outcomes.

Development and Testing of a Cognitive Behavioral Therapy Resource for Children’s Dental Anxiety

PubMed Central

Porritt, J.; Rodd, H.; Morgan, A.; Williams, C.; Gupta, E.; Kirby, J.; Creswell, C.; Newton, T.; Stevens, K.; Baker, S.; Prasad, S.; Marshman, Z.

2016-01-01

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative “person-based” approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen’s d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen’s d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children. PMID:28879243

A different perspective: introducing positive criminology.

PubMed

Ronel, Natti; Elisha, Ety

2011-04-01

Positive criminology is a new conceptual perspective of criminology, encompassing several theories and models. Positive criminology refers to a focus on individuals' encounters with forces and influences that are experienced as positive, which distance them from deviance and crime, whether by means of formal and informal therapy programs and interventions, such as self-help groups; through emphasis of positive social elements, such as exposure to goodness, social acceptance, and reintegrative shaming; or based on positive personal traits, such as resilience and coherence. The perspective of positive criminology broadens that of traditional criminology, which focuses mainly on understanding the factors and processes that lead individuals and groups to what is defined as deviant and criminal behavior. Positive criminology is implemented in treatment and rehabilitation of individuals and groups that have demonstrated deviant and criminal behavior, by emphasizing positive experiences that may potentially prevent or discourage continued criminal behavior. Positive criminology is also expressed in prevention based on a positive approach.

Cognitive-behavioral therapies for depression and substance use disorders: An overview of traditional, third-wave, and transdiagnostic approaches.

PubMed

Vujanovic, Anka A; Meyer, Thomas D; Heads, Angela M; Stotts, Angela L; Villarreal, Yolanda R; Schmitz, Joy M

2017-07-01

The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously. The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity. Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression. Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.

Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial

PubMed Central

Pramana, Gede; Lomas, James; Lindhiem, Oliver; Kendall, Philip C; Silk, Jennifer

2018-01-01

Background Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). Objective The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. Methods We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. Results Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). Conclusions The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment. PMID:29748165

Integrated Behavior Therapy for Selective Mutism: a randomized controlled pilot study.

PubMed

Bergman, R Lindsey; Gonzalez, Araceli; Piacentini, John; Keller, Melody L

2013-10-01

To evaluate the feasibility, acceptability, and preliminary efficacy of a novel behavioral intervention for reducing symptoms of selective mutism and increasing functional speech. A total of 21 children ages 4 to 8 with primary selective mutism were randomized to 24 weeks of Integrated Behavior Therapy for Selective Mutism (IBTSM) or a 12-week Waitlist control. Clinical outcomes were assessed using blind independent evaluators, parent-, and teacher-report, and an objective behavioral measure. Treatment recipients completed a three-month follow-up to assess durability of treatment gains. Data indicated increased functional speaking behavior post-treatment as rated by parents and teachers, with a high rate of treatment responders as rated by blind independent evaluators (75%). Conversely, children in the Waitlist comparison group did not experience significant improvements in speaking behaviors. Children who received IBTSM also demonstrated significant improvements in number of words spoken at school compared to baseline, however, significant group differences did not emerge. Treatment recipients also experienced significant reductions in social anxiety per parent, but not teacher, report. Clinical gains were maintained over 3 month follow-up. IBTSM appears to be a promising new intervention that is efficacious in increasing functional speaking behaviors, feasible, and acceptable to parents and teachers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Individual versus group female-specific cognitive behavior therapy for alcohol use disorder.

PubMed

Epstein, Elizabeth E; McCrady, Barbara S; Hallgren, Kevin A; Gaba, Ayorkor; Cook, Sharon; Jensen, Noelle; Hildebrandt, Thomas; Holzhauer, Cathryn Glanton; Litt, Mark D

2018-05-01

To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and within- and post-treatment outcomes. Women with AUD (n=155) were randomly assigned to 12 manual-guided sessions of G-FS-CBT or I-FS-CBT; 138 women attended at least one treatment session. Women in G-FS-CBT attended fewer sessions (M=7.6) than women in I-FS-CBT (M=9.7; p<.001). Women in both conditions reported high satisfaction with the treatments. Independent coders rated high fidelity of delivery of both G-FS-CBT and I-FS-CBT. Therapeutic alliance with the therapist was high in both conditions, with I-FS-CBT being slightly but significantly higher than G-FS-CBT. In the first six weeks of treatment, women in both treatment conditions significantly reduced their percent drinking days (PDD) and percent heavy days drinking (PHD) by equivalent amounts, maintained through the rest of treatment and the 12month follow up with no treatment condition effects. Women reported significant improvement in all but one of the secondary outcomes during treatment; gains made during treatment in depression, anxiety, autonomy, and interpersonal problems were maintained during the follow-up period, while gains made during treatment in use of coping skills, self-efficacy for abstinence, self-care, and sociotropy deteriorated over follow up but remained improved compared to baseline. Findings support the feasibility, acceptability, and efficacy of a group format for female-specific CBT for AUD, a new 12-session, single gender, community friendly, group therapy with programming specifically for women. Similar, positive outcomes for individual and group treatment formats were found for drinking, mood, coping skills, self-confidence, interpersonal functioning, and self-care. Copyright © 2018. Published by Elsevier Inc.

Therapeutic Self-Disclosure within DBT, Schema Therapy, and CBASP: Opportunities and Challenges

PubMed Central

Köhler, Stephan; Guhn, Anne; Betzler, Felix; Stiglmayr, Christian; Brakemeier, Eva-Lotta; Sterzer, Philipp

2017-01-01

In recent years, various therapeutic interventions have been established that extended behavior and cognitive behavior therapy (CBT) by so-called “third-wave” strategies. In order to address specific therapeutic challenges in certain subgroups of patients who do not sufficiently respond to “classical CBT,” some of these third-wave strategies put particular emphasis on therapist self-disclosure. This article highlights therapeutic self-disclosure as a means to address interpersonal problems by comparing three third-wave strategies: (a) acceptance and change strategies as used in Dialectical Behavioral Therapy (DBT), (b) the concept of “limited reparenting” as used in Schema Therapy (ST), and (c) disciplined personal involvement as used in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). On the basis of a critical discussion on opportunities and challenges within these three concepts, self-disclosure is proposed to be a promising therapeutic tool that is worth to be investigated in more depth in future studies. PMID:29238317

Vaginismus treatment. Hypnotherapy versus behavior therapy.

PubMed

Al-Sughayir, Mohammed A

2005-04-01

To investigate the effectiveness of hypnotherapy in the treatment of vaginismus compared to behavior therapy. A consecutive sample of 36 women with vaginismus (DSM-IV criteria) referred to the out-patient psychiatry clinic at King Abdul-Aziz University Hospital in Riyadh between 1999-2003 were divided into 2 groups for either treatment on a random basis. A female psychologist independently and carefully assessed patients before and after treatment. Patients were treated until they achieved satisfactory sexual intercourse. Although both behavior therapy and hypnotherapy were successful in treating vaginismus, hypnotherapy performed better than behavior therapy in reducing the level of the wife`s sex-related anxiety and in improving the husband`s sexual satisfaction score. Success tended to occur faster in women treated with hypnotherapy as they received fewer treatment sessions. Women with vaginismus can be successfully treated by hypnotherapy without simultaneous treatment of their husbands. Hypnotherapy can provide an acceptable time and cost effective therapeutic tool that helps resolve vaginismus and improves sexual satisfaction in both spouses.

Meeting the expectations of chronic tinnitus patients: comparison of a structured group therapy program for tinnitus management with a problem-solving group.

PubMed

Wise, K; Rief, W; Goebel, G

1998-06-01

Two different group treatments were evaluated in 144 in-patients suffering from impairment due to chronic tinnitus. A tinnitus management therapy (TMT) was developed using principles of cognitive-behavioral therapy and compared with problem solving group therapy. Self-ratings were used to evaluate the help patients found in dealing with life problems and tinnitus as well as the degree to which they felt they were being properly treated and taken seriously. Patients showed significantly more satisfaction with the TMT group and evaluated the help they found in coping with tinnitus and life problems significantly higher. Thus, in the light of unsatisfactory medical solutions and the poor acceptance of some psychological treatments for tinnitus, TMT appears to be an acceptable and helpful treatment program.

Weekly brief phone support in self-help cognitive behavioral therapy for insomnia disorder: Relevance to adherence and efficacy.

PubMed

Ho, Fiona Yan-Yee; Chung, Ka-Fai; Yeung, Wing-Fai; Ng, Tommy Ho-Yee; Cheng, Sammy Kin-Wing

2014-12-01

Self-help cognitive-behavioral therapy for insomnia (CBT-I) is an acceptable, low-intensity treatment in a stepped care model for insomnia. We tested the application of self-help CBT-I in a Chinese population. 312 participants with self-report of insomnia associated with distress or daytime impairment 3 or more nights per week for at least 3 months were randomized to self-help CBT-I with telephone support (SHS), self-help CBT-I (SH) and waiting-list (WL). The program was Internet-based with treatment materials delivered once per week, and lasted for 6 consecutive weeks, while the telephone support was limited to 15 min weekly. Mixed-effects analyses found significant group by time interaction in sleep and sleep-related cognitions at immediate and 4-week posttreatment. Post-hoc pairwise comparison with WL revealed that both SHS and SH had significantly higher sleep efficiency at immediate (p = .004 and p = .03, respectively) and 4-week posttreatment (p = .002 and p = .02, respectively) and lower insomnia and dysfunctional beliefs scores. The SHS group had additional improvements in sleep onset latency and sleep quality. Benefits with self-help CBT-I were maintained at 12-week posttreatment, but attrition rate was about 35%. Internet-based self-help CBT-I was effective and acceptable for treating insomnia in the Chinese population. A brief telephone support further enhanced the efficacy. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles.

PubMed

Shayeghian, Zeinab; Hassanabadi, Hamidreza; Aguilar-Vafaie, Maria E; Amiri, Parisa; Besharat, Mohammad Ali

2016-01-01

Evidence of the efficacy of existing psychological interventions for self-management in diabetes is limited. The current study aimed at assessing the effects of group-based ACT on self-management of patients with T2DM, considering the moderating role of coping styles. One hundred and six patients with type 2 diabetes were randomly assigned either to the education alone (n = 53) or to a combination of education and group-based acceptance and commitment therapy (n = 53) over a period of 10 sessions. In each group, 50 participants completed a 3 month follow-up assessment. After 3 months, compared to patients who received education alone, those in the group-based acceptance and commitment therapy condition were more likely to use effective coping strategies, reported better diabetes self-care, and optimum glycated hemoglobin (HbA1C) levels in the target range. Consideration of the role of coping style for a more accurate evaluation of the effects of acceptance and commitment therapy may be a useful addition to services provided for patients with type 2 diabetes.

Developing an integrated treatment for substance use and depression using cognitive-behavioral therapy.

PubMed

Osilla, Karen Chan; Hepner, Kimberly A; Muñoz, Ricardo F; Woo, Stephanie; Watkins, Katherine

2009-12-01

Providing a unified treatment approach to meet the substance abuse and mental health needs of clients is the preferred model for addressing co-occurring disorders. We developed a group-based cognitive-behavioral (CBT) integrated treatment for depression and substance use disorders (SUD) that could be delivered by counselors in SUD treatment settings and evaluated its feasibility and acceptability. We conducted an in-depth case study examining one implementation of the treatment using 15 focus groups with clients (n = 7) and semistructured interviews with counselors (n = 2) and administrators (n = 3). Using CBT as a treatment approach to integrate the treatment was widely accepted by clients, counselors, and administrators. Clients stated the treatment was applicable to multiple aspects of their lives and allowed them to recognize their clinical improvements over time. Counselors and administrators discussed challenges for long-term feasibility. Key decisions used to develop the treatment and recommendations for implementing integrated care in SUD settings are discussed.

Integrating Religion and Spirituality into Treatment for Late-Life Anxiety: Three Case Studies

ERIC Educational Resources Information Center

Barrera, Terri L.; Zeno, Darrell; Bush, Amber L.; Barber, Catherine R.; Stanley, Melinda A.

2012-01-01

Generalized anxiety disorder (GAD) is common in older adults and, although cognitive behavioral therapy (CBT) is an efficacious treatment for late-life GAD, effect sizes are only moderate and attrition rates are high. One way to increase treatment acceptability and enhance current cognitive behavioral treatments for GAD in older adults might be to…

Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder.

PubMed

Burklund, Lisa J; Torre, Jared B; Lieberman, Matthew D; Taylor, Shelley E; Craske, Michelle G

2017-03-30

Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment.

PubMed

Hooten, W Michael

2016-07-01

Chronic pain and mental health disorders are common in the general population, and epidemiological studies suggest that a bidirectional relationship exists between these 2 conditions. The observations from functional imaging studies suggest that this bidirectional relationship is due in part to shared neural mechanisms. In addition to depression, anxiety, and substance use disorders, individuals with chronic pain are at risk of other mental health problems including suicide and cigarette smoking and many have sustained sexual violence. Within the broader biopsychosocial model of pain, the fear-avoidance model explains how behavioral factors affect the temporal course of chronic pain and provides the framework for an array of efficacious behavioral interventions including cognitive-behavioral therapy, acceptance-based therapies, and multidisciplinary pain rehabilitation. Concomitant pain and mental health disorders often complicate pharmacological management, but several drug classes, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and anticonvulsants, have efficacy for both conditions and should be considered first-line treatment agents. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

[Acceptance and Commitment Therapy in the Treatment of Chronic Disease].

PubMed

Kuba, Katharina; Weißflog, Gregor

2017-12-01

Acceptance and Commitment Therapy (ACT) is an intervention representing a transdiagnostic and contextual approach that assumes that psychological suffering is caused by experiential avoidance. The primary intention of ACT is not to eliminate symptoms and to treat mental disorders. Instead, ACT aims to increase psychological flexibility, i. e. to broaden the repertoire of cognitions and behaviors when facing inner and outer aversive events or experiences. Psychological flexibility can be enhanced by working with the 6 core components of the ACT model. Experience-focused methods like metaphors and exercises for acceptance play a crucial role in the therapeutic work. In short, with ACT patients can learn: ▪ that rigid and inflexible attempts to fight aversive experience are problematic ▪ a mindful experience of inner and outer experience ▪ to differentiate between unchangeable and changeable events (acceptance) ▪ to identify values or respectively life goals and to behave in a way that is consistent with them (commitment)The therapeutic focus of ACT is to create a balance between acceptance and behavioral change consistent with chosen values. Chronic diseases are often associated with aversive inner and outer experiences. A growing number of studies support the efficacy of ACT. There is evidence that ACT can increase psychological flexibility and potentially also lead to better self-management within the context of chronic somatic diseases. © Georg Thieme Verlag KG Stuttgart · New York.

Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

PubMed

Lustyk, M Kathleen B; Gerrish, Winslow G; Shaver, Shelley; Keys, Shaunie L

2009-04-01

We systematically reviewed empirical studies that investigated the use of cognitive-behavioral therapy (CBT) for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Our multi-database search identified seven published empirical reports. Three were identified as randomized controlled trials (RCTs). The methods utilized to investigate therapeutic efficacy of CBT in these studies varied widely from case reports to RCTs with pharmacotherapy comparison groups. Initially we provide a brief overview of CBT and justifications for its potential use to treat PMS/PMDD. Next, we provide critical evaluations of the analyses used in each study focusing on the detection of intervention effects assessed by statistically significant time by group interactions. When possible we calculate effect sizes to elucidate the clinical significance of results. Our review revealed a dearth of evidence providing statistically significant CBT intervention effects. Issues such as overall time investment, latency to treatment effects, and complementary and combined therapies are considered. We present a theoretical argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this area. In conclusion, to produce the necessary evidence-base support for PMS/PMDD given the limited empirical evidence reported here, researchers are called on to produce methodologically rigorous investigations of psychosocial interventions for PMS/PMDD.

Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives.

PubMed

Castelnuovo, Gianluca; Pietrabissa, Giada; Manzoni, Gian Mauro; Cattivelli, Roberto; Rossi, Alessandro; Novelli, Margherita; Varallo, Giorgia; Molinari, Enrico

2017-01-01

Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial, social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account the possible contribution of mHealth and the stepped-care approach in health care.

Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives

PubMed Central

Castelnuovo, Gianluca; Pietrabissa, Giada; Manzoni, Gian Mauro; Cattivelli, Roberto; Rossi, Alessandro; Novelli, Margherita; Varallo, Giorgia; Molinari, Enrico

2017-01-01

Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial, social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account the possible contribution of mHealth and the stepped-care approach in health care. PMID:28652832

The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A Psychometric Evaluation of Cognitive Fusion in a Nonclinical and Highly Anxious Community Sample

ERIC Educational Resources Information Center

Herzberg, Kristin N.; Sheppard, Sean C.; Forsyth, John P.; Crede, Marcus; Earleywine, Mitch; Eifert, Georg H.

2012-01-01

Cognitive fusion--or the tendency to buy into the literal meaning of thoughts, feelings, and bodily sensations--plays an important role in the etiology and maintenance of anxiety disorders and figures prominently in third-generation behavior therapies such as acceptance and commitment therapy (ACT). Nonetheless, there is a lack of validated…

Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies.

PubMed

Hayes, Steven C; Villatte, Matthieu; Levin, Michael; Hildebrandt, Mikaela

2011-01-01

A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These "third wave" methods all emphasize the context and function of psychological events more so than their validity, frequency, or form, and for these reasons we use the term "contextual cognitive behavioral therapy" to describe their characteristics. Both putative processes, and component and process evidence, indicate that they are focused on establishing a more open, aware, and active approach to living, and that their positive effects occur because of changes in these processes. © 2011 by Annual Reviews. All rights reserved

Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial.

PubMed

Pramana, Gede; Parmanto, Bambang; Lomas, James; Lindhiem, Oliver; Kendall, Philip C; Silk, Jennifer

2018-05-10

Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment. ©Gede Pramana, Bambang Parmanto, James Lomas, Oliver Lindhiem, Philip C Kendall, Jennifer Silk. Originally published in JMIR Serious Games (http://games.jmir.org), 10.05.2018.

Comparative efficacy, acceptability, and safety of medicinal, cognitive-behavioral therapy, and placebo treatments for acute major depressive disorder in children and adolescents: a multiple-treatments meta-analysis.

PubMed

Ma, Dongfeng; Zhang, Zhijun; Zhang, Xiangrong; Li, Lingjiang

2014-06-01

New generation antidepressant therapies, including serotonin-norepinephrine reuptake inhibitor (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) were introduced in the late 1980s; however, few comprehensive studies compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in pediatric patients. Multiple-treatments meta-analysis (MTM) was conducted to assess efficacy, acceptability, and safety of contemporary interventions in children and adolescents with MDD. Cochrane Library, AMED, CINAHL, EMBASE, LiLACS, MEDLINE, PSYCINFO, PSYNDEX, and Journal of Medicine and Pharmacy databases were searched for randomized controlled trials (RCTs) comparing medicinal interventions (citalopram, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, venlafaxine), cognitive behavioral therapy (CBT), combined fluoxetine with CBT, and placebo treatment for acute MDD from January 1988 to March 2013. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Bayesian methods were used to conduct a MTM including age and funding subgroups. A total of 21 RCTs (4969 participants) were identified. Combined fluoxetine/CBT exhibited the highest efficacy, with fluoxetine alone superior to CBT, paroxetine, sertraline, citalopram, escitalopram, and placebo treatment. Sertraline, paroxetine, escitalopram, and venlafaxine showed superior acceptability to fluoxetine and combined fluoxetine/CBT. Combined fluoxetine/CBT combination was less safe, though CBT was safer than fluoxetine alone. Combined fluoxetine/CBT, fluoxetine, and mirtazapine exhibited the highest efficacy; sertraline, escitalopram, venlafaxine, and paroxetine were the best tolerated; and mirtazapine and venlafaxine were the safest. Sertraline and mirtazapine exhibited optimally balanced efficacy, acceptability, and safety for first-line acute treatment of child and adolescent MDD.

Acceptance and Commitment Therapy for the Treatment of Music Performance Anxiety: A Pilot Study with Student Vocalists

PubMed Central

Juncos, David G.; Heinrichs, Glenn A.; Towle, Philip; Duffy, Kiera; Grand, Sebastian M.; Morgan, Matthew C.; Smith, Jonathan D.; Kalkus, Evan

2017-01-01

This study investigated the use of Acceptance and Commitment Therapy (ACT) as a treatment for music performance anxiety (MPA) in an uncontrolled pilot design. ACT is a newer, “third-wave” therapy that differs from previous MPA treatments, because its goal is not to reduce symptoms of MPA. Rather, ACT aims to enhance psychological flexibility in the presence of unwanted symptoms through the promotion of six core processes collectively known as the ACT “Hexaflex.” A small group of student vocalists (N = 7) from an elite choral college were recruited using objective criteria for evaluating MPA. Participants received 12 ACT sessions, and their baseline functioning served as a pre-treatment control. Treatment consisted of an orientation to ACT, identifying experientially avoidant behaviors, facilitation of Hexaflex processes, group performances in which valued behaviors were practiced in front of one another, meditations, homework, and completion of self-report measures before, during, and after treatment (at a 1- and 3-month follow-up). Improvements were observed in participants' cognitive defusion, acceptance of MPA symptoms, and psychological flexibility at post-treatment and follow-ups. Students also appeared to improve their performance quality and reduce their shame over having MPA. These results add to existing research suggesting ACT is a promising intervention for MPA, while also highlighting how vocal students may be less impaired by physical MPA symptoms. PMID:28674509

Acceptance and Commitment Therapy for the Treatment of Music Performance Anxiety: A Pilot Study with Student Vocalists.

PubMed

Juncos, David G; Heinrichs, Glenn A; Towle, Philip; Duffy, Kiera; Grand, Sebastian M; Morgan, Matthew C; Smith, Jonathan D; Kalkus, Evan

2017-01-01

This study investigated the use of Acceptance and Commitment Therapy (ACT) as a treatment for music performance anxiety (MPA) in an uncontrolled pilot design. ACT is a newer, "third-wave" therapy that differs from previous MPA treatments, because its goal is not to reduce symptoms of MPA. Rather, ACT aims to enhance psychological flexibility in the presence of unwanted symptoms through the promotion of six core processes collectively known as the ACT "Hexaflex." A small group of student vocalists ( N = 7) from an elite choral college were recruited using objective criteria for evaluating MPA. Participants received 12 ACT sessions, and their baseline functioning served as a pre-treatment control. Treatment consisted of an orientation to ACT, identifying experientially avoidant behaviors, facilitation of Hexaflex processes, group performances in which valued behaviors were practiced in front of one another, meditations, homework, and completion of self-report measures before, during, and after treatment (at a 1- and 3-month follow-up). Improvements were observed in participants' cognitive defusion, acceptance of MPA symptoms, and psychological flexibility at post-treatment and follow-ups. Students also appeared to improve their performance quality and reduce their shame over having MPA. These results add to existing research suggesting ACT is a promising intervention for MPA, while also highlighting how vocal students may be less impaired by physical MPA symptoms.

High-intensity therapist-guided internet-based cognitive behavior therapy for alcohol use disorder: a pilot study.

PubMed

Sundström, Christopher; Kraepelien, Martin; Eék, Niels; Fahlke, Claudia; Kaldo, Viktor; Berman, Anne H

2017-05-26

A large proportion of individuals with alcohol problems do not seek psychological treatment, but access to such treatment could potentially be increased by delivering it over the Internet. Cognitive behavior therapy (CBT) is widely recognized as one of the psychological treatments for alcohol problems for which evidence is most robust. This study evaluated a new, therapist-guided internet-based CBT program (entitled ePlus) for individuals with alcohol use disorders. Participants in the study (n = 13) were recruited through an alcohol self-help web site ( www.alkoholhjalpen.se ) and, after initial internet screening, were diagnostically assessed by telephone. Eligible participants were offered access to the therapist-guided 12-week program. The main outcomes were treatment usage data (module completion, treatment satisfaction) as well as glasses of alcohol consumed the preceding week, measured with the self-rated Timeline Followback (TLFB). Participant data were collected at screening (T0), immediately pre-treatment (T1), post-treatment (T2) and 3 months post-treatment (T3). Most participants were active throughout the treatment and found it highly acceptable. Significant reductions in alcohol consumption with a large within-group effect size were found at the three-month follow-up. Secondary outcome measures of craving and self-efficacy, as well as depression and quality of life, also showed significant improvements with moderate to large within-group effect sizes. Therapist-guided internet-based CBT may be a feasible and effective alternative for people with alcohol use disorders. In view of the high acceptability and the large within-group effect sizes found in this small pilot, a randomized controlled trial investigating treatment efficacy is warranted. ClinicalTrials.gov ( NCT02384278 , February 26, 2015).

The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress.

PubMed

Lappalainen, Raimo; Sairanen, Essi; Järvelä, Elina; Rantala, Sanni; Korpela, Riitta; Puttonen, Sampsa; Kujala, Urho M; Myllymäki, Tero; Peuhkuri, Katri; Mattila, Elina; Kaipainen, Kirsikka; Ahtinen, Aino; Karhunen, Leila; Pihlajamäki, Jussi; Järnefelt, Heli; Laitinen, Jaana; Kutinlahti, Eija; Saarelma, Osmo; Ermes, Miikka; Kolehmainen, Marjukka

2014-04-04

Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes. 339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations. This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value-based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions. Current Clinical Trials NCT01738256, Registered 17 August, 2012.

[Etiology and therapy in anorexia nervosa (author's transl)].

PubMed

Wurst, E

1976-01-01

ASPERGER (1963) mentioned as a very important etiological aspect of anorexia nervosa a desintegration of intellectual and thymical functions causing the fact, that these patients are not able to accept the role of an adult, especially that one of a woman. We discuss that statment in connexion with ERIKSON'S (1974) concept about "ego-identity" ("Ich-Identitat") and "negative-identity" ("negative Identitat"). The pathological family-structure seems to reinforce the situation and the existence of inadequate behavior of patients with anorexia nervosa, who are often introverted and predestinated for conditioning. The therapy of these patients should focuse on the development of ego-identity, including the treatment of the family members, the modification of the inadapted behavior and a special endocrinological therapy.

Randomized, Controlled Pilot Trial of a Smartphone App for Smoking Cessation Using Acceptance and Commitment Therapy

PubMed Central

Bricker, Jonathan B.; Mull, Kristin; Kientz, Julie A.; Vilardaga, Roger M.; Mercer, Laina D.; Akioka, Katrina; Heffner, Jaimee L.

2014-01-01

Background There is a dual need for (1) innovative theory-based smartphone applications for smoking cessation and (2) controlled trials to evaluate their efficacy. Accordingly, this study tested the feasibility, acceptability, preliminary efficacy, and mechanism of behavioral change of an innovative smartphone-delivered Acceptance and Commitment Therapy (ACT) application for smoking cessation versus an application following US Clinical Practice Guidelines. Method Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (N = 196) that compared smartphone-delivered ACT for smoking cessation application (SmartQuit) with the National Cancer Institute's application for smoking cessation (QuitGuide). Results We recruited 196 participants in two months. SmartQuit participants opened their application an average of 37.2 times, as compared to 15.2 times for QuitGuide participants (p <.0001). The overall quit rates were 13% in SmartQuit vs. 8% in QuitGuide (OR=2.7; 95% CI=0.8-10.3). Consistent with ACT's theory of change, among those scoring low (below the median) on acceptance of cravings at baseline (n = 88), the quit rates were 15% in SmartQuit vs. 8% in QuitGuide (OR=2.9; 95% CI=0.6-20.7). Conclusions ACT is feasible to deliver by smartphone application and shows higher engagement and promising quit rates compared to an application that follows US Clinical Practice Guidelines. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed. PMID:25085225

A Randomized Controlled Trial of a Mindfulness and Acceptance Group Therapy for Residential Substance Use Patients.

PubMed

Shorey, Ryan C; Elmquist, Joanna; Gawrysiak, Michael J; Strauss, Catherine; Haynes, Ellen; Anderson, Scott; Stuart, Gregory L

2017-09-19

Substance use disorders are understood as a chronically relapsing condition that is difficult to treat. However, in recent years there have been promising developments in the treatment of substance use disorders, specifically with interventions based on mindfulness and acceptance and commitment therapy. Little research has examined whether these types of interventions may positively impact residential substance use treatment outcomes. Thus, in the current study we developed and examined, in a randomized controlled trial, a 4-week, eight-session, adjunctive mindfulness and acceptance group therapy for patients in residential substance use treatment. Our primary outcomes were substance use cravings, psychological flexibility, and dispositional mindfulness at treatment discharge. Patients (N = 117) from a private residential substance use facility were randomized to receive the adjunctive mindfulness and acceptance group or treatment-as-usual. Patients were assessed at treatment intake and at discharge from a 28-30-day residential program. Although treatment groups did not statistically differ at discharge on any primary outcome, small effect sizes favored the mindfulness and acceptance group on cravings and psychological flexibility. Conclusions/Importance: Continued research is needed to determine whether the addition of mindfulness and acceptance-based interventions improve outcomes long term following residential substance use treatment.

Training Community Mental Health Therapists to Deliver a Package of Evidence-Based Practice Strategies for School-Age Children with Autism Spectrum Disorders: A Pilot Study

PubMed Central

Drahota, Amy; Stadnick, Nicole

2012-01-01

Research on moving evidence-based practice (EBP) intervention strategies to community service settings for children with autism spectrum disorders (ASD) is urgently needed. The current pilot study addresses this need by examining the feasibility, acceptability and preliminary outcomes of training therapists practicing in community mental health (CMH) clinics to deliver a package of EBP strategies aimed to reduce challenging behaviors in school-age children with ASD. Results indicate that CMH therapists participated in both initial and ongoing training, were able to deliver the intervention with fidelity, and perceived the intervention strategies as useful. Parents participated in almost all sessions with their children and remained in therapy when therapists delivered the intervention. Meaningful reductions in child problem behaviors occurred over 5 months providing promising support for the intervention. PMID:22102293

Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents

PubMed Central

Patton, Susana

2016-01-01

Abstract Background: Because of the widening access gap between need for individual and pediatric psychology services and child specialist availability, secure videoconferencing options are more needed than ever to address access challenges across underserved settings. Methods: The authors summarize real-time videoconferencing evidence to date across individual therapy with children and pediatric psychology interventions using videoconferencing. The authors summarize emerging guidelines that inform best practices for individual child therapy over videoconferencing. Results: The authors present three case examples to illustrate best practices. The first behavioral pediatrics case summarizes evidence-based approaches in treating a rural young adolescent with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and hearing impairment. The second pediatric psychology case describes similarities and difference between on-site and videoconferencing services in treating a rural child with toileting concerns. The third adolescent case describes treatment of an urban honors student with depression. Conclusions: Videoconferencing is an effective approach to improving access to individual and pediatric psychology interventions for children and adolescents. Videoconferencing approaches are well accepted by families and show promise for disseminating evidence-based treatments to underserved communities. PMID:26745607

Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents.

PubMed

Nelson, Eve-Lynn; Patton, Susana

2016-04-01

Because of the widening access gap between need for individual and pediatric psychology services and child specialist availability, secure videoconferencing options are more needed than ever to address access challenges across underserved settings. The authors summarize real-time videoconferencing evidence to date across individual therapy with children and pediatric psychology interventions using videoconferencing. The authors summarize emerging guidelines that inform best practices for individual child therapy over videoconferencing. The authors present three case examples to illustrate best practices. The first behavioral pediatrics case summarizes evidence-based approaches in treating a rural young adolescent with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and hearing impairment. The second pediatric psychology case describes similarities and difference between on-site and videoconferencing services in treating a rural child with toileting concerns. The third adolescent case describes treatment of an urban honors student with depression. Videoconferencing is an effective approach to improving access to individual and pediatric psychology interventions for children and adolescents. Videoconferencing approaches are well accepted by families and show promise for disseminating evidence-based treatments to underserved communities.

[Multiprofessional inpatient psychotherapy of depression in old age].

PubMed

Cabanel, N; Kundermann, B; Franz, M; Müller, M J

2017-11-01

Depression is common in old age but is often underdiagnosed and inadequately treated. Although psychotherapy is considered effective for treating elderly patients with depression, it is rarely applied in inpatient settings. Furthermore, treatment on inpatient units specialized for elderly patients and implementation of a psychotherapeutic treatment approach are currently more the exception. From this background, a multiprofessional inpatient behavioral treatment program (MVT) for elderly depressed patients was developed at a specialized unit of a university-affiliated regional psychiatric hospital. The MVT is based on specific and modularized group therapies accompanied by individual therapeutic interventions. While the provision of group therapies (such as psychotherapy, social skills training, relaxation training, euthymic and mindfulness-based methods, exercise and occupational therapy as well as psychoeducational sessions for relatives) is assigned to specific professional groups, a joint multiprofessional treatment planning is of central relevance. First evaluations of different treatment components support the high acceptability of the MVT and highlight that psychotherapeutic inpatient treatment programs for the elderly are feasible. Further research is required to investigate the clinical efficacy of psychotherapy in elderly depressive inpatients.

Fluorine-19 MRI Contrast Agents for Cell Tracking and Lung Imaging

PubMed Central

Fox, Matthew S.; Gaudet, Jeffrey M.; Foster, Paula J.

2015-01-01

Fluorine-19 (19F)-based contrast agents for magnetic resonance imaging stand to revolutionize imaging-based research and clinical trials in several fields of medical intervention. First, their use in characterizing in vivo cell behavior may help bring cellular therapy closer to clinical acceptance. Second, their use in lung imaging provides novel noninvasive interrogation of the ventilated airspaces without the need for complicated, hard-to-distribute hardware. This article reviews the current state of 19F-based cell tracking and lung imaging using magnetic resonance imaging and describes the link between the methods across these fields and how they may mutually benefit from solutions to mutual problems encountered when imaging 19F-containing compounds, as well as hardware and software advancements. PMID:27042089

A state survey of Child Advocacy Center therapists' attitudes toward treatment manuals and evidence-based practice.

PubMed

Staudt, Marlys; Williams-Hayes, Mona

2011-01-01

The objective of this descriptive study was to examine Child Advocacy Center therapists' attitudes toward treatment manuals and evidence-based practices and to gather information about the treatments they use most frequently. An online survey was sent to 30 therapists employed by 15 Child Advocacy Centers in a southeastern state. The response rate was 70%. The respondents generally had positive attitudes toward the use of treatment manuals and the implementation of evidence-based practices. The treatment utilized most frequently was trauma focused cognitive-behavioral therapy. More outcome research of Child Advocacy Center services is needed, and information about how children and parents perceive the acceptability and outcomes of Child Advocacy Center services can be used to enhance services.

The COMMAND trial of cognitive therapy for harmful compliance with command hallucinations (CTCH): a qualitative study of acceptability and tolerability in the UK.

PubMed

Birchwood, Max; Mohan, Laura; Meaden, Alan; Tarrier, Nick; Lewis, Shon; Wykes, Til; Davies, Linda M; Dunn, Graham; Peters, Emmanuelle; Michail, Maria

2018-06-15

To explore service user experiences of a 9-month cognitive behavioural therapy for command hallucinations in the context of a randomised controlled trial including their views on acceptability and tolerability of the intervention. Qualitative study using semistructured interviews. The study took place across three sites: Birmingham, Manchester and London. Interviews were carried out at the sites where therapy took place which included service bases and participants' homes. Of 197 patients who consented to the trial, 98 received the Cognitive Behavior Therapy for Command Hallucinations (CTCH) intervention; 25 (15 males) of whom were randomly selected and consented to the qualitative study. The mean age of the sample was 42 years, and 68% were white British. Two superordinate themes were identified: participants' views about the aspects of CTCH they found most helpful; and participants' concerns with therapy. Helpful aspects of the therapy included gaining control over the voices, challenging the power and omniscience of the voices, following a structured approach, normalisation and mainstreaming of the experience of voices, and having peer support alongside the therapy. Concerns with the therapy included anxiety about completing CTCH tasks, fear of talking back to voices, the need for follow-up and ongoing support and concerns with adaptability of the therapy. Interpretation: CTCH was generally well received and the narratives validated the overall approach. Participants did not find it an easy therapy to undertake as they were challenging a persecutor they believed had great power to harm; many were concerned, anxious and occasionally disappointed that the voices did not disappear altogether. The trusting relationship with the therapist was crucial. The need for continued support was expressed. ISRCTN62304114, Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Acceptance and commitment group therapy for health anxiety--results from a pilot study.

PubMed

Eilenberg, T; Kronstrand, L; Fink, P; Frostholm, L

2013-06-01

Health anxiety (or hypochondriasis) is prevalent, may be persistent and disabling for the sufferers and associated with high societal costs. Acceptance and Commitment Therapy (ACT) is a new third-wave behavioral cognitive therapy that has not yet been tested in health anxiety. 34 consecutive Danish patients with severe health anxiety were referred from general practitioners or hospital departments and received a ten-session ACT group therapy. Patients were followed up by questionnaires for 6 months. There were significant reductions in health anxiety, somatic symptoms and emotional distress at 6 months compared to baseline: a 49% reduction in health anxiety (Whiteley-7 Index), a 47% decrease in emotional distress (SCL-8), and a 40% decrease in somatic symptoms (SCL-90R Somatization Subscale). The patients' emotional representations and perception of the consequences of their illness (IPQ) improved significantly, and 87% of the patients were very or extremely satisfied with the treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cognitive Behavior Therapy: Notes on Theory and Application with Children.

ERIC Educational Resources Information Center

Sigmon, Scott B.

Cognitive behavioral psychology is a new theoretical orientation. When applied in treatment, it is known as cognitive behavior therapy (CBT). CBT, although based primarily on an information processing model, rests firmly on the twin pillars of both behaviorism and cognitive psychology. Today cognitive therapy and behavioral therapy are terms which…

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews.

PubMed

Stawarz, Katarzyna; Preist, Chris; Tallon, Debbie; Wiles, Nicola; Coyle, David

2018-06-06

Hundreds of mental health apps are available to the general public. With increasing pressures on health care systems, they offer a potential way for people to support their mental health and well-being. However, although many are highly rated by users, few are evidence-based. Equally, our understanding of what makes apps engaging and valuable to users is limited. The aim of this paper was to analyze functionality and user opinions of mobile apps purporting to support cognitive behavioral therapy for depression and to explore key factors that have an impact on user experience and support engagement. We systematically identified apps described as being based on cognitive behavioral therapy for depression. We then conducted 2 studies. In the first, we analyzed the therapeutic functionality of apps. This corroborated existing work on apps' fidelity to cognitive behavioral therapy theory, but we also extended prior work by examining features designed to support user engagement. Engagement features found in cognitive behavioral therapy apps for depression were compared with those found in a larger group of apps that support mental well-being in a more general sense. Our second study involved a more detailed examination of user experience, through a thematic analysis of publicly available user reviews of cognitive behavioral therapy apps for depression. We identified 31 apps that purport to be based on cognitive behavioral therapy for depression. Functionality analysis (study 1) showed that they offered an eclectic mix of features, including many not based on cognitive behavioral therapy practice. Cognitive behavioral therapy apps used less varied engagement features compared with 253 other mental well-being apps. The analysis of 1287 user reviews of cognitive behavioral therapy apps for depression (study 2) showed that apps are used in a wide range of contexts, both replacing and augmenting therapy, and allowing users to play an active role in supporting their mental health and well-being. Users, including health professionals, valued and used apps that incorporated both core cognitive behavioral therapy and non-cognitive behavioral therapy elements, but concerns were also expressed regarding the unsupervised use of apps. Positivity was seen as important to engagement, for example, in the context of automatic thoughts, users expressed a preference to capture not just negative but also positive ones. Privacy, security, and trust were crucial to the user experience. Cognitive behavioral therapy apps for depression need to improve with respect to incorporating evidence-based cognitive behavioral therapy elements. Equally, a positive user experience is dependent on other design factors, including consideration of varying contexts of use. App designers should be able to clearly identify the therapeutic basis of their apps, but they should also draw on evidence-based strategies to support a positive and engaging user experience. The most effective apps are likely to strike a balance between evidence-based cognitive behavioral therapy strategies and evidence-based design strategies, including the possibility of eclectic therapeutic techniques. ©Katarzyna Stawarz, Chris Preist, Debbie Tallon, Nicola Wiles, David Coyle. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.06.2018.

2013 SYR Accepted Poster Abstracts.

PubMed

2013-01-01

SYR 2013 Accepted Poster abstracts: 1. Benefits of Yoga as a Wellness Practice in a Veterans Affairs (VA) Health Care Setting: If You Build It, Will They Come? 2. Yoga-based Psychotherapy Group With Urban Youth Exposed to Trauma. 3. Embodied Health: The Effects of a Mind�Body Course for Medical Students. 4. Interoceptive Awareness and Vegetable Intake After a Yoga and Stress Management Intervention. 5. Yoga Reduces Performance Anxiety in Adolescent Musicians. 6. Designing and Implementing a Therapeutic Yoga Program for Older Women With Knee Osteoarthritis. 7. Yoga and Life Skills Eating Disorder Prevention Among 5th Grade Females: A Controlled Trial. 8. A Randomized, Controlled Trial Comparing the Impact of Yoga and Physical Education on the Emotional and Behavioral Functioning of Middle School Children. 9. Feasibility of a Multisite, Community based Randomized Study of Yoga and Wellness Education for Women With Breast Cancer Undergoing Chemotherapy. 10. A Delphi Study for the Development of Protocol Guidelines for Yoga Interventions in Mental Health. 11. Impact Investigation of Breathwalk Daily Practice: Canada�India Collaborative Study. 12. Yoga Improves Distress, Fatigue, and Insomnia in Older Veteran Cancer Survivors: Results of a Pilot Study. 13. Assessment of Kundalini Mantra and Meditation as an Adjunctive Treatment With Mental Health Consumers. 14. Kundalini Yoga Therapy Versus Cognitive Behavior Therapy for Generalized Anxiety Disorder and Co-Occurring Mood Disorder. 15. Baseline Differences in Women Versus Men Initiating Yoga Programs to Aid Smoking Cessation: Quitting in Balance Versus QuitStrong. 16. Pranayam Practice: Impact on Focus and Everyday Life of Work and Relationships. 17. Participation in a Tailored Yoga Program is Associated With Improved Physical Health in Persons With Arthritis. 18. Effects of Yoga on Blood Pressure: Systematic Review and Meta-analysis. 19. A Quasi-experimental Trial of a Yoga based Intervention to Reduce Stress and Promote Health and Well-being Among Middle School Educators. 20. A Systematic Review of Yoga-based Interventions for Objective and Subjective Balance Measures. 21. Disparities in Yoga Use: A Multivariate Analysis of 2007 National Health Interview Survey Data. 22. Implementing Yoga Therapy Adapted for Older Veterans Who Are Cancer Survivors. 23. Randomized, Controlled Trial of Yoga for Women With Major Depressive Disorder: Decreased Ruminations as Potential Mechanism for Effects on Depression? 24. Yoga Beyond the Metropolis: A Yoga Telehealth Program for Veterans. 25. Yoga Practice Frequency, Relationship Maintenance Behaviors, and the Potential Mediating Role of Relationally Interdependent Cognition. 26. Effects of Medical Yoga in Quality of Life, Blood Pressure, and Heart Rate in Patients With Paroxysmal Atrial Fibrillation. 27. Yoga During School May Promote Emotion Regulation Capacity in Adolescents: A Group Randomized, Controlled Study. 28. Integrated Yoga Therapy in a Single Session as a Stress Management Technique in Comparison With Other Techniques. 29. Effects of a Classroom-based Yoga Intervention on Stress and Attention in Second and Third Grade Students. 30. Improving Memory, Attention, and Executive Function in Older Adults with Yoga Therapy. 31. Reasons for Starting and Continuing Yoga. 32. Yoga and Stress Management May Buffer Against Sexual Risk-Taking Behavior Increases in College Freshmen. 33. Whole-systems Ayurveda and Yoga Therapy for Obesity: Outcomes of a Pilot Study. 34. Women�s Phenomenological Experiences of Exercise, Breathing, and the Body During Yoga for Smoking Cessation Treatment. 35. Mindfulness as a Tool for Trauma Recovery: Examination of a Gender-responsive Trauma-informed Integrative Mindfulness Program for Female Inmates. 36. Yoga After Stroke Leads to Multiple Physical Improvements. 37. Tele-Yoga in Patients With Chronic Obstructive Pulmonary Disease and Heart Failure: A Mixed-methods Study of Feasibility, Acceptability, and Safety. 38. Effects of an Ashtanga Yoga-based Health and Wellness Curriculum on Physical and Emotional Well-being, Engagement Toward School, and Academic Performance of K-6 Students. 39. Yoga as a Facilitator for Participation Following an 8-week Yoga for Individuals With Chronic Stroke. 40. Standardization of Design and Reporting of Yoga Interventions for Musculoskeletal Conditions: A Delphi Approach. 41. Creating S.P.A.C.E. Through Yoga: Africa Yoga Project Teachers Promote Personal Transformation, Peaceful Communities, and Purpose-filled Service.

Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.

PubMed

Cully, Jeffrey A; Armento, Maria E A; Mott, Juliette; Nadorff, Michael R; Naik, Aanand D; Stanley, Melinda A; Sorocco, Kristen H; Kunik, Mark E; Petersen, Nancy J; Kauth, Michael R

2012-07-11

Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews and surveys from patients and providers). Patient-effectiveness outcomes include measures of depression, anxiety, and physical health functioning using blinded independent evaluators. Implementation outcomes include patient engagement and adherence and clinician brief cognitive behavioral therapy adoption and fidelity. Hybrid designs are needed to advance clinical effectiveness and implementation knowledge to improve healthcare practices. The current article describes the rationale and challenges associated with the use of a hybrid design for the study of brief cognitive behavioral therapy in primary care. Although trade-offs exist between scientific control and external validity, hybrid designs are part of an emerging approach that has the potential to rapidly advance both science and practice. NCT01149772 at http://www.clinicaltrials.gov/ct2/show/NCT01149772.

An intervention fidelity framework for technology-based behavioral interventions.

PubMed

Devito Dabbs, Annette; Song, Mi-Kyung; Hawkins, Robert; Aubrecht, Jill; Kovach, Karen; Terhorst, Lauren; Connolly, Mary; McNulty, Mary; Callan, Judith

2011-01-01

Despite the proliferation of health technologies, descriptions of the unique considerations and practical guidance for evaluating the intervention fidelity of technology-based behavioral interventions are lacking. The aims of this study were to (a) discuss how technology-based behavioral interventions challenge conventions about how intervention fidelity is conceptualized and evaluated, (b) propose an intervention fidelity framework that may be more appropriate for technology-based behavioral interventions, and (c) present a plan for operationalizing each concept in the framework using the intervention fidelity monitoring plan for Pocket PATH (Personal Assistant for Tracking Health), a mobile health technology designed to promote self-care behaviors after lung transplantation, as an exemplar. The literature related to intervention fidelity and technology acceptance was used to identify the issues that are unique to the fidelity of technology-based behavioral interventions and thus important to include in a proposed intervention fidelity framework. An intervention fidelity monitoring plan for technology-based behavioral interventions was developed as an example. The intervention fidelity monitoring plan was deemed feasible and practical to implement and showed utility in operationalizing the concepts such as assessing interventionists' delivery and participants' acceptance of the technology-based behavioral intervention. The framework has the potential to guide the development of implementation fidelity monitoring tools for other technology-based behavioral interventions. Further application and testing of this framework will allow for a better understanding of the role that technology acceptance plays in the adoption and enactment of the behaviors that technology-based behavioral interventions are intended to promote.

An Investigation of the Acceptability of Videoconferencing within a School-Based Behavioral Consultation Framework

ERIC Educational Resources Information Center

Fischer, Aaron J.; Dart, Evan H.; Leblanc, Hannah; Hartman, Kelsey L.; Steeves, Rachel O.; Gresham, Frank M.

2016-01-01

School-based behavioral consultation with classroom teachers is one of the primary ways school psychologists deliver intervention services to students. The present study aimed to evaluate the acceptability of videoconferencing (VC) with teachers as an alternative medium of consultative communication. Specifically, problem identification interviews…

Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach

PubMed Central

Koburger, Nicole; Larkin, Celine; Karwig, Gillian; Coffey, Claire; Maxwell, Margaret; Harris, Fiona; Rummel-Kluge, Christine; van Audenhove, Chantal; Sisask, Merike; Alexandrova-Karamanova, Anna; Perez, Victor; Purebl, György; Cebria, Annabel; Palao, Diego; Costa, Susana; Mark, Lauraliisa; Tóth, Mónika Ditta; Gecheva, Marieta; Ibelshäuser, Angela; Gusmão, Ricardo; Hegerl, Ulrich

2015-01-01

Background Depression incurs significant morbidity and confers increased risk of suicide. Many individuals experiencing depression remain untreated due to systemic and personal barriers to care. Guided Internet-based psychotherapeutic programs represent a promising means of overcoming such barriers and increasing the capacity for self-management of depression. However, existing programs tend to be available only in English and can be expensive to access. Furthermore, despite evidence of the effectiveness of a number of Internet-based programs, there is limited evidence regarding both the acceptability of such programs and feasibility of their use, for users and health care professionals. Objective This paper will present the protocol for the development, implementation, and evaluation of the iFightDepression tool, an Internet-based self-management tool. This is a cost-free, multilingual, guided, self-management program for mild to moderate depression cases. Methods The Preventing Depression and Improving Awareness through Networking in the European Union consortium undertook a comprehensive systematic review of the available evidence regarding computerized cognitive behavior therapy in addition to a consensus process involving mental health experts and service users to inform the development of the iFightDepression tool. The tool was implemented and evaluated for acceptability and feasibility of its use in a pilot phase in 5 European regions, with recruitment of users occurring through general practitioners and health care professionals who participated in a standardized training program. Results Targeting mild to moderate depression, the iFightDepression tool is based on cognitive behavioral therapy and addresses behavioral activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring, and healthy lifestyle habits. There is also a tailored version of the tool for young people, incorporating less formal language and additional age-appropriate modules on relationships and social anxiety. The tool is accompanied by a 3-hour training intervention for health care professionals. Conclusions It is intended that the iFightDepression tool and associated training for health care professionals will represent a valuable resource for the management of depression that will complement existing resources for health care professionals. It is also intended that the iFightDepression tool and training will represent an additional resource within a multifaceted approach to improving the care of depression and preventing suicidal behavior in Europe. PMID:26251104

Communication technology use and mHealth acceptance among HIV-infected men who have sex with men in Peru: implications for HIV prevention and treatment.

PubMed

Krishnan, Archana; Ferro, Enrico G; Weikum, Damian; Vagenas, Panagiotis; Lama, Javier R; Sanchez, Jorge; Altice, Frederick L

2015-01-01

The HIV epidemic in Peru is concentrated among men who have sex with men (MSM). Given that MSM have been documented as early adopters of emerging technology, we examined communication technology access and utilization, and mobile health (mHealth) acceptance among Peruvian MSM and transgender women (TGW) in order to gauge opportunities for mHealth-enabled HIV interventions. A convenience sample of 359 HIV-infected MSM and TGW recruited from three sites in Lima, Peru completed standardized assessments of alcohol use disorders (AUDs), risky sexual behavior, and antiretroviral therapy (ART) adherence along with self-constructed measures of communication technology access and utilization, and mHealth acceptance. Most participants (86%) had daily access to any cell phone, including smartphones (30%). The most frequent communication activities were receiving and making calls, and receiving and sending text messages using cell phones. On a 5-point Likert scale, participants expressed interest in using mHealth for medication reminders (M = 3.21, SD = 1.32) and engaging in anonymous online interactions with health professionals to discuss HIV-related issues (M = 3.56, SD = 1.33). Importantly, no significant differences were found in communication technology use and mHealth acceptance among participants with AUDs, depression, and suboptimal ART adherence, all of which are associated with poor HIV treatment outcomes. Findings show support for implementing mHealth-based intervention strategies using cell phones to assess and reduce HIV-risk behaviors among HIV-infected MSM and TGW.

A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder.

PubMed

Litz, Brett T; Engel, Charles C; Bryant, Richard A; Papa, Anthony

2007-11-01

The authors report an 8-week randomized, controlled proof-of-concept trial of a new therapist-assisted, Internet-based, self-management cognitive behavior therapy versus Internet-based supportive counseling for posttraumatic stress disorder (PTSD). Service members with PTSD from the attack on the Pentagon on September 11th or the Iraq War were randomly assigned to self-management cognitive behavior therapy (N=24) or supportive counseling (N=21). The dropout rate was similar to regular cognitive behavior therapy (30%) and unrelated to treatment arm. In the intent-to-treat group, self-management cognitive behavior therapy led to sharper declines in daily log-on ratings of PTSD symptoms and global depression. In the completer group, self-management cognitive behavior therapy led to greater reductions in PTSD, depression, and anxiety scores at 6 months. One-third of those who completed self-management cognitive behavior therapy achieved high-end state functioning at 6 months. Self-management cognitive behavior therapy may be a way of delivering effective treatment to large numbers with unmet needs and barriers to care.

Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

ERIC Educational Resources Information Center

Morton, Jane; Snowdon, Sharon; Gopold, Michelle; Guymer, Elise

2012-01-01

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current…

New Ways of Seeing and Being: Evaluating an Acceptance and Mindfulness Group for Parents of Young People with Intellectual Disabilities Who Display Challenging Behaviour

ERIC Educational Resources Information Center

Reid, Caroline; Gill, Freya; Gore, Nick; Brady, Serena

2016-01-01

The current study presents findings from an acceptance and commitment therapy-based intervention for family carers of children who have an intellectual/developmental disability and display high levels of challenging behaviour. The parent well-being workshops consist of two workshops incorporating acceptance and mindfulness-based exercises and…

A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Adolescents With Body Dysmorphic Disorder.

PubMed

Mataix-Cols, David; Fernández de la Cruz, Lorena; Isomura, Kayoko; Anson, Martin; Turner, Cynthia; Monzani, Benedetta; Cadman, Jacinda; Bowyer, Laura; Heyman, Isobel; Veale, David; Krebs, Georgina

2015-11-01

Body dysmorphic disorder (BDD) typically starts in adolescence, but evidence-based treatments are yet to be developed and formally evaluated in this age group. We designed an age-appropriate cognitive-behavioral therapy (CBT) protocol for adolescents with BDD and evaluated its acceptability and efficacy in a pilot randomized controlled trial. Thirty adolescents aged 12 to 18 years (mean = 16.0, SD = 1.7) with a primary diagnosis of BDD, together with their families, were randomly assigned to 14 sessions of CBT delivered over 4 months or a control condition of equivalent duration, consisting of written psycho-education materials and weekly telephone monitoring. Blinded evaluators assessed participants at baseline, midtreatment, posttreatment, and at 2-month follow-up. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent Version (mean baseline score = 37.13, SD = 4.98, range = 24-43). The CBT group showed a significantly greater improvement than the control group, both at posttreatment (time × group interaction coefficient [95% CI] = -11.26 [-17.22 to -5.31]; p = .000) and at 2-month follow-up (time × group interaction coefficient [95% CI] = -9.62 [-15.74 to -3.51]; p = .002). Six participants (40%) in the CBT group and 1 participant (6.7%) in the control condition were classified as responders at both time points (χ(2) = 4.658, p = .031). Improvements were also seen on secondary measures, including insight, depression, and quality of life at posttreatment. Both patients and their families deemed the treatment as highly acceptable. Developmentally tailored CBT is a promising intervention for young people with BDD, although there is significant room for improvement. Further clinical trials incorporating lessons learned in this pilot study and comparing CBT and pharmacological therapies, as well as their combination, are warranted. Cognitive-Behaviour Therapy for Adolescents With Body Dysmorphic Disorder; http://www.isrctn.com/; ISRCTN67699666. Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Modified Constraint-Induced Therapy for Children with Hemiplegic Cerebral Palsy: A Randomized Trial

ERIC Educational Resources Information Center

Wallen, Margaret; Ziviani, Jenny; Naylor, Olivia; Evans, Ruth; Novak, Iona; Herbert, Robert D.

2011-01-01

Aim: Conventional constraint-based therapies are intensive and demanding to implement, particularly for children. Modified forms of constraint-based therapies that are family-centred may be more acceptable and feasible for families of children with cerebral palsy (CP)-but require rigorous evaluation using randomized trials. The aim of this study…

Psychological Therapies for Auditory Hallucinations (Voices): Current Status and Key Directions for Future Research

PubMed Central

Thomas, Neil; Hayward, Mark; Peters, Emmanuelle; van der Gaag, Mark; Bentall, Richard P.; Jenner, Jack; Strauss, Clara; Sommer, Iris E.; Johns, Louise C.; Varese, Filippo; García-Montes, José Manuel; Waters, Flavie; Dodgson, Guy; McCarthy-Jones, Simon

2014-01-01

This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation. PMID:24936081

The Tailored Activity Program to reduce behavioral symptoms in individuals with dementia: feasibility, acceptability, and replication potential.

PubMed

Gitlin, Laura N; Winter, Laraine; Vause Earland, Tracey; Adel Herge, E; Chernett, Nancy L; Piersol, Catherine V; Burke, Janice P

2009-06-01

The Tailored Activity Program (TAP) is a home-based occupational therapy intervention shown to reduce behavioral symptoms and caregiver burden in a randomized trial. This article describes TAP, its assessments, acceptability, and replication potential. TAP involves 8 sessions for a period of 4 months. Interventionists identify preserved capabilities, previous roles, habits, and interests of individuals with dementia; develop activities customized to individual profiles; and train families in activity use. Interventionists documented time spent and ease conducting assessments, and observed receptivity of TAP. For each implemented prescribed activity, caregivers reported the amount of time their relative spent in activity and perceived benefits. The TAP assessment, a combination of neuropsychological tests, standardized performance-based observations, and clinical interviewing, yielded information on capabilities from which to identify and tailor activities. Assessments were easy to administer, taking an average of two 1-hr sessions. Of 170 prescribed activities, 81.5% were used, for an average of 4 times for 23 min by families between treatment sessions for a period of months. Caregivers reported high confidence in using activities, being less upset with behavioral symptoms (86%), and enhanced skills (93%) and personal control (95%). Interventionists observed enhanced engagement (100%) and pleasure (98%) in individuals with dementia during sessions. TAP offers families knowledge of their relative's capabilities and easy-to-use activities. The program was well received by caregivers. Prescribed activities appeared to be pleasurable and engaging to individuals with dementia. TAP merits further evaluation to establish efficacy with larger more diverse populations and consideration as a nonpharmacological approach to manage behavioral symptoms.

Patient-directed therapy during in-patient stroke rehabilitation: stroke survivors' views of feasibility and acceptability.

PubMed

Horne, Maria; Thomas, Nessa; McCabe, Candy; Selles, Rudd; Vail, Andy; Tyrrell, Pippa; Tyson, Sarah

2015-01-01

Patient-led therapy, in which patients work outside therapy sessions without direct supervision, is a possible way to increase the amount of therapy stroke patients' receive without increasing staff demands. Here, we report patients' views of patient-led mirror therapy and lower limb exercises. 94 stroke survivors with upper and lower limb limitations at least 1-week post-stroke undertook 4 weeks of daily patient-led mirror therapy or lower limb exercise, then completed questionnaires regarding their experience and satisfaction. A convenience random sample of 20 participants also completed a semi-structured telephone interview to consider their experience in more detail and to capture their longer term impressions. Participants were generally positive about patient-led therapy. About 71% found it useful; 68% enjoyed it; 59% felt it "worked" and 88% would recommend it to other patients. Exercise was viewed more positively than the mirror therapy. Difficulties included arranging the equipment and their position, particularly for more severe strokes, loss of motivation and concerns about working unsupervised. Patient-led mirror therapy and lower limb exercises during in-patient rehabilitation is generally feasible and acceptable to patients but "light touch" supervision to deal with any problems, and strategies to maintain focus and motivation are needed. Implications for Rehabilitation Most stroke patients receive insufficient therapy to maximize recovery during rehabilitation. As increases in staffing are unlikely there is an imperative to find ways for patients to increase the amount of exercise and practice of functional tasks they undertake without increasing demands on staff. Patient-led therapy (also known as patient-directed therapy or independent practice), in which patients undertake exercises or functional tasks practice prescribed by a professional outside formal therapy sessions is one way of achieving this. It is widely used in community-based rehabilitation but is uncommon in hospital-based stroke care. We explored the feasibility and acceptability of two types of patient-led therapy during hospital-based stroke care; mirror therapy for the upper limb and exercises (without a mirror) for the lower limb. Here, we report patients' experiences of undertaking patient-led therapy. Patient-led mirror therapy and lower limb exercises during in-patient stroke rehabilitation is generally feasible and acceptable to patients but "light touch" supervision to deal with any problems, and strategies to maintain focus and motivation are needed.

Feasibility study of a peer-facilitated low intensity cognitive-behavioral intervention for mild to moderate depression and anxiety in older adults.

PubMed

Seeley, John R; Manitsas, Tara; Gau, Jeff M

2017-09-01

The majority of older adults experiencing depression and/or anxiety do not receive adequate treatment due to limited access to evidence-based practices. Low intensity cognitive-behavioral intervention has been established as an evidence-based practice with the potential to increase the reach to older adults. The purpose of the current study is to evaluate the feasibility, acceptability, and potential efficacy of a low intensity, peer-supported, cognitive-behavioral intervention for mild to moderate depression and/or anxiety delivered by a local intergovernmental agency serving older adults. Sixty-two older adults (81% female) between 55 and 96 years of age were randomly assigned to either a peer-facilitated cognitive-behavioral bibliotherapy condition (n = 31) or a wait-list control condition (n = 31). The 10-week feasibility trial data indicated that (1) a majority of the participants were highly engaged in the intervention with an average number of 7.3 peer sessions attended and 2.1 workbooks completed, (2) the participants were quite satisfied with the peer mentoring sessions and moderately satisfied with the workbooks, and (3) there were clinically meaningful reductions in depressive symptoms for those assigned to the treatment condition compared to those that were wait-listed (d = .43), though the effect was non-significant (p = .099) due to the small sample size. The evidence for the impact on reducing anxiety symptoms was more equivocal with a non-significant, small effect size favoring the treatment condition. The pilot study provided preliminary evidence for the feasibility, acceptability, and potential efficacy of the peer-facilitated low intensity cognitive-behavioral therapy intervention approach.

Impact of personality psychopathology on outcome in short-term cognitive-behavioral therapy for Axis I disorders.

PubMed

Bédard, Mathieu; Russell, Jennifer J; Myhr, Gail

2015-12-15

Cognitive behavioral therapy (CBT) is efficacious for many Axis I disorders, though its effectiveness in the real world, for patients with Axis II comorbidity is less well known. This study examines the effectiveness of CBT for Axis I disorders in three groups of patients: those with personality disorders, those with personality disorder traits and those with no Axis II pathology. Consecutive referrals of patients with non-psychotic Axis I disorders were assessed for short-term CBT in a University Teaching Unit. While the acceptance rate was lower for individuals with personality disorders, there were no group differences in dropout rates. Of those who completed therapy (mean number of sessions=17.8, SD=11.2), those in the Personality Disorders group (n=45) had 4 sessions more on average than the Personality Disorder Traits group (n=42) or the No Axis II Group (n=266). All 3 groups were equally successful, whether the outcome was therapist opinion of success, the clinical global impression, or the reliable change index based on patient-reported symptom change. Intent to treat analysis results paralleled those of the completer analysis. Our findings indicate that the presence of a personality disorder does not negatively impact therapy adherence or success in short-term CBT for an Axis I disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis

PubMed Central

Zhou, Xinyu; Hetrick, Sarah E; Cuijpers, Pim; Qin, Bin; Barth, Jürgen; Whittington, Craig J; Cohen, David; Del Giovane, Cinzia; Liu, Yiyun; Michael, Kurt D; Zhang, Yuqing; Weisz, John R; Xie, Peng

2015-01-01

Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from −0.47 to −0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from −0.26 to −1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials. PMID:26043339

Factors affecting home care patients' acceptance of a web-based interactive self-management technology

PubMed Central

Karsh, Ben-Tzion; Severtson, Dolores J; Burke, Laura J; Brown, Roger L; Brennan, Patricia Flatley

2010-01-01

Objective With the advent of personal health records and other patient-focused health technologies, there is a growing need to better understand factors that contribute to acceptance and use of such innovations. In this study, we employed the Unified Theory of Acceptance and Use of Technology as the basis for determining what predicts patients' acceptance (measured by behavioral intention) and perceived effective use of a web-based, interactive self-management innovation among home care patients. Design Cross-sectional secondary analysis of data from a randomized field study evaluating a technology-assisted home care nursing practice with adults with chronic cardiac disease. Measurement and analysis A questionnaire was designed based on validated measurement scales from prior research and was completed by 101 participants for measuring the acceptance constructs as part of the parent study protocol. Latent variable modeling with item parceling guided assessment of patients' acceptance. Results Perceived usefulness accounted for 53.9% of the variability in behavioral intention, the measure of acceptance. Together, perceived usefulness, health care knowledge, and behavioral intention accounted for 68.5% of the variance in perceived effective use. Perceived ease of use and subjective norm indirectly influenced behavioral intention, through perceived usefulness. Perceived ease of use and subjective norm explained 48% of the total variance in perceived usefulness. Conclusion The study demonstrates that perceived usefulness, perceived ease of use, subjective norm, and healthcare knowledge together predict most of the variance in patients' acceptance and self-reported use of the web-based self-management technology. PMID:21131605

Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression.

PubMed

Furukawa, Toshi A; Efthimiou, Orestis; Weitz, Erica S; Cipriani, Andrea; Keller, Martin B; Kocsis, James H; Klein, Daniel N; Michalak, Johannes; Salanti, Georgia; Cuijpers, Pim; Schramm, Elisabeth

2018-05-30

Persistent depressive disorder is prevalent, disabling, and often difficult to treat. The cognitive-behavioral analysis system of psychotherapy (CBASP) is the only psychotherapy specifically developed for its treatment. However, we do not know which of CBASP, antidepressant pharmacotherapy, or their combination is the most efficacious and for which types of patients. This study aims to present personalized prediction models to facilitate shared decision-making in treatment choices to match patients' characteristics and preferences based on individual participant data network metaregression. We conducted a comprehensive search for randomized controlled trials comparing any two of CBASP, pharmacotherapy, or their combination and sought individual participant data from identified trials. The primary outcomes were reduction in depressive symptom severity for efficacy and dropouts due to any reason for treatment acceptability. All 3 identified studies (1,036 participants) were included in the present analyses. On average, the combination therapy showed significant superiority over both monotherapies in terms of efficacy and acceptability, while the latter 2 treatments showed essentially similar results. Baseline depression, anxiety, prior pharmacotherapy, age, and depression subtypes moderated their relative efficacy, which indicated that for certain subgroups of patients either drug therapy or CBASP alone was a recommendable treatment option that is less costly, may have fewer adverse effects and match an individual patient's preferences. An interactive web app (https://kokoro.med.kyoto-u.ac.jp/CBASP/prediction/) shows the predicted disease course for all possible combinations of patient characteristics. Individual participant data network metaregression enables treatment recommendations based on individual patient characteristics. © 2018 S. Karger AG, Basel.

Overcoming Recruitment Challenges of Web-based Interventions for Tobacco Use: The Case of Web-based Acceptance and Commitment Therapy for Smoking Cessation

PubMed Central

Heffner, Jaimee L; Wyszynski, Christopher M; Comstock, Bryan; Mercer, Laina D.; Bricker, Jonathan

2013-01-01

Web-based behavioral interventions for substance use are being developed at a rapid pace, yet there is a dearth of information regarding the most effective methods for recruiting participants into web-based intervention trials. In this paper, we describe our successful recruitment of participants into a pilot trial of web-based Acceptance and Commitment Therapy (ACT) for smoking cessation and compare traditional and web-based methods of recruitment in terms of their effects on baseline participant characteristics, association with study retention and treatment outcome, yield, and cost-effectiveness. Over a 10-week period starting June 15, 2010, we recruited 222 smokers for a web-based smoking cessation study using a variety of recruitment methods. The largest portion of randomized participants were recruited through Google AdWords (36%), followed by medical Internet media (23%), standard media (14%), word of mouth (12%), broadcast emails (11%), and social media (6%). Recruitment source was not related to baseline participant characteristics, 3-month data retention, or 30-day point prevalence smoking abstinence at the 3-month outcome assessment. Cost per randomized participant ranged from $5.27/participant for word of mouth to $172.76/participant for social media, with a mean cost of $42.48/participant. Our diversified approach to recruitment, including both traditional and web-based methods, enabled timely enrollment of participants into the study. Because there was no evidence of a substantive difference in baseline characteristics, retention, or outcomes based on recruitment channel, the yield and cost-effectiveness of recruitment methods may be the more critical considerations in developing a feasible recruitment plan for a web-based smoking cessation intervention study. PMID:23770645

Overcoming recruitment challenges of web-based interventions for tobacco use: the case of web-based acceptance and commitment therapy for smoking cessation.

PubMed

Heffner, Jaimee L; Wyszynski, Christopher M; Comstock, Bryan; Mercer, Laina D; Bricker, Jonathan

2013-10-01

Web-based behavioral interventions for substance use are being developed at a rapid pace, yet there is a dearth of information regarding the most effective methods for recruiting participants into web-based intervention trials. In this paper, we describe our successful recruitment of participants into a pilot trial of web-based Acceptance and Commitment Therapy (ACT) for smoking cessation and compare traditional and web-based methods of recruitment in terms of their effects on baseline participant characteristics, association with study retention and treatment outcome, yield, and cost-effectiveness. Over a 10-week period starting June 15, 2010, we recruited 222 smokers for a web-based smoking cessation study using a variety of recruitment methods. The largest portion of randomized participants were recruited through Google AdWords (36%), followed by medical Internet media (23%), standard media (14%), word of mouth (12%), broadcast emails (11%), and social media (6%). Recruitment source was not related to baseline participant characteristics, 3-month data retention, or 30-day point prevalence smoking abstinence at the 3-month outcome assessment. Cost per randomized participant ranged from $5.27/participant for word of mouth to $172.76/participant for social media, with a mean cost of $42.48/participant. Our diversified approach to recruitment, including both traditional and web-based methods, enabled timely enrollment of participants into the study. Because there was no evidence of a substantive difference in baseline characteristics, retention, or outcomes based on recruitment channel, the yield and cost-effectiveness of recruitment methods may be the more critical considerations in developing a feasible recruitment plan for a web-based smoking cessation intervention study. Copyright © 2013 Elsevier Ltd. All rights reserved.

New Directions in the Cognitive-Behavioral Treatment of OCD: Theory, Research, and Practice.

PubMed

Abramowitz, Jonathan S; Blakey, Shannon M; Reuman, Lillian; Buchholz, Jennifer L

2018-05-01

The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages. Copyright © 2017. Published by Elsevier Ltd.

Comparison of Mothers' and Fathers' Opinions of Parent-Child Interaction Therapy

ERIC Educational Resources Information Center

Tiano, Jennifer D.; Grate, Rebecca M.; McNeil, Cheryl B.

2013-01-01

Opinions of parenting programs mostly have been obtained from mothers. Because mothers and fathers' interactions with children differ, gathering data from both parents regarding behavior modification and parenting programs is necessary. This project was part of a larger study and compared mothers and fathers' acceptability of Parent-Child…

Psychotropic Drugs and Children: A 2007 Update

ERIC Educational Resources Information Center

Center for Health and Health Care in Schools, 2007

2007-01-01

The safe and effective use of medications for the treatment of certain medical conditions and illnesses has enabled many children to attend school and achieve academic success. In medical practice, widespread acceptance of drug therapy for behavioral disorders has facilitated diagnosis and treatment of these conditions in ambulatory care. Recent…

The Feasibility and Acceptability to Service Users of CIRCuiTS, a Computerized Cognitive Remediation Therapy Programme for Schizophrenia.

PubMed

Reeder, Clare; Pile, Victoria; Crawford, Polly; Cella, Matteo; Rose, Diana; Wykes, Til; Watson, Andrew; Huddy, Vyv; Callard, Felicity

2016-05-01

Cognitive remediation (CR) is a psychological therapy, effective in improving cognitive performance and functioning in people with schizophrenia. As the therapy becomes more widely implemented within mental health services its longevity and uptake is likely to depend on its feasibility and acceptability to service users and clinicians. To assess the feasibility and acceptability of a new strategy-based computerized CR programme (CIRCuiTS) for people with psychosis. Four studies were conducted using mixed methods. Perceptions of attractiveness, comprehensibility, acceptability and usability were assessed using self-report questionnaires in 34 non-clinical participants (study 1), and five people with a schizophrenia diagnosis and three experienced CR therapists (studies 2 and 3). The ease with which pre-specified therapy programmes could be assembled was also assessed by three therapists (Study 2). Finally, the satisfaction of 20 service users with a diagnosis of schizophrenia regarding their experience of using CIRCuiTS in the context of a course of the CR therapy was assessed in a qualitative interview study (study 4). Ratings of perceived attractiveness, comprehensibility, acceptability and usability consistently exceeded pre-set high targets by non-clinical, clinical and therapist participants. Qualitative analysis of satisfaction with CIRCuiTS showed that receiving the therapy was generally seen to be a positive experience, leading to perceptions that cognitive functioning had improved and attempts to incorporate new strategy use into daily activities. CIRCuiTS demonstrates high acceptability and ease of use for both service users with a schizophrenia diagnosis and clinicians.

Asian Women's Action for Resilience and Empowerment Intervention: Stage I Pilot Study.

PubMed

Hahm, Hyeouk Chris; Chang, Stephanie Tzu-Han; Lee, Gloria Yoonseung; Tagerman, Michelle D; Lee, Christina S; Trentadue, Mia Pamela; Hien, Denise A

2017-01-01

This study describes the development and pilot test of Asian Women's Action for Resilience and Empowerment (AWARE), a culturally informed group psychotherapy intervention designed to reduce depressive symptoms, suicidality, substance use, and HIV and sexual risk behaviors among 1.5 and second generation Asian American (AA) women. To participate, AA women had to meet the criteria for posttraumatic stress disorder (PTSD) or have a history of exposure to interpersonal violence (IPV) as determined using the Clinician-Administered PTSD Scale (CAPS) and Traumatic Life Events Questionnaire (TLEQ). This article also presents the preliminary feasibility and acceptability of AWARE from its Stage I pilot study of nine Chinese, Korean, and Vietnamese American women. To foster holistic treatment, AWARE was developed based on original research findings from Stage 0 and integrated theoretical models including fractured identity theory, empowerment theory, cognitive behavioral therapy (CBT), mindfulness-based techniques, and the AIDS Risk Reduction Model (ARRM). The development of AWARE was an iterative process informed by participant feedback, which led to frequent intervention modifications for a future randomized controlled trial (RCT) in Stage II. A qualitative analysis of participant feedback informed the following modifications: further exploration of feelings, improvements in technology delivery, learning and practicing coping skills, more specific cultural tailoring related to sexual health, decreased number of sessions and increased time per session. Findings provide support for the acceptability and feasibility of AWARE as "culturally informed" for AA young women with IPV histories, high-risk behaviors, and mental health issues.

United We Stand: Emphasizing Commonalities Across Cognitive-Behavioral Therapies

PubMed Central

Mennin, Douglas S.; Ellard, Kristen K.; Fresco, David M.; Gross, James J.

2016-01-01

Cognitive behavioral therapy (CBT) has a rich history of alleviating the suffering associated with mental disorders. Recently, there have been exciting new developments, including multi-component approaches, incorporated alternative therapies (e.g., meditation), targeted and cost-effective technologies, and integrated biological and behavioral frameworks. These field-wide changes have led some to emphasize the differences among variants of CBT. Here, we draw attention to commonalities across cognitive-behavioral therapies, including shared goals, change principles, and therapeutic processes. Specifically, we offer a framework for examining common CBT characteristics that emphasizes behavioral adaptation as a unifying goal and three core change principles, namely (1) context engagement to promote adaptive imagining and enacting of new experiences; (2) attention change to promote adaptive sustaining, shifting, and broadening of attention; and (3) cognitive change to promote adaptive perspective taking on events so as to alter verbal meanings. Further, we argue that specific intervention components including behavioral exposure/activation, attention training, acceptance/tolerance, decentering/defusion, and cognitive reframing may be emphasized to a greater or lesser degree by different treatment packages but are still fundamentally common therapeutic processes that are present across approaches and are best understood by their relationships to these core CBT change principles. We conclude by arguing for shared methodological and design frameworks for investigating unique and common characteristics to advance a unified and strong voice for CBT in a widening, increasingly multimodal and interdisciplinary, intervention science. PMID:23611074

Randomized, controlled pilot trial of a smartphone app for smoking cessation using acceptance and commitment therapy.

PubMed

Bricker, Jonathan B; Mull, Kristin E; Kientz, Julie A; Vilardaga, Roger; Mercer, Laina D; Akioka, Katrina J; Heffner, Jaimee L

2014-10-01

There is a dual need for (1) innovative theory-based smartphone applications for smoking cessation and (2) controlled trials to evaluate their efficacy. Accordingly, this study tested the feasibility, acceptability, preliminary efficacy, and mechanism of behavioral change of an innovative smartphone-delivered acceptance and commitment therapy (ACT) application for smoking cessation vs. an application following US Clinical Practice Guidelines. Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (n=196) that compared smartphone-delivered ACT for smoking cessation application (SmartQuit) with the National Cancer Institute's application for smoking cessation (QuitGuide). We recruited 196 participants in two months. SmartQuit participants opened their application an average of 37.2 times, as compared to 15.2 times for QuitGuide participants (p<0001). The overall quit rates were 13% in SmartQuit vs. 8% in QuitGuide (OR=2.7; 95% CI=0.8-10.3). Consistent with ACT's theory of change, among those scoring low (below the median) on acceptance of cravings at baseline (n=88), the quit rates were 15% in SmartQuit vs. 8% in QuitGuide (OR=2.9; 95% CI=0.6-20.7). ACT is feasible to deliver by smartphone application and shows higher engagement and promising quit rates compared to an application that follows US Clinical Practice Guidelines. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Effects of video-based therapy preparation targeting experiential acceptance or the therapeutic alliance.

PubMed

Johansen, Ayna B; Lumley, Mark; Cano, Annmarie

2011-06-01

Preparation for psychotherapy may enhance the psychotherapeutic process, reduce drop-outs, and improve outcomes, but the effective mechanisms of such preparation are poorly understood. Previous studies have rarely targeted specific processes that are associated with positive therapy outcomes. This randomized experiment compared the effects of preparatory videos that targeted either the Therapeutic Alliance, Experiential Acceptance, or a Control video on early therapeutic process variables in 105 patients seen in individual therapy. Participants watched the videos just before their first therapy session. No significant differences were found between the Alliance and Experiential Acceptance videos on patient recommendations, immediate affective reactions, or working alliance and attrition after the first session. However, the Therapeutic Alliance video produced an immediate increase in negative mood relative to the Control video, whereas the Experiential acceptance video produced a slight increase in positive mood relative to the Alliance video. Surprisingly, patients who viewed the Alliance video were rated significantly lower than the control group on therapist-rated alliance after the first session. These findings suggest there may be specific process effects in the early phase of treatment based on the type of pretraining material used, and also indicate that video-based pretraining efforts could be counterproductive. Furthermore, this research contributes to the literature by providing insights into methodological considerations for future work on the use of technology in psychotherapy and challenges associated with preparing people for successful psychotherapy.

Developing Singing Confidence in Early Childhood Teachers Using Acceptance and Commitment Therapy and Group Singing: A Randomized Trial

ERIC Educational Resources Information Center

Swain, Nicola; Bodkin-Allen, Sally

2017-01-01

Early childhood teachers are often required to sing, which requires confidence. The purpose of the present study was to treat early childhood teachers who self-identified as uncertain singers using either a group singing (GS) approach, or a talking approach, based on Acceptance and Commitment Therapy (ACT). The aim of the study was to increase…

A Community-based Survey of the Awareness and Acceptability of Oral Rehydration Therapy (ORT) as a Treatment for Acute Diarrhoea in Children.

ERIC Educational Resources Information Center

Ekanem, E. E.; Benebo, N. S.

1988-01-01

A total of 267 Nigerian mothers with children under the age of five years were investigated regarding the degree of their awareness and acceptance of oral rehydration therapy in the treatment of childhood diarrhea. Results indicate that only 39 percent of the mothers had heard of ORT in treating diarrhea. (RJC)

Feasibility of dialectical behavior therapy with suicidal and self-harming adolescents with multi-problems: training, adherence, and retention.

PubMed

Tørmoen, A J; Grøholt, B; Haga, E; Brager-Larsen, A; Miller, A; Walby, F; Stanley, B; Mehlum, L

2014-01-01

We evaluated the feasibility of DBT training, adherence, and retention preparing for a randomized controlled trial of Dialectical Behavior Therapy (DBT) adapted for Norwegian adolescents engaging in self-harming behavior and diagnosed with features of borderline personality disorder. Therapists were intensively trained and evaluated for adherence. Adherence scores, treatment retention, and present and previous self-harm were assessed. Twenty-seven patients were included (mean age 15.7 years), all of them with recent self-harming behaviors and at least 3 features of Borderline Personality Disorder. Therapists were adherent and 21 (78%) patients completed the whole treatment. Three subjects reported self-harm at the end of treatment, and urges to self-harm decreased. At follow up, 7 of 10 subjects reported no self-harm. DBT was found to be well accepted and feasible. Randomized controlled trials are required to test the effectiveness of DBT for adolescents.

A Systematic and Integrated Review of Mobile-Based Technology to Promote Active Lifestyles in People With Type 2 Diabetes.

PubMed

McMillan, Kathryn Anne; Kirk, Alison; Hewitt, Allan; MacRury, Sandra

2017-03-01

The aim was to review studies examining the effectiveness, acceptability, and feasibility of mobile-based technology for promoting active lifestyles in people with type 2 diabetes (T2D). Benefits of leading an active lifestyle following a diagnosis of T2D, including improved glycemic control, have been reported. Studies examining the specific use of mobile-based technologies to promote an active lifestyle in T2D have not previously been reviewed. Research studies examining effectiveness, feasibility or acceptability of mobile-based technology for active lifestyle promotion for T2D management were included (n = 9). The databases searched included PubMed, Medline, ScienceDirect, and ACM Digital Library (January 2005 to October 2015). Studies were categorized as (1) informing, (2) monitoring, (3) provoking, or (4) sustaining behavior change. Technologies used included smartphone or tablet apps, diabetes personal digital assistant, continuous glucose monitor and accelerometer, pedometer, and a website delivered by a smartphone. No articles examined the effectiveness of mobile-based technology in monitoring health behaviors and behavior change. Four of the studies found mobile-based technology to be motivational and supportive for behavior change. The visual reinforcement was identified as motivational. The feasibility and acceptability of using mobile-based technology to provide sustained lifestyle change and the effectiveness of mobile-based technology in monitoring health behaviors and behavior change have not been investigated. No studies examined all 3 of the outcomes or focused decreasing the participants' sedentary behavior. Limited research has examined the feasibility, acceptability, and effectiveness of mobile-based technology to promote active lifestyles and subsequently good diabetes management in people with T2D.

Behavioral function effects on intervention acceptability and effectiveness for self-injurious behavior.

PubMed

Hastings, Richard P; Boulton, Holly V N; Monzani, Louisa C; Tombs, Anna K H

2004-01-01

A variety of variables have been found to augment perceived social validity of behavioral interventions. In the present study, potential effects of behavioral function were evaluated. Sixty students inexperienced in work with people with mental retardation, and 60 experienced staff watched one of two carefully matched acted videos depicting self-injury maintained by attention or escape from task demands. Participants were also told whether the self-injury depicted typically led to mild or severe consequences for the person filmed. Participants rated six interventions in terms of their acceptability and effectiveness for the behavior depicted. A hierarchy of acceptability was replicated: reinforcement-based procedures were rated as more acceptable and effective. There were also effects of behavior severity and rater experience. However, few effects of behavioral function were found. Potential implications of staff undifferentiated attitudes towards functional treatments are discussed.

Cognitive and Emotion Regulation Change Processes in Cognitive Behavioural Therapy for Social Anxiety Disorder.

PubMed

O'Toole, Mia S; Mennin, Douglas S; Hougaard, Esben; Zachariae, Robert; Rosenberg, Nicole K

2015-01-01

The objective of the study was to investigate variables, derived from both cognitive and emotion regulation conceptualizations of social anxiety disorder (SAD), as possible change processes in cognitive behaviour therapy (CBT) for SAD. Several proposed change processes were investigated: estimated probability, estimated cost, safety behaviours, acceptance of emotions, cognitive reappraisal and expressive suppression. Participants were 50 patients with SAD, receiving a standard manualized CBT program, conducted in groups or individually. All variables were measured pre-therapy, mid-therapy and post-therapy. Lower level mediation models revealed that while a change in most process measures significantly predicted clinical improvement, only changes in estimated probability and cost and acceptance of emotions showed significant indirect effects of CBT for SAD. The results are in accordance with previous studies supporting the mediating role of changes in cognitive distortions in CBT for SAD. In addition, acceptance of emotions may also be a critical component to clinical improvement in SAD during CBT, although more research is needed on which elements of acceptance are most helpful for individuals with SAD. The study's lack of a control condition limits any conclusion regarding the specificity of the findings to CBT. Change in estimated probability and cost, and acceptance of emotions showed an indirect effect of CBT for SAD. Cognitive distortions appear relevant to target with cognitive restructuring techniques. Finding acceptance to have an indirect effect could be interpreted as support for contemporary CBT approaches that include acceptance-based strategies. Copyright © 2014 John Wiley & Sons, Ltd.

Behavior Therapy for Tourette Syndrome: A Systematic Review and Meta-analysis.

PubMed

Wile, Daryl J; Pringsheim, Tamara M

2013-08-01

When tics caused by Tourette Syndrome cause meaningful impairment for patients, a comprehensive treatment approach includes education of patients, peers, and family, treatment of comorbid behavioral disorders if present, and consideration of behavior therapy and pharmacotherapy for tics themselves. This systematic review and meta-analysis demonstrates that behavior therapies based on Habit Reversal Therapy, including the Comprehensive Behavioral Intervention for Tics are effective in reducing tic severity when compared with supportive psychotherapy. When these behavior therapies are unavailable, Exposure with Response Prevention may also be effective. Both face-to-face and telehealth delivery methods for behavior therapy improve tic severity, and broader distribution of behavior therapy through increased training or telehealth methods is encouraged. High-quality randomized trials comparing behavior therapies for tics with pharmacotherapy are needed.

The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress

PubMed Central

2014-01-01

Background Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes. Methods/Design 339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations. Discussion This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value–based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions. Trial registration Current Clinical Trials NCT01738256, Registered 17 August, 2012. PMID:24708617

Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder

PubMed Central

Otto, Michael W.; Hinton, Devon E.

2009-01-01

Cambodian refugees represent a severely traumatized population living in the United States. In this paper, we describe the modification of a cognitive-behavior therapy program to facilitate delivery of an exposure-based treatment for posttraumatic stress disorder while addressing some of the challenges brought by differences in language and culture between providers and patients. Our treatment modifications include the use of metaphors and culturally relevant examples to aid the communication of core concepts by interpreters, an emphasis on teaching the “process” of exposure therapy rather than relying on specific exposure practice in the group setting, a focus on interoceptive exposure to allow more effective group practice and to address culturally specific symptom interpretations, attention to the way in which treatment procedures interacted with culturally specific beliefs, and efforts to integrate treatment services within the community. Although data are limited, results to date suggest that this modified treatment was acceptable to patients and offered benefits on the order of large effect sizes. PMID:20072706

Using Cognitive Behavior Therapy and Mindfulness Techniques in the Management of Chronic Pain in Primary Care.

PubMed

Baker, Norah

2016-06-01

Chronic pain and its associated syndrome have become increasingly prevalent in primary care. With the increase in narcotic use and subsequent adverse events, primary care physicians often seek safer alternatives to treating this condition. Prescribing narcotics necessitates using methods to screen for high abuse risk and protect against misuse. With the understanding of how chronic pain is related to mental illnesses such as depression and posttraumatic stress disorder, mindfulness techniques and behavioral therapy can be used to help decrease the dependence on dangerous opioid medications and help patients understand, accept, and cope with their chronic pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Alcoholism, politics, and bureaucracy: the consensus against controlled-drinking therapy in America.

PubMed

Peele, S

1992-01-01

Controlled drinking has long been rejected as a therapeutic goal in traditional American alcoholism treatment. More striking has been the adoption of this position by behaviorists who once fostered controlled-drinking (CD) therapy, such as Peter Nathan, former director of the Rutgers Center of Alcohol Studies. This shift has occurred even while the evidence for rejecting the value of moderation training is unclear. Rather than being justified empirically, this rejection must instead be understood as a strategy behaviorists have used to jettison a politically explosive element in the behavioral package in order to gain overall acceptance for the behavioral approach to treating alcoholism. However, this strategy entails significant scientific, clinical, social, and ethical costs.

Handheld technology acceptance in radiologic science education and training programs

NASA Astrophysics Data System (ADS)

Powers, Kevin Jay

The purpose of this study was to explore the behavioral intention of directors of educational programs in the radiologic sciences to adopt handheld devices to aid in managing student clinical data. Handheld devices were described to participants as a technology representing a class of mobile electronic devices including, but not limited to, personal digital assistants such as a Palm TX, Apple iPod Touch, Apple iPad or Hewlett Packard iPaq, and cellular or smartphones with third generation mobile capabilities such as an Apple iPhone, Blackberry or Android device. The study employed a non-experimental, cross-sectional survey design to determine the potential of adopting handheld technologies based on the constructs of Davis's (1989) Technology Acceptance Model. An online self-report questionnaire survey instrument was used to gather study data from 551 entry level radiologic science programs specializing in radiography, radiation therapy, nuclear medicine and medical sonography. The study design resulted in a single point in time assessment of the relationship between the primary constructs of the Technology Acceptance Model: perceived usefulness and perceived ease of use, and the behavioral intention of radiography program directors to adopt the information technology represented by hand held devices. Study results provide justification for investing resources to promote the adoption of mobile handheld devices in radiologic science programs and study findings serve as a foundation for further research involving technology adoption in the radiologic sciences.

Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up

PubMed Central

2011-01-01

Background To date, there are no empirically validated treatments of good quality for adolescents showing suicidality and non-suicidal self-injurious behavior. Risk factors for suicide are impulsive and non-suicidal self-injurious behavior, depression, conduct disorders and child abuse. Behind this background, we tested the main hypothesis of our study; that Dialectical Behavioral Therapy for Adolescents is an effective treatment for these patients. Methods Dialectical Behavioral Therapy (DBT) has been developed by Marsha Linehan - especially for the outpatient treatment of chronically non-suicidal patients diagnosed with borderline personality disorder. The modified version of DBT for Adolescents (DBT-A) from Rathus & Miller has been adapted for a 16-24 week outpatient treatment in the German-speaking area by our group. The efficacy of treatment was measured by a pre-/post- comparison and a one-year follow-up with the aid of standardized instruments (SCL-90-R, CBCL, YSR, ILC, CGI). Results In the pilot study, 12 adolescents were treated. At the beginning of therapy, 83% of patients fulfilled five or more DSM-IV criteria for borderline personality disorder. From the beginning of therapy to one year after its end, the mean value of these diagnostic criteria decreased significantly from 5.8 to 2.75. 75% of patients were kept in therapy. For the behavioral domains according to the SCL-90-R and YSR, we have found effect sizes between 0.54 and 2.14. During treatment, non-suicidal self-injurious behavior reduced significantly. Before the start of therapy, 8 of 12 patients had attempted suicide at least once. There were neither suicidal attempts during treatment with DBT-A nor at the one-year follow-up. Conclusions The promising results suggest that the interventions were well accepted by the patients and their families, and were associated with improvement in multiple domains including suicidality, non-suicidal self-injurious behavior, emotion dysregulation and depression from the beginning of therapy to the one-year follow-up. PMID:21276211

Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors.

PubMed

Van Houdenhove, Boudewijn; Luyten, Patrick

2008-01-01

Syndromes characterized by chronic, medically unexplained fatigue, effort- and stress-intolerance, and widespread pain are highly prevalent in medicine. In chronic fatigue syndrome (CFS) and fibromyalgia (FM), various perpetuating factors may impair patients' quality of life and functioning and impede recovery. Although cognitive-behavioral and graded-exercise therapy are evidence-based treatments, the effectiveness and acceptability of therapeutic interventions in CFS/FM may largely depend on a customized approach taking the heterogeneity of perpetuating factors into account. Further research should clarify the aim and outcome of different treatment strategies in CFS/FM, as well as the underlying mechanisms of change, including those facilitating neurobiological recovery.

Cognitive Enhancement Therapy for Adults with Autism Spectrum Disorder: Results of an 18-Month Feasibility Study

PubMed Central

Eack, Shaun M.; Greenwald, Deborah P.; Hogarty, Susan S.; Bahorik, Amber L.; Litschge, Maralee Y.; Mazefsky, Carla A.; Minshew, Nancy J.

2013-01-01

Adults with autism experience significant impairments in social and non-social information processing for which few treatments have been developed. This study conducted an 18-month uncontrolled trial of Cognitive Enhancement Therapy (CET), a comprehensive cognitive rehabilitation intervention, in 14 verbal adults with autism spectrum disorder to investigate its feasibility, acceptability, and initial efficacy in treating these impairments. Results indicated that CET was satisfying to participants, with high treatment attendance and retention. Effects on cognitive deficits and social behavior were also large (d = 1.40 to 2.29) and statistically significant (all p < .001). These findings suggest that CET is a feasible, acceptable, and potentially effective intervention for remediating the social and non-social cognitive impairments in verbal adults with autism. PMID:23619953

A Comparison of Eating Patterns Across Two Obesity Treatments: Behavior Therapy vs. Behavioral Choice Treatment

DTIC Science & Technology

2003-10-06

body mass index ( BMI ) of 25 to 29.9 kg/m2 and obesity as a BMI of 30 kg/m2 and above. Conceptually, a 1 Eating Patterns body mass of 30 is...increased psychopathology, particularly anxiety disorders, depression, substance abuse, and increased body dissatisfaction (Fitzgibbon, Stolley...discrepancy between weight and dieting is most likely explained by cultural differences in perception and acceptance of weight and body image satisfaction

A review of the effectiveness of cognitive-behavioral group therapy on the reduction of body image concern in patients with breast cancer.

PubMed

Faraji, J; Mahdavi, A; Samkhaniyan, E; Asadi, S H; Dezhkam, N

2015-01-01

Objective: Taking the appropriate psychological actions to boost the mental health of patients with breast cancer is critical. This research was performed with the aim of examining the effectiveness of cognitive-behavioral group therapy on reducing body image concerns in patients with breast cancer. Methodology: TThe method used was quasi-experimental with a pretest-posttest plan and control group. Therefore, 40 patients with breast cancer who had referred to the oncology and radiotherapy department of Imam Hossein Hospital of Tehran were selected by convenience sampling method and organized into two groups: experimental and control group. Both groups were pretested by using demographic and body image concern questionnaires. Then the experimental group received cognitive-behavioral group therapy training for eight sessions and the control group did not receive any intervention. Afterwards, both groups were post-tested, and the data were analyzed by using SPSS software with descriptive and inferential statistics methods. Findings: The findings showed that the cognitive-behavioral group therapy training significantly contributed to the reduction of body image concern in patients with cancer (p < 0.001). Conclusions: It was concluded from this research that cognitive-behavioral group therapy training is an effective strategy to help patients with breast cancer who suffer from the concern about body image due to its high efficiency, especially when it was held in groups, it had low cost, and it was acceptable by the patients.

A Pragmatic Evaluation of the National Cancer Institute Physician Data Query (PDQ)®-Based Brief Counseling on Cancer-Related Fatigue among Patients Undergoing Radiation Therapy

PubMed Central

Bauml, Joshua; Xie, Sharon X; Penn, Courtney; Desai, Krupali; Dong, Kimberly W; Bruner, Deborah Watkins; Vapiwala, Neha; Mao, Jun James

2018-01-01

Purpose Cancer-Related Fatigue (CRF) negatively affects quality of life among cancer patients. This study seeks to evaluate the outcome and patient receptiveness of a brief counseling program based on National Cancer Institute (NCI) PDQ® information to manage CRF when integrated into Radiation Therapy (RT). Methods We conducted a prospective cohort study among patients undergoing non-palliative RT. Patients with stage I–III tumors and with Karnofsky score 60 or better were given a ten-minute behavioral counseling session during the first two weeks of RT. The Brief Fatigue Inventory (BFI) was administered at baseline/end of RT. Results Of 93 patients enrolled, 89% found the counseling useful and practical. By the end of RT, 59% reported increased exercise, 41.6% sought nutrition counseling, 72.7% prioritized daily activities, 74.4% took daytime naps, and 70.5% talked with other cancer patients. Regarding counseling, patients who had received chemotherapy prior to RT had no change in fatigue (−0.2), those who received RT alone had mild increase in fatigue (0.7, p=0.02), and those who received concurrent chemotherapy experienced a substantial increase in fatigue (3.0 to 5.2, p=0.05). Higher baseline fatigue and receipt of chemotherapy were predictive of worsened fatigue in a multivariate model (both p<0.01). Conclusion Our data suggests that brief behavioral counseling based on NCI guidelines is well accepted by patients showing an uptake in many activities to cope with CRF. Those who receive concurrent chemotherapy and with higher baseline fatigue are at risk for worsening fatigue despite of guideline-based therapy. PMID:29479490

Cognitive-Behavioral Therapy of Panic Disorder with Secondary Major Depression: A Preliminary Investigation.

ERIC Educational Resources Information Center

Laberge, Benoit; And Others

1993-01-01

Investigated extent to which cognitive-behavioral therapy can be used successfully in treatment of secondary depressed panic patients. Findings from eight panic patients with major depression and seven panic patients without major depression showed that cognitive-behavioral therapy was significantly superior to information-based therapy in…

Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study

PubMed Central

Silverman, Michelle; Sherpa, Dawa Phuti; Naegle, Madeline A; Kim, Hyorim; Coffman, Donna L; Ferdschneider, Marcy

2017-01-01

Background An increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors. Objective The aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband. Methods We recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected. Results Quantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified. Conclusions Delivering intervention material “just-in-time,” at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies. PMID:28687533

Coordinated Technology-Delivered Treatment to Prevent Rehospitalization in Schizophrenia: A Novel Model of Care.

PubMed

Brunette, Mary F; Rotondi, Armando J; Ben-Zeev, Dror; Gottlieb, Jennifer D; Mueser, Kim T; Robinson, Delbert G; Achtyes, Eric D; Gingerich, Susan; Marcy, Patricia; Schooler, Nina R; Meyer-Kalos, Piper; Kane, John M

2016-04-01

Despite advances in schizophrenia treatment, symptom relapses and rehospitalizations impede recovery for many people and are a principal driver of the high cost of care. Technology-delivered or technology-enhanced treatment may be a cost-effective way to provide flexible, personalized evidence-based treatments directly to people in their homes and communities. However, evidence for the safety, acceptability, and efficacy of such interventions is only now being established. The authors of this Open Forum describe a novel, technology-based approach to prevent relapse after a hospitalization for psychosis, the Health Technology Program (HTP), which they developed. HTP provides in-person relapse prevention planning that directs use of tailored, technology-based treatment based on cognitive-behavioral therapy for psychosis, family psychoeducation for schizophrenia, and prescriber decision support through a Web-based program that solicits information from clients at every visit. Technology-based treatments are delivered through smartphones and computers.

Acceptance of clinical decision support surveillance technology in the clinical pharmacy.

PubMed

English, Dan; Ankem, Kalyani; English, Kathleen

2017-03-01

There are clinical and economic benefits to incorporating clinical decision support systems (CDSSs) in patient care interventions in the clinical pharmacy setting. However, user dissatisfaction and resistance to HIT can prevent optimal use of such systems, particularly when users employ system workarounds and overrides. The present study applied a modified version of the unified theory of acceptance and use of technology (UTAUT) to evaluate the disposition and satisfaction with CDSS among clinical pharmacists who perform surveillance to identify potential medication therapy interventions on patients in the hospital setting. A survey of clinical pharmacists (N = 48) was conducted. Partial least squares (PLS) regression was used to analyze the influence of the UTAUT-related variables on behavioral intention and satisfaction with CDSS among clinical pharmacists. While behavioral intention did not predict actual use of HIT, facilitating conditions had a direct effect on pharmacists' use of CDSS. Likewise, satisfaction with CDSS was found to have a direct effect on use, with more satisfied users being less inclined to employ workarounds or overrides of the system. Based on the findings, organizational structures that facilitate CDSS use and user satisfaction affect the extent to which pharmacy and health care management maximize use in the clinical pharmacy setting.

Parental Social Cognitions: Considerations in the Acceptability of and Engagement in Behavioral Parent Training

ERIC Educational Resources Information Center

Mah, Janet W. T.; Johnston, Charlotte

2008-01-01

Behavioral parent training (BPT) is a widely used, evidence-based treatment for externalizing child behaviors. However, the ability of BPT programs to be maximally effective remains limited by relatively low rates of acceptance, attendance, and adherence to treatment. Previous reviews have focused on a variety of demographic and mental health…

Communication Technology Use and mHealth Acceptance among HIV-infected Men who have Sex with Men in Peru: Implications for HIV Prevention and Treatment

PubMed Central

Krishnan, Archana; Ferro, Enrico G.; Weikum, Damian; Vagenas, Panagiotis; Lama, Javier R.; Sanchez, Jorge; Altice, Frederick L.

2014-01-01

The HIV epidemic in Peru is concentrated among men who have sex with men (MSM). Given that MSM have been documented as early adopters of emerging technology, we examined communication technology access and utilization, and mobile health (mHealth) acceptance among Peruvian MSM and transgender women (TGW) in order to gauge opportunities for mHealth-enabled HIV interventions. A convenience sample of 359 HIV-infected MSM and TGW recruited from three sites in Lima, Peru completed standardized assessments of alcohol use disorders (AUDs), risky sexual behavior, and antiretroviral therapy (ART) adherence along with self-constructed measures of communication technology access and utilization, and mHealth acceptance. Most (86%) participants had daily access to any cell phone, including smartphones (30%). The most frequent communication activities were receiving and making calls, and receiving and sending text messages using cell phones. On a 5-point Likert scale, participants expressed interest in using mHealth for medication reminders (M=3.21, SD=1.32) and engaging in anonymous online interactions with health professionals to discuss HIV-related issues (M=3.56, SD=1.33). Importantly, no significant differences were found in communication technology use and mHealth acceptance among participants with AUDs, depression and suboptimal ART adherence, all of which are associated with poor HIV treatment outcomes. Findings show support for implementing mHealth-based intervention strategies using cell phones to assess and reduce HIV-risk behaviors among HIV-infected MSM and TGW. PMID:25285464

Behavior guidance techniques in Pediatric Dentistry: attitudes of parents of children with disabilities and without disabilities.

PubMed

de Castro, Alessandra Maia; de Oliveira, Fabiana Sodré; de Paiva Novaes, Myrian Stella; Araújo Ferreira, Danielly Cunha

2013-01-01

This study compared the parental acceptance of pediatric behavior guidance techniques (BGT). Forty parents of children without disabilities (Group A) and another 40 parents of children with disabilities (Group B) were selected. Each BGT was explained by a single examiner and it was presented together with a photograph album. After that parents evaluated the acceptance in: totally unacceptable, somewhat acceptable, acceptable, and totally acceptable. Results indicated that in Group A, the BGT based on communicative guidance was accepted by most participants. In Group B, just one mother considered totally unacceptable the voice control method and other two, tell-show-do. For both groups, the general anesthesia was the less accepted BGT. There was statistically significant difference in acceptance for protective stabilization with a restrictive device in Group B. Children's parents with and without disabilities accepted behavioral guidance techniques, but basic techniques showed higher rates of acceptance than advanced techniques. ©2013 Special Care Dentistry Association and Wiley Periodicals, Inc.

Nonlibrary Partnerships: Acceptable Use (and Behavior) in the Web-based Depository.

ERIC Educational Resources Information Center

Brinkerhoff, Kathie

2000-01-01

Discusses problems facing federal depository libraries regarding patron behavior when using Web sites. Topics include acceptable use policies; existing laws and enforcement offices; protecting library property; pornography, including child pornography; sexual harassment; and other forms of staff harassment. (LRW)

Mindfulness-based cognitive therapy for generalized anxiety disorder.

PubMed

Evans, Susan; Ferrando, Stephen; Findler, Marianne; Stowell, Charles; Smart, Colette; Haglin, Dean

2008-05-01

While cognitive behavior therapy has been found to be effective in the treatment of generalized anxiety disorder (GAD), a significant percentage of patients struggle with residual symptoms. There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD. Mindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn and colleagues. MBSR uses training in mindfulness meditation as the core of the program. MBCT incorporates cognitive strategies and has been found effective in reducing relapse in patients with major depression (Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 6, 615-623). Eligible subjects recruited to a major academic medical center participated in the group MBCT course and completed measures of anxiety, worry, depressive symptoms, mood states and mindful awareness in everyday life at baseline and end of treatment. Eleven subjects (six female and five male) with a mean age of 49 (range=36-72) met criteria and completed the study. There were significant reductions in anxiety and depressive symptoms from baseline to end of treatment. MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD. Future directions include development of a randomized clinical trial of MBCT for GAD.

A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients.

PubMed

Waller, Glenn; Tatham, Madeleine; Turner, Hannah; Mountford, Victoria A; Bennetts, Alison; Bramwell, Kate; Dodd, Julie; Ingram, Lauren

2018-03-01

Existing forms of evidence-based cognitive behavior therapy for eating disorders (CBT-ED) are relatively effective for nonunderweight cases. However, they are also expensive compared to CBT for other disorders. This study reports the first outcomes for a shorter, 10-session form of CBT-ED (CBT-T) for such cases, designed to be less demanding of resources. A case series of 106 nonunderweight eating disordered cases were considered for this effectiveness study. A protocolized 10-session version of CBT-ED was delivered by clinical assistants, under supervision. Measures assessed eating attitudes and behaviors, anxiety, depression, personality pathology, and the working alliance. Intention-to-treat analyses were used. Suitability, acceptability, working alliance ratings, and retention were all positive. Outcomes by the end of therapy and at three-month follow-up were positive for all symptoms, with levels of change, abstinence and remission that were comparable to those from effectiveness studies of longer forms of CBT. Higher levels of pretreatment anxiety predicted retention in treatment, but no factors predicted poorer response. Early change in eating attitudes and the working alliance were the strongest predictors of a positive response. This 10-session form of CBT-ED for nonunderweight eating disorders performed at a level that is comparable to versions of CBT-ED that are twice as long, despite being delivered by nonspecialist therapists. Replication and longer-term follow-ups are needed to ensure retained effects. However, CBT-T has promise as a therapy for use in a range of healthcare settings, to enhance access to treatment for such eating disorders. © 2018 Wiley Periodicals, Inc.

Psychological therapies for auditory hallucinations (voices): current status and key directions for future research.

PubMed

Thomas, Neil; Hayward, Mark; Peters, Emmanuelle; van der Gaag, Mark; Bentall, Richard P; Jenner, Jack; Strauss, Clara; Sommer, Iris E; Johns, Louise C; Varese, Filippo; García-Montes, José Manuel; Waters, Flavie; Dodgson, Guy; McCarthy-Jones, Simon

2014-07-01

This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

Improving International-Level Chess Players' Performance with an Acceptance-Based Protocol: Preliminary Findings

ERIC Educational Resources Information Center

Ruiz, Francisco J.; Luciano, Carmen

2012-01-01

This study compared an individual, 4-hr intervention based on acceptance and commitment therapy (ACT) versus a no-contact control condition in improving the performance of international-level chess players. Five participants received the brief ACT protocol, with each matched to another chess player with similar characteristics in the control…

Effects of an Oral-Sensory/Oral-Motor Stimulation/Positive Reinforcement Program on the Acceptance of Nonpreferred Foods by Youth with Physical and Multiple Disabilities

ERIC Educational Resources Information Center

Bailey, Rita L.; Angell, Maureen E.

2005-01-01

This study employed a multiple probe design to evaluate the effectiveness of a school-based lunchtime oral-sensory/oral-motor/positive reinforcement program on food acceptance behaviors of three youth with multiple disabilities. Overall dramatic gains in food acceptance behaviors of all participants indicated that trained school personnel were…

United we stand: emphasizing commonalities across cognitive-behavioral therapies.

PubMed

Mennin, Douglas S; Ellard, Kristen K; Fresco, David M; Gross, James J

2013-06-01

Cognitive behavioral therapy (CBT) has a rich history of alleviating the suffering associated with mental disorders. Recently, there have been exciting new developments, including multicomponent approaches, incorporated alternative therapies (e.g., meditation), targeted and cost-effective technologies, and integrated biological and behavioral frameworks. These field-wide changes have led some to emphasize the differences among variants of CBT. Here, we draw attention to commonalities across cognitive-behavioral therapies, including shared goals, change principles, and therapeutic processes. Specifically, we offer a framework for examining common CBT characteristics that emphasizes behavioral adaptation as a unifying goal and three core change principles, namely (a) context engagement to promote adaptive imagining and enacting of new experiences; (b) attention change to promote adaptive sustaining, shifting, and broadening of attention; and (c) cognitive change to promote adaptive perspective taking on events so as to alter verbal meanings. Further, we argue that specific intervention components, including behavioral exposure/activation, attention training, acceptance/tolerance, decentering/defusion, and cognitive reframing, may be emphasized to a greater or lesser degree by different treatment packages but are still fundamentally common therapeutic processes that are present across approaches and are best understood by their relationships to these core CBT change principles. We conclude by arguing for shared methodological and design frameworks for investigating unique and common characteristics to advance a unified and strong voice for CBT in a widening, increasingly multimodal and interdisciplinary, intervention science. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Effects of Acceptance and Commitment Therapy on Man Smokers' Comorbid Depression and Anxiety Symptoms and Smoking Cessation: A Randomized Controlled Trial.

PubMed

Davoudi, Mohammadreza; Omidi, Abdollah; Sehat, Mojtaba; Sepehrmanesh, Zahra

2017-07-01

Besides physical problems, cigarette smoking is associated with a high prevalence of comorbid depression and anxiety symptoms. One of the reasons behind high post-cessation smoking lapse and relapse rates is inattentiveness to these symptoms during the process of cessation. The aim of this study was to examine the effects of acceptance and commitment therapy (ACT) on male smokers' comorbid depression and anxiety symptoms and smoking cessation. This two-group pre-test-post-test randomized controlled trial was done on a random sample of seventy male smokers. Participants were randomly and evenly allocated to an intervention and a control group. Patients in these groups received either acceptance or commitment therapy or routine psychological counseling services include cognitive behavior therapy, respectively. Study data were collected through a demographic questionnaire, the Structural Clinical Interview (SCI) for Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) disorders, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Micro Smokerlyzer carbon monoxide monitor. The SPSS software was employed to analyze the data. After the intervention, depression and anxiety scores and smoking cessation rate in the intervention group were respectively lower and higher than the control group (P < 0.050). ACT can significantly improve comorbid depression and anxiety symptoms and smoking cessation rate. Thus, it can be used to simultaneously manage depression, anxiety, and cigarette smoking.

Preparing for highly active antiretroviral therapy rollout in rural South Africa: an assessment using the information, motivation, and behavioral skills model.

PubMed

Simon, Margo D; Altice, Frederick L; Moll, Anthony P; Shange, Mbuso; Friedland, Gerald H

2010-04-01

Following a controversial history and before South Africa started the world's largest highly active antiretroviral therapy (HAART) rollout, little was known about community-level information, motivation, and behavioral skills (IMB) regarding HAART in high-HIV-prevalence rural communities. The IMB model has been shown to predict behaviors that are associated with desirable HAART outcomes. We conducted an anonymous, cross-sectional "HAART-Felt Prospects" survey among HIV-serostatus-unknown young adults in Tugela Ferry, KwaZulu-Natal. We aimed to identify behavioral aspects of HAART preparedness that could be targeted by local interventions to enhance HAART outcomes. Data analysis included: percent correct, thematic means based on a four-point Likert-scale, and composite quotients. Subjects (N=176) were Zulu (99%), young (mean 19 years), and severely impoverished (55%). Relatively high levels of information were reported: overall correct score was 46%, secondary-transmission-of-resistance information was highest (81%), and only 15% reported traditional or government-advocated folk remedies cure or treat HIV/AIDS. Motivation quotient was "consistent" with favorable HAART behaviors; attitudes toward medication-taking behaviors (3.48) and condom use during HAART (3.43) ranked the highest. Desire for HIV testing (71%) was associated with HIV treatment optimism [adjusted odds ratio (AOR)=4.0, p=0.0004] and previous experience with good treatment outcome [AOR=3.2, p=0.01]. Acceptance of HAART (93%) was associated with HIV optimism [AOR=18.0, p=0.001] and not believing government-advocated folk remedies cure or treat HIV/AIDS [AOR=10.0, p=0.04]. Behavioral skills quotient was "neutral" for favorable HAART behaviors; side effects self-efficacy was the highest (3.16); and medication-taking self-efficacy the lowest (2.51). Only 47% believed disclosing HIV-serostatus would be easy. Despite controversy surrounding HAART initiation, these results suggest that local South African at-risk youth were relatively well-poised for HAART rollout. This conclusion is supported by subsequent successful HAART rollout locally. Community-based assessments are urgently needed as HAART rollouts continue. Adaptation of this IMB-based survey may better inform efforts to enhance HAART-program implementation in resource-limited settings globally.

[Acceptance and Commitment Therapy: Theoretical background and practice].

PubMed

Eisenbeck, Nikolett; Schlosser, Károly Kornél; Szondy, Máté; Szabó-Bartha, Anett

The Acceptance and Commitment Therapy (ACT) is one of the modern, so-called third-wave behavioural therapies. Among them the most successful is ACT, both in the number of therapists and respective scientific research. ACT's theoretical and philosophical background is described explicitly and its therapeutic interventions were developed according to this philosophy. Its psychopathological model is based on the idea that mainly the person's regulatory efforts of their own thoughts and feelings lead to psychological problems. That is, the source of human suffering and various psychological problems is the so called psychological inflexibility: control attempts of private events instead of living a life based on personal values and long-term goals. Therefore, clinical work in ACT focuses on the acceptance and defusion of the unwanted inner experiences and on the development of a meaningful life. The present article aims to provide a comprehensive description of ACT in Hungarian: its theoretical background, clinical techniques, and efficacy. At the end of the article, the state of ACT in Hungary will also be briefly discussed.

Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference.

PubMed

Navarro-Haro, María V; López-Del-Hoyo, Yolanda; Campos, Daniel; Linehan, Marsha M; Hoffman, Hunter G; García-Palacios, Azucena; Modrego-Alarcón, Marta; Borao, Luis; García-Campayo, Javier

2017-01-01

Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants' attention and gives users the illusion of "being there" in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high "presence" in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to practice mindfulness based on clinical expert feedback. VR is a technology with potential to increase computerized dissemination of DBT® skills training modules. Future research is warranted.

Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference.

PubMed Central

Navarro-Haro, María V.; López-del-Hoyo, Yolanda; Campos, Daniel; Linehan, Marsha M.; Hoffman, Hunter G.; García-Palacios, Azucena; Modrego-Alarcón, Marta; Borao, Luis; García-Campayo, Javier

2017-01-01

Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants’ attention and gives users the illusion of “being there” in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high “presence” in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to practice mindfulness based on clinical expert feedback. VR is a technology with potential to increase computerized dissemination of DBT® skills training modules. Future research is warranted. PMID:29166665

Art therapy for people with psychosis: a narrative review of the literature.

PubMed

Attard, Angelica; Larkin, Michael

2016-11-01

Art therapy enables individuals to use art to creatively express themselves and communicate differently with themselves, others, and their reality. The National Institute for Health and Clinical Excellence guidelines for psychosis and schizophrenia suggest that arts therapies, which include art therapy, are considered to improve negative symptoms of psychosis. We examined the effectiveness of art therapy for people with psychosis and explored whether art therapy is a meaningful and acceptable intervention in this Review. Seven electronic databases were searched for empirical papers that concerned the use of art therapy for adults with psychosis that were published from 2007 onwards. The search identified 18 papers. High-quality quantitative articles provided inconclusive evidence for the effectiveness of art therapy in adults with psychosis. However, high-quality qualitative articles indicated that therapists and clients considered art therapy to be a beneficial, meaningful, and acceptable intervention, although this conclusion was based on a small number of studies. In this Review, we discuss the theoretical, clinical, and methodological issues in light of the development of more robust research, which is needed to corroborate individuals' experiences and guide evidence-based practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pilot randomized controlled trial of a mindfulness-based group intervention in adolescent girls at risk for type 2 diabetes with depressive symptoms.

PubMed

Shomaker, Lauren B; Bruggink, Stephanie; Pivarunas, Bernadette; Skoranski, Amanda; Foss, Jillian; Chaffin, Ella; Dalager, Stephanie; Annameier, Shelly; Quaglia, Jordan; Brown, Kirk Warren; Broderick, Patricia; Bell, Christopher

2017-06-01

(1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance. Parallel-group, randomized controlled pilot trial conducted at a university. Thirty-three girls 12-17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16). Both interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation. Adolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition. Most adolescents attended ≥80% sessions (mindfulness: 92% versus cognitive-behavioral: 87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05). A mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance. ClinicalTrials.gov identifier: NCT02218138 clinicaltrials.gov. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pilot Randomized Controlled Trial of a Mindfulness-Based Group Intervention in Adolescent Girls at Risk for Type 2 Diabetes with Depressive Symptoms

PubMed Central

Shomaker, Lauren B.; Bruggink, Stephanie; Pivarunas, Bernadette; Skoranski, Amanda; Foss, Jillian; Chaffin, Ella; Dalager, Stephanie; Annameier, Shelly; Quaglia, Jordan; Brown, Kirk Warren; Broderick, Patricia; Bell, Christopher

2017-01-01

Objective (1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance. Design and setting Parallel-group, randomized controlled pilot trial conducted at a university. Participants Thirty-three girls 12-17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16). Interventions Both interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation. Main outcome measures Adolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition. Results Most adolescents attended ≥80% sessions (mindfulness:92% versus cognitive-behavioral:87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05). Conclusions A mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance. PMID:28619307

Game-Based Cognitive-Behavioral Therapy (GB-CBT) Group Program for Children Who Have Experienced Sexual Abuse: A Preliminary Investigation

ERIC Educational Resources Information Center

Misurell, Justin R.; Springer, Craig; Tryon, Warren W.

2011-01-01

This preliminary investigation examined the efficacy of a game-based cognitive-behavioral therapy group program for elementary school-aged children who have experienced sexual abuse. Treatment aimed to improve: (a) internalizing symptoms, (b) externalizing behaviors, (c) sexually inappropriate behaviors, (d) social skills deficits, (e) self-esteem…

Relative Cost-Effectiveness of Treatments for Adolescent Depression: 36-Week Results from the TADS Randomized Trial

ERIC Educational Resources Information Center

Domino, Marisa Elena; Foster, E. Michael; Vitiello, Benedetto; Kratochvil, Christopher J.; Burns, Barbara J.; Silva, Susan G.; Reinecke, Mark A.; March, John S.

2009-01-01

Randomized controlled trials that involve 327 participants aged 12 to 18 who were diagnosed with major depression were given either fluoxetine alone, cognitive-behavioral therapy, or a combination of both. Cost-effectiveness acceptability curves suggest that combination treatment is highly likely to be the most cost-effective treatment than…

An Empirical Model of Body Image Disturbance Using Behavioral Principles Found in Functional Analytic Psychotherapy and Acceptance and Commitment Therapy

ERIC Educational Resources Information Center

Callaghan, Glenn M.; Duenas, Julissa A.; Nadeau, Sarah E.; Darrow, Sabrina M.; Van der Merwe, Jessica; Misko, Jennifer

2012-01-01

The literature examining body image disturbance and Body Dysmorphic Disorder (BDD) is fraught with competing theoretical constructions of the etiology and nosology of these problems. Recent studies on various forms of psychopathology suggest that intrapersonal processes, including experiential avoidance, and interpersonal processes such as…

Assessing Psychological Flexibility: What Does It Add above and beyond Existing Constructs?

ERIC Educational Resources Information Center

Gloster, Andrew T.; Klotsche, Jens; Chaker, Samia; Hummel, Katrin V.; Hoyer, Jurgen

2011-01-01

The construct of psychological flexibility (PF) is a central concept in acceptance and commitment therapy. It is defined as the process of contacting the present moment fully as a conscious human being and persisting in or changing behavior in the service of chosen values. PF is hypothesized to be an important aspect of healthy psychological…

Development and Preliminary Evaluation of a One-Week Summer Treatment Program for Separation Anxiety Disorder

ERIC Educational Resources Information Center

Santucci, Lauren C.; Ehrenreich, Jill T.; Trosper, Sarah E.; Bennett, Shannon M.; Pincus, Donna B.

2009-01-01

Numerous clinical trials have demonstrated the efficacy of cognitive behavior therapy (CBT) for the treatment of childhood Separation Anxiety Disorder (SAD) and other anxiety disorders yet additional research may still be needed to better access and engage anxious youth. In this study, we investigated the acceptability and preliminary utility of a…

The attitude of Canadian university students toward a behavior-based blood donor health assessment questionnaire.

PubMed

Go, Stephanie L; Lam, Cindy T Y; Lin, Yahui T; Wong, Deborah J; Lazo-Langner, Alejandro; Chin-Yee, Ian

2011-04-01

In Canada, all men who have sex with men (MSM) are indefinitely deferred from donating blood. The purpose of this study was to determine the acceptability of an alternative behavior-based donor health questionnaire among Canadian university students. Further we sought to determine the perception of blood safety associated with specific risk behaviors. Questions found on the Canadian Blood Services' donor health assessment questionnaire as well as from studies assessing high-risk behavior for human immunodeficiency virus infection were included. For each question participants were asked to rate the acceptability, comfort in answering, perceived effect on blood safety, and whether the question would deter them from donating blood. Data were analyzed using nonparametric tests. A total of 741 students participated in the study. Questions regarding sexual practices of the donor were rated less important for blood safety compared to those assessing for sexually transmitted infections, sex for money, and injection drug use (30%-62% vs. 69%-95% unsafe). A total of 24.4% of students rated both questions on MSM status and a behavior-based alternative as equally unacceptable. We found an inverse correlation between perception of safety and acceptability of questions. Our findings suggest that a behavior-based screening modification is unlikely to change opinions or satisfy those who object to the MSM current policy in place. Acceptability of these questions might be related to a poor understanding of the effect of sexual practices on blood supply safety. © 2010 American Association of Blood Banks.

Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability

PubMed Central

Botella, Cristina; Serrano, Berenice; Baños, Rosa M; Garcia-Palacios, Azucena

2015-01-01

Introduction The essential feature of post-traumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. According to evidence-based intervention guidelines and empirical evidence, one of the most extensively researched and validated treatments for PTSD is prolonged exposure to traumatic events; however, exposure therapy can present some limitations. Virtual reality (VR) can help to improve prolonged exposure because it creates fictitious, safe, and controllable situations that can enhance emotional engagement and acceptance. Objective In addition to carrying out a review to evaluate the efficacy of VR exposure-based therapy (VR-EBT) for the treatment of PTSD, the aim of this study was to contribute to analyzing the use of VR-EBT by: first, evaluating the adequacy of psychological treatment protocols that use VR-EBT to treat PTSD; and second, analyzing the acceptability of VR-EBT. Method We performed a replica search with descriptors and databases used in two previous reviews and updated to April 2015. Next, we carried out an evaluation of the efficacy, adequacy, and acceptability of VR-EBT protocols. Results Results showed that VR-EBT was effective in the treatment of PTSD. The findings related to adequacy showed that not all studies using VR-EBT reported having followed the clinical guidelines for evidence-based interventions in the treatment of PTSD. Regarding acceptability, few studies evaluated this subject. However, the findings are very promising, and patients reported high acceptability and satisfaction with the inclusion of VR in the treatment of PTSD. Conclusion The main weaknesses identified in this review focus on the need for more controlled studies, the need to standardize treatment protocols using VR-EBT, and the need to include assessments of acceptability and related variables. Finally, this paper highlights some directions and future perspectives for using VR-EBT in PTSD treatment. PMID:26491332

Investigating m-Health Acceptance from a Protection Motivation Theory Perspective: Gender and Age Differences.

PubMed

Guo, Xitong; Han, Xiaocui; Zhang, Xiaofei; Dang, Yuanyuan; Chen, Chun

2015-08-01

Mobile health (m-health) services are becoming increasingly important and widely accepted. However, empirical studies on potential users' m-health acceptance behavior remain underexplored. Indeed, m-health adoption is not only a technology acceptance behavior, but also a health-related behavior. Based on the Protection Motivation Theory, this article explores users' m-health adoption behavior from the perspectives of threat appraisal and coping appraisal, and also examines the moderating role of gender and age through a survey of potential users. The survey was conducted among 500 potential m-health service participants. Our results show that threat appraisal and coping appraisal factors influence adoption intention through attitude. It is also found that gender and age play different moderating roles with threat appraisal and coping appraisal factors. Gender and age play different roles between threat appraisal and coping appraisal factors in the acceptance of m-health. Implications for research and practice are discussed.

D-Cycloserine Augmentation of Cognitive-Behavioral Therapy: Directions for Pilot Research in Pediatric Obsessive-Compulsive Disorder

ERIC Educational Resources Information Center

Storch, Eric A.; McKay, Dean; Reid, Jeannette M.; Geller, Daniel A.; Goodman, Wayne K.; Lewin, Adam B.; Murphy, Tanya K.

2010-01-01

This paper discusses a recent translational success in combining behavioral psychotherapy with a novel medication, d-cycloserine (DCS), to augment cognitive-behavioral therapy (CBT) for anxiety disorders. The literature on behavioral theory of exposure-based therapies is provided, followed by a discussion of the role of DCS in enhancing extinction…

Unfolding the values of work - therapists´ experience of addressing the return to work process in occupational rehabilitation based on Acceptance and Commitment Therapy.

PubMed

Klevanger, Nina E; Fimland, Marius S; Johnsen, Roar; Rise, Marit B

2018-04-27

Facilitating return to work can be challenging due to the complexity of work disability. Few studies have examined rehabilitation programs based on Acceptance and Commitment Therapy that intend to support return to work, and none have investigated therapists' experience with providing such programs. The aim of this study was therefore to explore therapists' experience of addressing the return to work process in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy. This was a qualitative interview study supported by participant observation. Therapists were interviewed regarding their experiences with addressing return to work in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy. In addition, the rehabilitation program was investigated through participant observation. The interviews were analysed according to Interpretative Phenomenological Analysis and informed by an analysis of field notes from the participant observation. Acceptance and Commitment Therapy was experienced as a meaningful approach to facilitate return to work, as it allowed therapists to address all relevant aspects of the individual participant's life that might influence work participation. The therapists' twofold goal was to support participants in building both a meaningful life and sustainable work participation. To do so, they attempted to instil long-term and interrelated processes concerning ownership, causes of sick leave, relation to expectations, the values of work, and the scope of agency. Unfolding values connected to work participation might reconcile the tension between work and family life by integrating work with other areas of life. Providing work participation with personal meaning also seems especially commensurable with a context where economy presents a poor incentive for return to work. Therapists should, however, be attentive to the need to secure the prominence of return to work by relating participants' chosen themes explicitly to their return to work process. Therapists should also be aware of the dilemma that may arise when they attempt to refrain from providing advice while simultaneously encouraging actions they consider appropriate to facilitate sustainable work participation. In addition, having an individual-oriented approach to occupational rehabilitation may obscure the extent to which return to work is a multi-stakeholder process.

An Acceptance and Mindfulness-Based Approach to Social Phobia: A Case Study

ERIC Educational Resources Information Center

Brady, Victoria Popick; Whitman, Sarah M.

2012-01-01

Over the past few years, there has been a proliferation of theoretical discussions and empirical research on the use of acceptance and mindfulness-based therapies to treat anxiety disorders. Because these treatment approaches are in their infancy, many clinicians may still be uncertain about how to apply such treatments in their work with clients.…

A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders.

PubMed

Schmidt, Ulrike; Lee, Sally; Beecham, Jennifer; Perkins, Sarah; Treasure, Janet; Yi, Irene; Winn, Suzanne; Robinson, Paul; Murphy, Rebecca; Keville, Saskia; Johnson-Sabine, Eric; Jenkins, Mari; Frost, Susie; Dodge, Liz; Berelowitz, Mark; Eisler, Ivan

2007-04-01

To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories. Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.

Therapygenetics: 5-HTTLPR genotype predicts the response to exposure therapy for agoraphobia.

PubMed

Knuts, Inge; Esquivel, Gabriel; Kenis, Gunter; Overbeek, Thea; Leibold, Nicole; Goossens, Lies; Schruers, Koen

2014-08-01

This study was intended to assess the extent to which the low-expression allele of the serotonin transporter gene promoter predicts better response to exposure-based behavior therapy in patients with panic disorder with agoraphobia (PDA). Ninety-nine patients with PDA underwent a 1-week in vivo exposure-based behavior therapy program and provided saliva samples to extract genomic DNA and classify individuals according to four allelic forms (SA, SG, LA, LG) of the 5-HTT-linked polymorphic region (5-HTTLPR). We determined whether the 5-HTTLPR genotype predicted change in avoidance behavior in PDA following treatment. After controlling for pre-treatment avoidance behavior, the 5-HTTLPR low-expression genotypes showed a more favorable response to exposure therapy two weeks following treatment, compared to the other patients. This study suggests a genetic contribution to treatment outcome following behavior therapy and implicates the serotonergic system in response to exposure-based treatments in PDA. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation.

PubMed

Juarascio, Adrienne; Shaw, Jena; Forman, Evan; Timko, C Alix; Herbert, James; Butryn, Meghan; Bunnell, Douglas; Matteucci, Alyssa; Lowe, Michael

2013-07-01

Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction.

PubMed

Olmstead, Todd A; Ostrow, Cary D; Carroll, Kathleen M

2010-08-01

To determine the cost-effectiveness, from clinic and patient perspectives, of a computer-based version of cognitive-behavioral therapy (CBT4CBT) as an addition to regular clinical practice for substance dependence. PARTICIPANTS, DESIGN AND MEASUREMENTS: This cost-effectiveness study is based on a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomly assigned to treatment as usual (TAU) or TAU plus biweekly access to computer-based training in CBT (TAU plus CBT4CBT). The primary patient outcome measure was the total number of drug-free specimens provided during treatment. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were used to determine the cost-effectiveness of TAU plus CBT4CBT relative to TAU alone. Results are presented from both the clinic and patient perspectives and are shown to be robust to (i) sensitivity analyses and (ii) a secondary objective patient outcome measure. The per patient cost of adding CBT4CBT to standard care was $39 ($27) from the clinic (patient) perspective. From the clinic (patient) perspective, TAU plus CBT4CBT is likely to be cost-effective when the threshold value to decision makers of an additional drug-free specimen is greater than approximately $21 ($15), and TAU alone is likely to be cost-effective when the threshold value is less than approximately $21 ($15). The ICERs for TAU plus CBT4CBT also compare favorably to ICERs reported elsewhere for other empirically validated therapies, including contingency management. TAU plus CBT4CBT appears to be a good value from both the clinic and patient perspectives. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Advantages and Challenges of A Village Doctor-Based Cognitive Behavioral Therapy for Late-Life Depression in Rural China: A Qualitative Study.

PubMed

Tang, Xinfeng; Yang, Fahui; Tang, Tan; Yang, Xuemei; Zhang, Weijun; Wang, Xiaohua; Ji, Li; Xiao, Yun; Ma, Kun; Wang, Ying; Kong, Xianglei; Wang, Jianping; Liu, Jun; Xu, Qian; Tian, Donghua; Qu, Zhiyong

2015-01-01

The delivery of mental health services in rural China has been notably limited due to lack of qualified mental health professionals among other impeding factors. A village doctor-based cognitive behavioral therapy intervention may be one way of improving accessibility. The purpose of this study was to explore the advantages and challenges of implementing this intervention, as delivered by trained village doctors, to treat late-life depression in rural China. We conducted one focus group discussion with 10 village doctors, 10 individual interviews with each of the village doctors, and individual interviews with 19 older adults. The topic guides were advantages and challenges of the intervention program from the perspective of the village doctors and older adults. Interviews were audio-recorded, transcribed, coded using NVivo 8, and analyzed using thematic analysis. The village doctors stressed the importance of role-playing and using instructive manuals in the training. Proper supervision was also a key component of the program. The benefits received from the intervention for the village doctors and the elders were positive such that both the doctors and the older adults were willing to implement/receive this intervention. Cultural and political factors (renqing and perceived policy consideration) facilitated the elders' access to mental health services. Challenges included a lack of real therapy (in contrast to role-playing) demonstrated in the training and lack of a step-by-step manual based on different types of problems encountered. Other impediments to the successful implementation of the intervention included the time constraints of village doctors and the presence of other people when conducting the intervention. The present study has demonstrated that the intervention program is likely to be an acceptable geriatric depression intervention in rural China if several challenges are appropriately addressed.

Interrelating Behavioral Measures of Distress Tolerance with Self-Reported Experiential Avoidance.

PubMed

Schloss, Heather M; Haaga, David A F

2011-03-01

Experiential avoidance and distress intolerance play a central role in novel behavior therapies, yet they appear to overlap considerably the REBT concept of low frustration tolerance. Using baseline data from 100 adult cigarette smokers enrolled in a clinical trial of smoking cessation therapies, the present study evaluated the convergent validity of common questionnaire measures of experiential avoidance (Acceptance and Action Questionnaire; AAQ; Hayes et al. 2004, and Avoidance and Inflexibility Scale: AIS; Gifford et al. 2004) and behavioral measures of distress tolerance (computerized Mirror Tracing Persistence Task: MTPT-C: Strong et al. 2003; computerized Paced Auditory Serial Addition Task; PASAT-C; Lejuez et al. 2003). The distress tolerance measures correlated significantly (r = .29) with one another. However, the questionnaire measures of experiential avoidance did not correlate with each other, nor with the behavioral measures. Further research is needed on the validity of measuring experiential avoidance by self-report and of the overlap versus distinctiveness of seemingly similar constructs such as experiential avoidance, distress tolerance, and frustration tolerance.

Interrelating Behavioral Measures of Distress Tolerance with Self-Reported Experiential Avoidance

PubMed Central

Schloss, Heather M.

2011-01-01

Experiential avoidance and distress intolerance play a central role in novel behavior therapies, yet they appear to overlap considerably the REBT concept of low frustration tolerance. Using baseline data from 100 adult cigarette smokers enrolled in a clinical trial of smoking cessation therapies, the present study evaluated the convergent validity of common questionnaire measures of experiential avoidance (Acceptance and Action Questionnaire; AAQ; Hayes et al. 2004, and Avoidance and Inflexibility Scale: AIS; Gifford et al. 2004) and behavioral measures of distress tolerance (computerized Mirror Tracing Persistence Task: MTPT-C: Strong et al. 2003; computerized Paced Auditory Serial Addition Task; PASAT-C; Lejuez et al. 2003). The distress tolerance measures correlated significantly (r = .29) with one another. However, the questionnaire measures of experiential avoidance did not correlate with each other, nor with the behavioral measures. Further research is needed on the validity of measuring experiential avoidance by self-report and of the overlap versus distinctiveness of seemingly similar constructs such as experiential avoidance, distress tolerance, and frustration tolerance. PMID:21448252

Counselor attitudes toward contingency management for substance use disorder: effectiveness, acceptability, and endorsement of incentives for treatment attendance and abstinence☆

PubMed Central

Aletraris, Lydia; Shelton, Jeff S.; Roman, Paul M.

2015-01-01

Despite research demonstrating its effectiveness, use of contingency management (CM) in substance use disorder treatment has been limited. Given the vital role that counselors play as arbiters in the use of therapies, examination of their attitudes can provide insight into how further use of CM might be effectively promoted. In this paper, we examine 731 counselors' attitudes toward the effectiveness and acceptability of CM in treatment, as well as their specific attitudes toward both unspecified and tangible incentives for treatment attendance and abstinence. Compared to cognitive behavioral therapy, motivational interviewing, and community reinforcement approach, counselors rated CM as the least effective and least acceptable psychosocial intervention. Exposure through the use of CM in a counselor's employing organization was positively associated with perceptions of acceptability, agreement that incentives have a positive effect on the client–counselor relationship, and endorsement of tangible incentives for abstinence. Endorsement of tangible incentives for treatment attendance was significantly greater among counselors with more years in the treatment field, and counselors who held at least a master's degree. Counselors' adaptability or openness to innovations was also positively associated with attitudes toward CM. Further, female counselors and counsellors with a greater 12-step philosophy were less likely to endorse the use of incentives. A highlight of our study is that it offers the first specific assessment of the impact of “Promoting Awareness of Motivational Incentives” (PAMI), a Web-based tool based on findings of CM protocols tested within the Clinical Trials Network (CTN), on counselors employed outside the CTN. We found that 10% of counselors had accessed PAMI, and those who had accessed PAMI were more likely to report a higher degree of perceived effectiveness of CM than those who had not. This study lays the groundwork for vital research on the impact of multiple Web-based educational strategies. Given the barriers to CM adoption, identifying predictors of positive attitudes among counselors can help diffuse CM into routine clinical practice. PMID:26001821

Predictors of community therapists' use of therapy techniques in a large public mental health system.

PubMed

Beidas, Rinad S; Marcus, Steven; Aarons, Gregory A; Hoagwood, Kimberly E; Schoenwald, Sonja; Evans, Arthur C; Hurford, Matthew O; Hadley, Trevor; Barg, Frances K; Walsh, Lucia M; Adams, Danielle R; Mandell, David S

2015-04-01

Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist-Family Revised. Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique.

Psychosocial interventions in the treatment of youth diagnosed or at high-risk for pediatric bipolar disorder: A review of the literature.

PubMed

Frías, Álvaro; Palma, Cárol; Farriols, Núria

2015-01-01

Pediatric bipolar disorder (PBD) has emerged as a research field in which psychosocial treatments have provided a plethora of empirical findings over the last decade. We addressed this issue through a systematic review aimed of establishing their effectiveness and feasibility as adjunctive therapies for youth with PBD or at high-risk for PBD. A comprehensive search of databases was performed between 1990 and September 2014. Overall, 33 studies were specifically related to the issue and 20 of them were original articles. Evidence suggests that both "multi-family psychoeducational psychotherapy' and "family-focused therapy" are possible effective treatments for PBD. Likewise, "child and family-focused cognitive-behavioral therapy" may be characterized as a treatment in its experimental phase. The remaining therapies fail to obtain enough empirical support due to inconsistent findings among clinical trials or data solely based on case reports. Studies of psychosocial treatments provide concluding results concerning their feasibility and acceptability. Larger sample sizes and more randomized controlled trials are mandatory for diminishing methodological shortcomings encountered in the treatments displayed. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Auditing Access to Outpatient Rehabilitation Services for Children With Traumatic Brain Injury and Public Insurance in Washington State.

PubMed

Fuentes, Molly M; Thompson, Leah; Quistberg, D Alex; Haaland, Wren L; Rhodes, Karin; Kartin, Deborah; Kerfeld, Cheryl; Apkon, Susan; Rowhani-Rahbar, Ali; Rivara, Frederick P

2017-09-01

To identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services. Audit study with paired calls, where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury and public or private insurance. Outpatient rehabilitation clinics. Sample of rehabilitation clinics (N=287): 195 physical therapy (PT) clinics, 109 occupational therapy (OT) clinics, 102 speech therapy (ST) clinics, and 11 rehabilitation medicine clinics. Not applicable. Acceptance of public insurance and the number of business days until the next available appointment. Therapy clinics were more likely to accept private insurance than public insurance (relative risk [RR] for PT clinics, 1.33; 95% confidence interval [CI], 1.22-1.44; RR for OT clinics, 1.40; 95% CI, 1.24-1.57; and RR for ST clinics, 1.42; 95% CI, 1.25-1.62), with no significant difference for rehabilitation medicine clinics (RR, 1.10; 95% CI, 0.90-1.34). The difference in median wait time between clinics that accepted public insurance and those accepting only private insurance was 4 business days for PT clinics and 15 days for ST clinics (P≤.001), but the median wait time was not significantly different for OT clinics or rehabilitation medicine clinics. When adjusting for urban and multidisciplinary clinic statuses, the wait time at clinics accepting public insurance was 59% longer for PT (95% CI, 39%-81%), 18% longer for OT (95% CI, 7%-30%), and 107% longer for ST (95% CI, 87%-130%) than that at clinics accepting only private insurance. Distance to clinics varied by discipline and area within the state. Therapy clinics were less likely to accept public insurance than private insurance. Therapy clinics accepting public insurance had longer wait times than did clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A meta-analysis of dropout rates in acceptance and commitment therapy.

PubMed

Ong, Clarissa W; Lee, Eric B; Twohig, Michael P

2018-05-01

Many psychotherapies, including cognitive behavioral therapy and acceptance and commitment therapy (ACT), have been found to be effective interventions for a range of psychological and behavioral health concerns. Another aspect of treatment utility to consider is dropout, as interventions only work if clients are engaged in them. To date, no research has used meta-analytic methods to examine dropout in ACT. Thus, the objectives of the present meta-analysis were to (1) determine the aggregate dropout rate for ACT in randomized controlled trials, (2) compare dropout rates in ACT to those in other psychotherapies, and (3) identify potential moderators of dropout in ACT. Our literature search yielded 68 studies, representing 4,729 participants. The weighted mean dropout rates in ACT exclusive conditions and ACT inclusive conditions (i.e., those that included an ACT intervention) were 15.8% (95% CI: 11.9%, 20.1%) and 16.0% (95% CI: 12.5%, 19.8%), respectively. ACT dropout rates were not significantly different from those of established psychological treatments. In addition, dropout rates did not vary by client characteristics or study methodological quality. However, master's-level clinicians/therapists (weighted mean = 29.9%, CI: 17.6%, 43.8%) were associated with higher dropout than psychologists (weighted mean = 12.4%, 95% CI: 6.7%, 19.4%). More research on manipulable, process variables that influence dropout is needed. Copyright © 2018 Elsevier Ltd. All rights reserved.

The use of mobile phones to deliver acceptance and commitment therapy in the prevention of mother-child HIV transmission in Nigeria.

PubMed

Ishola, A G; Chipps, J

2015-12-01

The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) programme using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. We used a Solomon four-group (two intervention and two control groups) randomised design. The study population was 144 randomly selected, HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling. A total of 132 participants (33 per site) were enrolled in the study from the two intervention and two control sites. In the pre-tests, the intervention and control groups did not differ significantly with regard to demographics. Evaluation of the pre- and post-tests of the intervention group indicated significantly higher Action and Acceptance Questionnaire (AAQ-II) scores. The introduction of a mobile phone acceptance and commitment therapy programme may result in greater psychological flexibility in women diagnosed with HIV. © The Author(s) 2015.

The effects of orff-based music therapy and social work groups on childhood grief symptoms and behaviors.

PubMed

Hilliard, Russell E

2007-01-01

This study evaluated and compared the effects of Orff-based music therapy, social work, and wait-list control groups on behavioral problems and grief symptoms of bereaved school-aged children. Social work and music therapy sessions were provided weekly for one hour over an eight-week period. Participants (N = 26) attended three different public elementary schools, and each school was randomly assigned to one of the conditions. Pre and posttest measures consisted of the Behavior Rating Index for Children (BRIC) and the Bereavement Group Questionnaire for Parents and Guardians (BP). The BRIC measured behavioral distress and the BP measured grief symptoms prior to and following participation in the assigned conditions. Statistical analyses indicated that participants in the music therapy group significantly improved in the behaviors and grief symptoms, and those in the social work group experienced a significant reduction in their behavioral problems but not their grief symptoms. Participants in the wait-list control group made no significant improvements in either their grief symptoms or behavioral problems. A reduction in behavioral distress as measured by the BRIC and a reduction in grief symptoms as measured by the BP is the most desired outcome. This study supports the use of Orff-based music therapy interventions for bereaved children in a school-based grief program. Recommendations for future research are included.

Classification of complementary and alternative medical practices: Family physicians' ratings of effectiveness.

PubMed

Fries, Christopher J

2008-11-01

ABSTRACTOBJECTIVETo develop a classification of complementary and alternative medicine (CAM) practices widely available in Canada based on physicians' effectiveness ratings of the therapies.DESIGNA self-administered postal questionnaire asking family physicians to rate their "belief in the degree of therapeutic effectiveness" of 15 CAM therapies.SETTINGProvince of Alberta.PARTICIPANTSA total of 875 family physicians.MAIN OUTCOME MEASURESDescriptive statistics of physicians' awareness of and effectiveness ratings for each of the therapies; factor analysis was applied to the ratings of the 15 therapies in order to explore whether or not the data support the proposed classification of CAM practices into categories of accepted and rejected.RESULTSPhysicians believed that acupuncture, massage therapy, chiropractic care, relaxation therapy, biofeedback, and spiritual or religious healing were effective when used in conjunction with biomedicine to treat chronic or psychosomatic indications. Physicians attributed little effectiveness to homeopathy or naturopathy, Feldenkrais or Alexander technique, Rolfing, herbal medicine, traditional Chinese medicine, and reflexology. The factor analysis revealed an underlying dimensionality to physicians' effectiveness ratings of the CAM therapies that supports the classification of these practices as either accepted or rejected.CONCLUSIONThis study provides Canadian family physicians with information concerning which CAM therapies are generally accepted by their peers as effective and which are not.

Behavioral competence as a positive youth development construct: conceptual bases and implications for curriculum development.

PubMed

Ma, Hing Keung

2006-01-01

Behavioral competence refers to the ability to use non-verbal and verbal strategies to perform socially acceptable and normative behavior in social interactions. The main objective is to teach our children to be courteous, graceful, and fair so that they behave with respect and responsibility in social interactions with others. The importance of behavioral competence is discussed and it is emphasized that the competence to behave or act effectively must be based on a positive or prosocial motivation or disposition. The behavioral program units cover the following three types of behaviors: applause, criticism, and apology. The general goal is to foster the development of socially acceptable character, manner, and normative behavior. This paper is part of the development of the positive youth development program in Hong Kong.

Effectiveness of Cognitive Behavioral Therapy on Spiritual Well-Being and Emotional Intelligence of the Elderly Mourners.

PubMed

Solaimani Khashab, Abas; Ghamari Kivi, Hosain; Fathi, Davod

2017-04-01

Objective: Grief is one of the most painful experiences of the humans after linking emotions. In the literature of trauma, grief and mourning can be seen on many topics. Intervention and treatment of grief seems necessary as the period of mourning is prolonged. Thus, this study aimed at understanding the effectiveness of cognitive behavioral therapy on spiritual well-being and emotional intelligence in the elderly bereavement. Method: This was an experimental study with pre-and posttest design, and control group. The population of this study was the elderly mourners in city of Ardabil in 15-2014. After conducting clinical interviews and diagnostic tests using the sampling method, 30 elderly mourners selected. Spiritual Well-Being questionnaire and Emotional Intelligence questionnaire were used for data collection. The questionnaire and pretest-posttest were used in this study. Data were analyzed using multivariate analysis of covariance. Results: The results of the data analysis revealed that cognitive behavioral therapy increased spiritual well-being and emotional intelligence of the mourners was not significantly different between the 2 groups (P<0.01). However, the means of Spiritual Well-Being and Emotional Intelligence at pretest was not significant in the intervention group compared with the control group (P>0.05). Conclusion: Method of cognitive behavioral therapy helps confront the emotional drain and grief acceptance, increasing the spiritual well-being and emotional intelligence of the elderly bereavement.‏.

Effectiveness of Cognitive Behavioral Therapy on Spiritual Well-Being and Emotional Intelligence of the Elderly Mourners

PubMed Central

Solaimani Khashab, Abas; Ghamari Kivi, Hosain; Fathi, Davod

2017-01-01

Objective: Grief is one of the most painful experiences of the humans after linking emotions. In the literature of trauma, grief and mourning can be seen on many topics. Intervention and treatment of grief seems necessary as the period of mourning is prolonged. Thus, this study aimed at understanding the effectiveness of cognitive behavioral therapy on spiritual well-being and emotional intelligence in the elderly bereavement. Method: This was an experimental study with pre-and posttest design, and control group. The population of this study was the elderly mourners in city of Ardabil in 15-2014. After conducting clinical interviews and diagnostic tests using the sampling method, 30 elderly mourners selected. Spiritual Well-Being questionnaire and Emotional Intelligence questionnaire were used for data collection. The questionnaire and pretest-posttest were used in this study. Data were analyzed using multivariate analysis of covariance. Results: The results of the data analysis revealed that cognitive behavioral therapy increased spiritual well-being and emotional intelligence of the mourners was not significantly different between the 2 groups (P<0.01). However, the means of Spiritual Well-Being and Emotional Intelligence at pretest was not significant in the intervention group compared with the control group (P>0.05). Conclusion: Method of cognitive behavioral therapy helps confront the emotional drain and grief acceptance, increasing the spiritual well-being and emotional intelligence of the elderly bereavement.‏ PMID:28659981

Jogging the Cogs: Trauma-Focused Art Therapy and Cognitive Behavioral Therapy with Sexually Abused Children

ERIC Educational Resources Information Center

Pifalo, Terry

2007-01-01

Art therapy in conjunction with cognitive behavioral therapy reduces symptoms and enhances the potential for positive outcomes for sexually abused children in trauma-focused treatment. This article presents a treatment model that utilizes specific art therapy interventions to facilitate treatment, based on research on the effectiveness of combined…

Psychological Inflexibility and Child Anxiety.

PubMed

Simon, Ellin; Verboon, Peter

2016-01-01

Psychological flexibility is the main outcome of acceptance commitment therapy. Insight into the usefulness of measuring psychological flexibility is an important step to enable studies on the effectiveness of acceptance commitment therapy in middle-aged children (8-10 years). For this purpose, we examined the factor structure, the construct validity and the reliability of the Avoidance and Fusion Questionnaire for Youth. The Avoidance and Fusion Questionnaire for Youth taps psychological inflexibility (the opposite of psychological flexibility) in children and adolescents. Although the questionnaire has been extensively validated in older children, this is not the case for middle-aged children. The Avoidance and Fusion Questionnaire for Youth contains 17 items and is constituted of the subscales cognitive fusion, experiential avoidance and behavioral ineffectiveness. A shortened 8-item version also exists, the Avoidance and Fusion Questionnaire for Youth-8, which does not distinguish between these subscales. We performed a confirmatory factor analysis. Additionally, we assessed the relationship between psychological flexibility and child anxiety. Children, aged 8-10 years, were recruited via regular primary schools. Of the 459 approached children, 267 (58 %) parents signed informed consents for their children (Age: M  = 9.18; SD  = .79; Sex: n boys  = 137, 51 %). Children completed the questionnaires during regular classes. In this sample, the 17-item version of the Avoidance and Fusion Questionnaire for Youth was less appropriate for measuring psychological inflexibility than the 8-item version. Furthermore, we found a significant positive relationship between psychological inflexibility and child anxiety. We argue that acceptance commitment therapy would be an interesting candidate for intervening early on in dysfunctional child anxiety, as acceptance commitment therapy's cognitive elements require cognitive skills that children are likely to master early on.

A dialectical behavior therapy skills intervention for women with suicidal behaviors in rural Nepal: A single-case experimental design series.

PubMed

Ramaiya, Megan K; McLean, Caitlin; Regmi, Upasana; Fiorillo, Devika; Robins, Clive J; Kohrt, Brandon A

2018-07-01

Suicide in low- and middle-income countries (LMICs) accounts for 75% of the world's burden of suicide mortality and is the leading single cause of death among Nepali reproductive age women. To advance treatment for suicidal behaviors in LMICs, a single-case experimental design (SCED) was conducted of a culturally adapted Dialectical Behavior Therapy skills intervention for Nepali populations (DBT-N). Ten Nepali women with histories of suicidality participated in the 10-session intervention. Outcomes of emotion regulation, suicidal ideation, depression, anxiety, resilience, and coping skills use were measured at multiple time points pre-intervention, during, and at follow-up. Qualitative interviewing assessed DBT-N's feasibility and acceptability. Participants showed improvements in emotion regulation over the course of treatment, which were associated with increased skills use. Rapid, sustained reductions in suicidal ideation and improvements in resilience were observed after DBT-N initiation. This SCED supports conducting further evaluation of DBT-N through controlled trials with emotion regulation as a target mechanism of action for reducing suicidal behaviors in LMICs. © 2018 Wiley Periodicals, Inc.

Acceptance and Commitment Therapy as a Novel Treatment for Eating Disorders: An Initial Test of Efficacy and Mediation

ERIC Educational Resources Information Center

Juarascio, Adrienne; Shaw, Jena; Forman, Evan; Timko, C. Alix; Herbert, James; Butryn, Meghan; Bunnell, Douglas; Matteucci, Alyssa; Lowe, Michael

2013-01-01

Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high…

Determinants of the effect of existential behavioral therapy for bereaved partners: a qualitative study.

PubMed

Kögler, Monika; Brandl, Jürgen; Brandstätter, Monika; Borasio, Gian Domenico; Fegg, Martin Johannes

2013-11-01

Informal caregivers of palliative patients took part in existential behavioral therapy (EBT), a group intervention comprising mindfulness exercises to reduce psychological distress and improve quality of life. This study examined what the participants perceived as helpful to cope with their loss during the first year of bereavement, particularly with regard to the EBT intervention. Sixteen problem-centered, semi-structured interviews were evaluated with content analysis. Two main categories were found: social support and self-regulation. Social support includes sense of belonging as well as emotional, cognitive, and practical help experienced from others. Mindfulness and acceptance, a clear focus on the positive, and orientation toward the future were helpful strategies of self-regulation; these were also part of the EBT intervention. Mindfulness was understood as permitting emotions and acceptance of one's inner processes, even if they were not pleasant, and was found to be helpful to stop ruminative thinking. The categories considered as being helpful parallel core elements of EBT and recent grief theories. The intervention was found to be supportive and met the needs of the participants. The interviewees appreciated the continuity of EBT support from palliative care into bereavement.

Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators

PubMed Central

Craske, Michelle G; Niles, Andrea N.; Burklund, Lisa J.; Wolitzky-Taylor, Kate B.; Vilardaga, Jennifer C. Plumb; Arch, Joanna J.; Saxbe, Darby E.; Lieberman, Matthew D.

2014-01-01

Objective Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. Method The current study (N=87) was a 3-arm randomized clinical trial comparing CBT, Acceptance and Commitment therapy (ACT), and a waitlist control group (WL) in participants with a DSM-IV diagnosis of social phobia. Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and post-treatment, and participants assigned to CBT and ACT also completed assessments at 6 and 12 months following baseline. Assessments consisted of self-report measures, a public speaking task, and clinician ratings. Results Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-mo follow-up in CBT compared to ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control, and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes. Conclusions Implications for clinical practice and future research are discussed. PMID:24999670

Bullying and the Need to Belong: Early Adolescents' Bullying-Related Behavior and the Acceptance They Desire and Receive from Particular Classmates

ERIC Educational Resources Information Center

Olthof, Tjeert; Goossens, Frits A.

2008-01-01

Based on the notion that one of the motives underlying children's antisocial behavior is their need to belong to particular peers, it was examined how each of four types of bullying-related behavior would be related to the acceptance that 10 to 13-year-old children desired and received from same- and other-sex children with different…

Preschool children's taste acceptance of highly concentrated fluoride compounds: effects on nonverbal behavior.

PubMed

Kolb, Anne-Kathrin; Schmied, Kirsten; Fassheber, Peter; Heinrich-Weltzien, Roswitha

2013-01-01

The aim of this video-based study was to examine the taste acceptance of children between the ages of 2 and 5 years regarding highly concentrated fluoride preparations in kindergarten-based preventive programs. The fluoride preparation Duraphat was applied to 16 children, Elmex fluid to 15 children, and Fluoridin N5 to 14 children. The procedure was conducted according to a standardized protocol and videotaped Three raters evaluated the children's nonverbal behavior as a measure of taste acceptance on the Frankl Behavior Rating Scale. The interrater reliability (intraclass correlation coefficient; ICC) was .86. In an interview, children indicated the taste of the fluoride preparations on a three-point "smiley" rating scale. The interviewer used a hand puppet during the survey to establish confidence between the children and examiners. Children's nonverbal behavior was significantly more positive after Fluoridin N5 and Duraphat were applied compared to the application of Elmex fluid. The same trend was found during the smiley assessment. The response of children who displayed cooperative positive behavior before the application of fluoride preparations was significantly more positive than those who displayed uncooperative negative behavior. To achieve a high acceptance of the application of fluoride preparations among preschool children, flavorful preparations should be used.

A 12-week pilot study of acceptance of a computer-based chronic disease self-monitoring system among patients with type 2 diabetes mellitus and/or hypertension.

PubMed

Yan, Mian; Or, Calvin

2017-08-01

This study tested a structural model examining the effects of perceived usefulness, perceived ease of use, attitude, subjective norm, perceived behavioral control, health consciousness, and application-specific self-efficacy on the acceptance (i.e. behavioral intention and actual usage) of a computer-based chronic disease self-monitoring system among patients with type 2 diabetes mellitus and/or hypertension. The model was tested using partial least squares structural equation modeling, with 119 observations that were obtained by pooling data across three time points over a 12-week period. The results indicate that all of the seven constructs examined had a significant total effect on behavioral intention and explained 74 percent of the variance. Also, application-specific self-efficacy and behavioral intention had a significant total effect on actual usage and explained 17 percent of the variance. This study demonstrates that technology acceptance is determined by patient characteristics, technology attributes, and social influences. Applying the findings may increase the likelihood of acceptance.

Outcome Expectancy as a Predictor of Treatment Response in Cognitive Behavioral Therapy for Public Speaking Fears Within Social Anxiety Disorder

PubMed Central

Price, Matthew; Anderson, Page L.

2012-01-01

Outcome expectancy, the extent that clients anticipate benefiting from therapy, is theorized to be an important predictor of treatment response for cognitive–behavioral therapy. However, there is a relatively small body of empirical research on outcome expectancy and the treatment of social anxiety disorder. This literature, which has examined the association mostly in group-based interventions, has yielded mixed findings. The current study sought to further evaluate the effect of outcome expectancy as a predictor of treatment response for public-speaking fears across both individual virtual reality and group-based cognitive– behavioral therapies. The findings supported outcome expectancy as a predictor of the rate of change in public-speaking anxiety during both individual virtual reality exposure therapy and group cognitive– behavioral therapy. Furthermore, there was no evidence to suggest that the impact of outcome expectancy differed across virtual reality or group treatments. PMID:21967073

Ecological Momentary Interventions: Incorporating Mobile Technology Into Psychosocial and Health Behavior Treatments

PubMed Central

Heron, Kristin E.; Smyth, Joshua M.

2009-01-01

Purpose Psychosocial and health behavior treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These Ecological Momentary Interventions [EMI] are treatments that are provided to people during their everyday lives (i.e., in real time) and in natural settings (i.e., real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviors and psychological and physical symptoms. Methods Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. Results There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviors and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. Conclusions Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviors and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive. PMID:19646331

Structured dyadic behavior therapy processes for ADHD intervention.

PubMed

Curtis, David F

2014-03-01

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) present significant problems with behavioral disinhibition that often negatively affect their peer relationships. Although behavior therapies for ADHD have traditionally aimed to help parents and teachers better manage children's ADHD-related behaviors, therapy processes seldom use peer relationships to implement evidence-based behavioral principles. This article introduces Structured Dyadic Behavior Therapy as a milieu for introducing effective behavioral techniques within a socially meaningful context. Establishing collaborative behavioral goals, benchmarking, and redirection strategies are discussed to highlight how in-session dyadic processes can be used to promote more meaningful reinforcement and change for children with ADHD. Implications for improving patient care, access to care, and therapist training are also discussed.

Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study.

PubMed

Leonard, Noelle Regina; Silverman, Michelle; Sherpa, Dawa Phuti; Naegle, Madeline A; Kim, Hyorim; Coffman, Donna L; Ferdschneider, Marcy

2017-07-07

An increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors. The aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband. We recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected. Quantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified. Delivering intervention material "just-in-time," at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies. ©Noelle Regina Leonard, Michelle Silverman, Dawa Phuti Sherpa, Madeline A Naegle, Hyorim Kim, Donna L Coffman, Marcy Ferdschneider. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 07.07.2017.

Acceptance-Based versus Standard Behavioral Treatment for Obesity: Results from the Mind Your Health Randomized Controlled Trial

PubMed Central

Forman, Evan M.; Butryn, Meghan L.; Manasse, Stephanie M.; Crosby, Ross D.; Goldstein, Stephanie P.; Wyckoff, Emily P.; Thomas, J. Graham

2016-01-01

Objective To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT). Design and Methods Participants with overweight and obesity (n=190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator and moderator measurements were taken at baseline, 6 months and/or 12 months, and weight was also measured every session. Results Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83) than did those assigned to SBT (9.8% ± 0.87; p=.005). A condition by quadratic time effect on session-by-session weights (p=.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs 48.9%; p=.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges. Conclusion Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision making. PMID:27670400

Acceptance-based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial.

PubMed

Forman, Evan M; Butryn, Meghan L; Manasse, Stephanie M; Crosby, Ross D; Goldstein, Stephanie P; Wyckoff, Emily P; Thomas, J Graham

2016-10-01

To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT). Participants with overweight and obesity (n = 190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at baseline, 6 months, and/or 12 months, and weight was also measured every session. Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83%) than did those assigned to SBT (9.8% ± 0.87%; P = 0.005). A condition by quadratic time effect on session-by-session weights (P = 0.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs. 48.9%; P = 0.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges. Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision-making. © 2016 The Obesity Society.

Clinical Trial of Abstinence-Based Vouchers and Cognitive-Behavioral Therapy for Cannabis Dependence

ERIC Educational Resources Information Center

Budney, Alan J.; Moore, Brent A.; Rocha, Heath L.; Higgins, Stephen T.

2006-01-01

Ninety cannabis-dependent adults seeking treatment were randomly assigned to receive cognitive-behavioral therapy, abstinence-based voucher incentives, or their combination. Treatment duration was 14 weeks, and outcomes were assessed for 12 months post treatment. Findings suggest that (a) abstinence-based vouchers were effective for engendering…

Attachment-Based Family Therapy: "Adherence" and Differentiation

ERIC Educational Resources Information Center

Diamond, Gary M.; Diamond, Guy S.; Hogue, Aaron

2007-01-01

This study examined the fidelity of attachment-based family therapy (ABFT) for depressed adolescents. Trained observers used the therapist behavior rating scale (3rd version) to code therapist behaviors in 45 sessions of ABFT and 45 sessions each from two empirically based treatments for adolescent substance abusers: multidimensional family…

Assessing the feasibility, acceptability, and potential effectiveness of a behavioral-automaticity focused lifestyle intervention for African Americans with metabolic syndrome: The Pick two to Stick to protocol.

PubMed

Fritz, Heather; Brody, Aaron; Levy, Philip

2017-09-01

Metabolic syndrome (MetS) significantly increases the risk of developing diabetes and cardiovascular disease. Being physically active and eating a healthy diet can reduce MetS risk factors. Too frequently, however, studies report that the effects of interventions targeting those factors are not maintained once interventions are withdrawn. A potential solution to the problem is targeting behavioral automaticity (habit-development) to aid in initiation and maintenance of health-behavior changes. The Pick two to Stick To (P2S2), is an 8-week, theory-based hybrid (face-to-face/telecoaching) habit focused lifestyle intervention designed to increase healthful physical activity and dietary behavioral automaticity. The purpose of this article is to describe the rationale and protocol for evaluating the P2S2 program's feasibility, acceptability and potential effectiveness. Using a prospective, non-comparative design, the P2S2 program will be implemented by trained occupational therapy 'coaches' to 40 African Americans aged 40 and above with MetS recruited from the emergency department. Semi-structured interviews with participants, bi-weekly research meetings with study staff, and observations of intervention delivery will provide data for a process evaluation. Estimates of effectiveness include weight, blood pressure, waist circumference, BMI, and behavioral automaticity measures that will be collected at baseline and week 20. The P2S2 program could facilitate the development of healthful dietary and physical activity habits in an underserved population. Whether interventions aimed at changing habits can feasibly influence this automaticity, particularly for high-risk, low resource communities where other barriers exist, is not known. This pilot study, therefore, will fill an important gap, providing insight to inform subsequent trials.

Appetite-Focused Cognitive-Behavioral Therapy in the Treatment of Binge Eating with Purging

ERIC Educational Resources Information Center

Dicker, Stacy L.; Craighead, Linda Wilcoxon

2004-01-01

The first-line treatment for bulimia nervosa (BN), cognitive-behavioral therapy (CBT), uses food-based self-monitoring. Six young women presenting with BN or significant purging behavior were treated with a modification, Appetite-Focused CBT (CBT-AF), in which self-monitoring is based on appetite cues and food monitoring is proscribed. This change…

Survey of parental acceptance of massage therapy, energy therapy and acupuncture for their children in the acute pediatric inpatient rehabilitation setting.

PubMed

Rybczynski, Suzanne; Katz, Elana; Schultz, Scott; Salorio, Cynthia

2016-08-01

To examine factors that influence parents' decision to accept or decline complementary therapies on an inpatient rehabilitation unit. Parents of children aged 2-21 admitted for acute pediatric rehabilitation were provided a survey regarding their child's use of massage, energy therapy and acupuncture during admission. They were also asked about religious beliefs, education, perceived severity of injury and perceived response to the therapies. The study was conducted on the Inpatient Acute Pediatric Rehabilitation Unit at Kennedy Krieger Institute in Baltimore, Maryland, USA. Of those who completed the survey (n=38), 39% accepted massage services, 49% accepted energy therapy, and 16% accepted acupuncture for their child. Acceptance of massage services was significantly correlated with belonging to an organized religion (p<0.05). Participation in weekly religious services was associated with rejection of energy therapy (p<0.01). Prior parental experience with massage and acupuncture was associated with acceptance of these services for their child (p<0.01). Chronicity of condition and family education was not related to acceptance or rejection of services. Over 80% of parents felt massage and energy therapy helped the recovery process. In 63% of parents surveyed, acupuncture was felt to help the recovery process. Prior exposure to massage therapy and acupuncture was the most important factor in a parent accepting these services for their child. All three services were subjectively felt to have facilitated recovery. Future studies should assess subjective versus objective utility of these therapies in acute pediatric rehabilitation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Acceptance and Commitment Therapy versus Cognitive Therapy for the Treatment of Comorbid Eating Pathology

ERIC Educational Resources Information Center

Juarascio, Adrienne S.; Forman, Evan M.; Herbert, James D.

2010-01-01

Previous research has indicated that although eating pathology is prevalent in college populations, both CBT and non-CBT-based therapies achieve only limited effectiveness. The current study examined several questions related to the treatment of eating pathology within the context of a larger randomized controlled trial that compared standard CBT…

Inaccuracy of perceived competence ratings is associated with problem behaviors in 5-year-old children.

PubMed

Klaver, Jacqueline M; Palo, Amanda D; DiLalla, Lisabeth F

2014-01-01

The authors examined problem behaviors in preschool children as a function of perceived competence. Prior research has demonstrated a link between inaccuracy of self-perceptions and teacher-reported externalizing behaviors in preschool aged boys. This study extended past research by adding data collected from observed behaviors in a laboratory setting, as well as parent reports of internalizing and externalizing behaviors. Five-year-old children completed the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA) in the lab, participated in a 10-min puzzle interaction task with their cotwin and mother, and completed a short task assessing cognitive abilities. Children were grouped into 3 self-esteem categories (unrealistically low, realistic, and unrealistically high) based on comparisons of self-reported (PSPCSA) versus actual competencies for maternal acceptance, peer acceptance, and cognitive competence. Results showed that children who overreported their maternal acceptance and peer acceptance had significantly more parent-reported externalizing problems as well as internalizing problems. There were no significant differences in accuracy for cognitive competence. The findings from this study underscore the negative impact of unrealistically high self-appraisal on problem behaviors in young children.

Developing an Integrative Play Therapy Group Model for Middle School Male Students to Address Bullying Behaviors

ERIC Educational Resources Information Center

Jordan, Jakarla

2016-01-01

This research examines the systematic process of developing an integrative play therapy group model for middle school male students, ages 11-15 who participate in bullying behaviors. Play therapy approaches and evidence-based practices are documented as effective measures for addressing bullying behaviors with children and adolescents. This group…

Cognitive-Behavioral Therapy for Anxiety Disordered Youth: A Randomized Clinical Trial Evaluating Child and Family Modalities

ERIC Educational Resources Information Center

Kendall, Philip C.; Hudson, Jennifer L.; Gosch, Elizabeth; Flannery-Schroeder, Ellen; Suveg, Cynthia

2008-01-01

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9%…

Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes.

PubMed

Villatte, Jennifer L; Vilardaga, Roger; Villatte, Matthieu; Plumb Vilardaga, Jennifer C; Atkins, David C; Hayes, Steven C

2016-02-01

A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau-U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults. Copyright © 2015 Elsevier Ltd. All rights reserved.

Feasibility and Acceptability of Classroom-Based Interventions for Students with Emotional/Behavioral Challenges at the High School Level

ERIC Educational Resources Information Center

State, Talida M.; Harrison, Judith R.; Kern, Lee; Lewis, Timothy J.

2017-01-01

Little is known about the feasibility and acceptability of interventions designed to address the needs of high school students with emotional and behavioral challenges and adopted by their teachers. In this study, 336 general and special education teachers rated classwide interventions (e.g., expectations, routines, positive student-teacher…

Acceptability of online self-help to people with depression: users' views of MoodGYM versus informational websites.

PubMed

Schneider, Justine; Sarrami Foroushani, Pooria; Grime, Paul; Thornicroft, Graham

2014-03-28

Little is known about the factors that influence acceptability of and adherence to online psychological interventions. Evidence is needed to guide further development of promising programs. Our goal was to investigate users' views of two online approaches to self-help for depression: computerized cognitive behavior therapy (cCBT) and informational websites, in a workplace context. Computerized CBT offers an inexpensive and accessible alternative to face-to-face therapy, and employers have an interest in reducing the working time lost to depression or stress. Yet little is known about how employees, who have actual experience of using online approaches, judge the intervention as a process. The qualitative data reported here were collected within an online randomized controlled trial whose participants had diagnosable depression. The experimental intervention was a 5-week cCBT program called MoodGYM, and the control condition was five informational websites about mental health. Data were collected via online questionnaires. There was no evidence of the superiority of either in terms of treatment outcomes. In parallel, using brief rating scales and open-ended questions designed for this purpose, we examined the relative acceptability of each approach over time, including perceptions of cCBT compared to seeing a health care professional. At least 60% of participants held online therapy to be at least as acceptable as seeing a professional about mental health issues, and they were more likely to retain this opinion over time if they used the interactive program, MoodGYM, rather than informational websites alone. Barriers to cCBT use fell into four categories: intrinsic, intrapersonal problems; extrinsic technical problems; generic issues mostly pertaining to perceptions of cCBT; and specific issues about the intervention or control condition. These indicate strategies for improving engagement. As first-aid for mild to moderate mental health problems, evidence-based computerized approaches have broad acceptability. This could be increased by attending to the barriers noted here and by proactively managing users' expectations at individual and organizational levels. The findings have implications for occupational health providers and others addressing the needs of working-age adults with depression. They also raise methodological issues for online research. International Standard Randomized Controlled Trial Number (ISRCTN): 24529487; http://www.controlled-trials.com/ISRCTN24529487 (Archived by Webcite at http://www.webcitation.org/6O8cCL4mh).

Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety

PubMed Central

2014-01-01

Background Questions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety. Methods Of the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes. Results Findings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes. Conclusions Sustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation. PMID:25030651

Non-Pharmacological Approaches to Reducing Negative Behavioral Symptoms: A Scoping Review

PubMed Central

Wong, Carin; Leland, Natalie E.

2017-01-01

Background The management of negative behavioral symptoms among residents with dementia is a challenge that nursing homes face in delivering quality care. Objective Examine evidence documenting non-pharmacological interventions that reduce negative behavioral symptoms among nursing home residents with dementia and the role occupational therapy practitioners have in this area. Method A scoping review was completed for intervention studies published from 1987 to 2014, targeting negative behavioral symptoms among nursing home residents over 60 years of age with dementia. Interventions were categorized based on the AOTA Occupational Therapy Practice Framework. Results Twenty-two studies met the inclusion criteria. Four types of interventions were identified: occupation-based interventions, context and environment interventions, exercise interventions, and daily routine-based interventions. Conclusion The non-pharmacological interventions were found to align with the scope of occupational therapy. This suggests that occupational therapy practitioners can contribute to the development and evaluation of non-pharmacological interventions aimed to reduce negative behavioral symptoms. PMID:27504691

Head Motion Modeling for Human Behavior Analysis in Dyadic Interaction

PubMed Central

Xiao, Bo; Georgiou, Panayiotis; Baucom, Brian; Narayanan, Shrikanth S.

2015-01-01

This paper presents a computational study of head motion in human interaction, notably of its role in conveying interlocutors’ behavioral characteristics. Head motion is physically complex and carries rich information; current modeling approaches based on visual signals, however, are still limited in their ability to adequately capture these important properties. Guided by the methodology of kinesics, we propose a data driven approach to identify typical head motion patterns. The approach follows the steps of first segmenting motion events, then parametrically representing the motion by linear predictive features, and finally generalizing the motion types using Gaussian mixture models. The proposed approach is experimentally validated using video recordings of communication sessions from real couples involved in a couples therapy study. In particular we use the head motion model to classify binarized expert judgments of the interactants’ specific behavioral characteristics where entrainment in head motion is hypothesized to play a role: Acceptance, Blame, Positive, and Negative behavior. We achieve accuracies in the range of 60% to 70% for the various experimental settings and conditions. In addition, we describe a measure of motion similarity between the interaction partners based on the proposed model. We show that the relative change of head motion similarity during the interaction significantly correlates with the expert judgments of the interactants’ behavioral characteristics. These findings demonstrate the effectiveness of the proposed head motion model, and underscore the promise of analyzing human behavioral characteristics through signal processing methods. PMID:26557047

Effectiveness of Morita Therapy-Based Consultation for a School-Refusing Adolescent with Psychogenic Fever

ERIC Educational Resources Information Center

Maeda, Naoki

2017-01-01

Morita therapy, developed by Shoma Morita (1874-1938) in Japan, is a type of psychotherapy that has been applied to deal with neurotic symptoms. This therapeutic approach is based on the conviction that neurotic symptoms are universal issues that eventually subside if the symptoms are accepted and everyday activities are carried out. By examining…

Bacteriophage Therapy for Staphylococcus aureus Biofilm-Infected Wounds: A New Approach to Chronic Wound Care

DTIC Science & Technology

2013-02-01

J Am Coll Surg. 2012;215:388–399. 25. Carter MJ, Warriner RA III. Evidence - based medicine in wound care: Time for a new paradigm. Adv Skin Wound Care...therapy: Facts and fiction. Int J Med Microbiol. 2006;296:5–14. Evidence - Based Medicine : Questions and Answers Q: Will PRS still review, accept, and

Oral rehydration therapy: a community trial comparing the acceptability of homemade sucrose and cereal-based solutions.

PubMed

Chowdhury, A M; Karim, F; Rohde, J E; Ahmed, J; Abed, F H

1991-01-01

Sugar-based oral rehydration therapy (ORT) for diarrhoea is promoted in many countries of the world. One programme in Bangladesh has instructed more than 13 million mothers in the preparation of a sugar-salt solution in the home; despite very high rates of correct mixing and knowledge, subsequent application was found in only some 20% of all diarrhoea episodes. Since rice is far more available in rural homes (95%) than any type of sugar (30%) and rice gruel is a widely accepted food during illness, a field trial was conducted in three areas (total population, 68,345) to compare the acceptability and use of rice-based ORT with that of sugar-based ORT. Although the mothers unanimously agreed that the rice-based solutions "stopped" the diarrhoea more quickly, they used the sugar-based solutions twice as often (in 40% of severe watery episodes) as the rice-based solutions (in 18%), because the rice-ORT was much more time-consuming and difficult to prepare. The observed reduced utilization of home-made rice-ORT makes it a poor substitute for sugar-ORT at the community level in rural Bangladesh.

5 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices

MedlinePlus

... some evidence that mindfulness-based stress reduction and cognitive-behavioral therapy improves pain and functional limitation compared to usual ... pain found that mindfulness-based stress reduction and cognitive-behavioral therapy resulted in greater improvement in pain and functional ...

Evaluating a Web-Based Cognitive-Behavioral Therapy for Maladaptive Perfectionism in University Students

ERIC Educational Resources Information Center

Radhu, Natasha; Daskalakis, Zafiris J.; Arpin-Cribbie, Chantal A.; Irvine, Jane; Ritvo, Paul

2012-01-01

Objective: This study assessed a Web-based cognitive-behavioral therapy (CBT) for maladaptive perfectionism, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress. Participants: Participants were undergraduate students defined as maladaptive perfectionists through a screening questionnaire at an urban…

Marketing analysis of a positive technology app for the self-management of psychological stress.

PubMed

Wiederhold, Brenda K; Boyd, Chelsie; Sulea, Camelia; Gaggioli, Andrea; Riva, Giuseppe

2014-01-01

The INTERSTRESS project developed a completely new concept in the treatment of psychological stress: Interreality, a concept that combines cognitive behavioral therapy with a hybrid, closed-loop empowering experience bridging real and virtual worlds. This model provides the opportunity for individual citizens to become active participants in their own health and well-being. This article contains the results of the Marketing Trial and analysis of the opinions of individual consumers/end users of the INTERSTRESS product. The specific objective of this study was to evaluate the feasibility, efficacy and user acceptance of a novel mobile-based relaxation training tool in combination with biofeedback exercises and wearable biosensors. Relaxation was aided through immersion in a mobile virtual scenario (a virtual island) featuring pre-recorded audio narratives guiding a series of relaxation exercises. During biofeedback exercises, a wearable biosensor system provided data which directly modified the virtual reality experience in real-time. Thirty-six participants evaluated the product and overall feedback from users was positive, with some variation seen based on participant gender. A larger market study is now underway to understand if there are cultural variations in acceptability of the device.

Case Study: Successful Medication Withdrawal Using Cognitive-Behavioral Therapy for a Preadolescent with OCD

ERIC Educational Resources Information Center

Sallinen, Bethany J.; Nangle, Douglas W.; O'Grady, April C.

2004-01-01

The aim of this study was to evaluate the effectiveness of the addition of manual-based cognitive-behavioral therapy to a medication regimen of clomipramine and fluoxetine and the withdrawal of medication during cognitive-behavioral therapy. The participant was an 11-year-old girl with symptoms of obsessive thoughts about germs and illness and…

Linguistic and Cultural Adaptation of a Computer-Based Counseling Program (CARE+ Spanish) to Support HIV Treatment Adherence and Risk Reduction for People Living With HIV/AIDS: A Randomized Controlled Trial.

PubMed

Kurth, Ann E; Chhun, Nok; Cleland, Charles M; Crespo-Fierro, Michele; Parés-Avila, José A; Lizcano, John A; Norman, Robert G; Shedlin, Michele G; Johnston, Barbara E; Sharp, Victoria L

2016-07-13

Human immunodeficiency virus (HIV) disease in the United States disproportionately affects minorities, including Latinos. Barriers including language are associated with lower antiretroviral therapy (ART) adherence seen among Latinos, yet ART and interventions for clinic visit adherence are rarely developed or delivered in Spanish. The aim was to adapt a computer-based counseling tool, demonstrated to reduce HIV-1 viral load and sexual risk transmission in a population of English-speaking adults, for use during routine clinical visits for an HIV-positive Spanish-speaking population (CARE+ Spanish); the Technology Acceptance Model (TAM) was the theoretical framework guiding program development. A longitudinal randomized controlled trial was conducted from June 4, 2010 to March 29, 2012. Participants were recruited from a comprehensive HIV treatment center comprising three clinics in New York City. Eligibility criteria were (1) adults (age ≥18 years), (2) Latino birth or ancestry, (3) speaks Spanish (mono- or multilingual), and (4) on antiretrovirals. Linear and generalized mixed linear effects models were used to analyze primary outcomes, which included ART adherence, sexual transmission risk behaviors, and HIV-1 viral loads. Exit interviews were offered to purposively selected intervention participants to explore cultural acceptability of the tool among participants, and focus groups explored the acceptability and system efficiency issues among clinic providers, using the TAM framework. A total of 494 Spanish-speaking HIV clinic attendees were enrolled and randomly assigned to the intervention (arm A: n=253) or risk assessment-only control (arm B, n=241) group and followed up at 3-month intervals for one year. Gender distribution was 296 (68.4%) male, 110 (25.4%) female, and 10 (2.3%) transgender. By study end, 433 of 494 (87.7%) participants were retained. Although intervention participants had reduced viral loads, increased ART adherence and decreased sexual transmission risk behaviors over time, these findings were not statistically significant. We also conducted 61 qualitative exit interviews with participants and two focus groups with a total of 16 providers. A computer-based counseling tool grounded in the TAM theoretical model and delivered in Spanish was acceptable and feasible to implement in a high-volume HIV clinic setting. It was able to provide evidence-based, linguistically appropriate ART adherence support without requiring additional staff time, bilingual status, or translation services. We found that language preferences and cultural acceptability of a computer-based counseling tool exist on a continuum in our urban Spanish-speaking population. Theoretical frameworks of technology's usefulness for behavioral modification need further exploration in other languages and cultures. ClinicalTrials.gov NCT01013935; https://clinicaltrials.gov/ct2/show/NCT01013935 (Archived by WebCite at http://www.webcitation.org/6ikaD3MT7).

Cognitive-Behavioral Couple Therapies: Review of the Evidence for the Treatment of Relationship Distress, Psychopathology, and Chronic Health Conditions.

PubMed

Fischer, Melanie S; Baucom, Donald H; Cohen, Matthew J

2016-09-01

Cognitive-behavioral couple therapy (CBCT) is an approach to assisting couples that has strong empirical support for alleviating relationship distress. This paper provides a review of the empirical status of CBCT along with behavioral couple therapy (BCT), as well as the evidence for recent applications of CBCT principles to couple-based interventions for individual psychopathology and medical conditions. Several meta-analyses and major reviews have confirmed the efficacy of BCT and CBCT across trials in the United States, Europe, and Australia, and there is little evidence to support differential effectiveness of various forms of couple therapy derived from behavioral principles. A much smaller number of effectiveness studies have shown that successful implementation in community settings is possible, although effect sizes tend to be somewhat lower than those evidenced in randomized controlled trials. Adapted for individual problems, cognitive-behavioral couple-based interventions appear to be at least as effective as individual cognitive behavioral therapy (CBT) across a variety of psychological disorders, and often more effective, especially when partners are substantially involved in treatment. In addition, couple-based interventions tend to have the unique added benefit of improving relationship functioning. Findings on couple-based interventions for medical conditions are more varied and more complex to interpret given the greater range of target outcomes (psychological, relational, and medical variables). © 2016 Family Process Institute.

Humanistic therapies versus other psychological therapies for depression

PubMed Central

Churchill, Rachel; Davies, Philippa; Caldwell, Deborah; Moore, Theresa HM; Jones, Hannah; Lewis, Glyn; Hunot, Vivien

2014-01-01

This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all humanistic therapies compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of different humanistic therapy models (person-centred, gestalt, process-experiential, transactional analysis, existential and non-directive therapies) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all humanistic therapies compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression. PMID:25278809

Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness.

PubMed

Bhat, Amritha; Reed, Susan; Mao, Johnny; Vredevoogd, Mindy; Russo, Joan; Unger, Jennifer; Rowles, Roger; Unützer, Jürgen

2017-09-07

Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.

Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder.

PubMed

Price, Matthew; Anderson, Page L

2012-06-01

Outcome expectancy, the extent that clients anticipate benefiting from therapy, is theorized to be an important predictor of treatment response for cognitive-behavioral therapy. However, there is a relatively small body of empirical research on outcome expectancy and the treatment of social anxiety disorder. This literature, which has examined the association mostly in group-based interventions, has yielded mixed findings. The current study sought to further evaluate the effect of outcome expectancy as a predictor of treatment response for public-speaking fears across both individual virtual reality and group-based cognitive-behavioral therapies. The findings supported outcome expectancy as a predictor of the rate of change in public-speaking anxiety during both individual virtual reality exposure therapy and group cognitive-behavioral therapy. Furthermore, there was no evidence to suggest that the impact of outcome expectancy differed across virtual reality or group treatments. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study.

PubMed

Pagoto, Sherry; Tulu, Bengisu; Agu, Emmanuel; Waring, Molly E; Oleski, Jessica L; Jake-Schoffman, Danielle E

2018-06-20

Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps. This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss. Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks. Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively). Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery. ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2). ©Sherry Pagoto, Bengisu Tulu, Emmanuel Agu, Molly E Waring, Jessica L Oleski, Danielle E Jake-Schoffman. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.06.2018.

Empirical Testing of a Theoretical Extension of the Technology Acceptance Model: An Exploratory Study of Educational Wikis

ERIC Educational Resources Information Center

Liu, Xun

2010-01-01

This study extended the technology acceptance model and empirically tested the new model with wikis, a new type of educational technology. Based on social cognitive theory and the theory of planned behavior, three new variables, wiki self-efficacy, online posting anxiety, and perceived behavioral control, were added to the original technology…

Findings of VA/DoD CPG on CAM Therapies for PTSD

DTIC Science & Technology

2011-01-26

reaching than formal diagnoses – Suicide, adjustment problems, relationship & family problems, divorce, risky behaviors , etc. 2011 MHS Conference PTSD...restructuring; or stress inoculation training B •Imagery Rehearsal Therapy C •Patient Education •Psychodynamic Therapy • Hypnosis •Relaxation...Techniques •Group Therapy I •Family Therapy •Web-based CBT •Dialectical Behavioral 2011 MHS Conference PTSD Treatment: Pharmacotherapy SR

Group cognitive behavior therapy for Japanese patients with social anxiety disorder: preliminary outcomes and their predictors

PubMed Central

Chen, Junwen; Nakano, Yumi; Ietzugu, Tetsuji; Ogawa, Sei; Funayama, Tadashi; Watanabe, Norio; Noda, Yumiko; Furukawa, Toshi A

2007-01-01

Background A number of studies have provided strong evidence for the use of cognitive behavior therapy (CBT) in the treatment of social anxiety disorder (SAD). However, all of the previous reports were from Europe and North America and it is unknown whether Western psychological therapies are effective for SAD in non-Western cultures. The present pilot study aimed to evaluate CBT program for SAD which was originally developed for Western patients, among Japanese patients. Methods Fifty-seven outpatients who participated in group CBT for SAD were evaluated using eight self-reported and one clinician-administered questionnaires to measure various aspects of SAD symptomatology at the beginning and at the end of the program. Pre- and post-treatment scores were compared and the magnitude of treatment effect was quantified as well based once on the intention-to-treat (ITT) and once among the completers only. We also examined baseline predictors of the CBT outcomes. Results Seven patients (12%) did not complete the program. For the ITT sample, the percentage of reduction was 20% to 30% and the pre to post treatment effect sizes ranged from 0.37 to 1.01. Among the completers, the respective figures were 20% to 33% and 0.41 to 1.19. We found no significant pretreatment predictor of the outcomes. Conclusion Group CBT for SAD is acceptable and can bring about a similar degree of symptom reduction among Japanese patients with SAD as among Western patients. PMID:18067685

The credibility of exposure therapy: Does the theoretical rationale matter?

PubMed

Arch, Joanna J; Twohig, Michael P; Deacon, Brett J; Landy, Lauren N; Bluett, Ellen J

2015-09-01

Little is understood about how the public perceives exposure-based therapy (ET) for treating anxiety and trauma-related disorders or how ET rationales affect treatment credibility. Distinct approaches to framing ET are practiced, including those emphasized in traditional cognitive behavioral therapy, acceptance and commitment therapy, and the more recent inhibitory learning model. However, their relative effect on ET's credibility remains unknown. A final sample of 964 U.S. adults provided baseline views of ET. Participants rated ET treatment credibility following a simple ET definition (pre-rationale) and following randomization to rationale modules addressing ET goals, fear, and cognitive strategies from distinct theoretical perspectives (post-rationale). Baseline ET views, symptoms, and sociodemographic characteristics were examined as putative moderators and predictors. At baseline, the majority had never heard of ET. From pre- to post-rationale, ET treatment credibility significantly increased but the rationales' theoretical perspective had little impact. More negative baseline ET views, specific ethnic/racial minority group status, and lower education moderated or predicted greater increases in treatment credibility following the rationale. ET remains relatively unknown as a treatment for anxiety or trauma, supporting the need for direct-to-consumer marketing. Diverse theory-driven rationales similarly increased ET credibility, particularly among those less likely to use ET. Copyright © 2015 Elsevier Ltd. All rights reserved.

A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders.

PubMed

Shawyer, Frances; Farhall, John; Mackinnon, Andrew; Trauer, Tom; Sims, Eliza; Ratcliff, Kirk; Larner, Chris; Thomas, Neil; Castle, David; Mullen, Paul; Copolov, David

2012-02-01

Command hallucinations represent a special problem for the clinical management of psychosis. While compliance with both non-harmful and harmful commands can be problematic, sometimes in the extreme, active efforts to resist commands may also contribute to their malignancy. Previous research suggests Cognitive Behaviour Therapy (CBT) to be a useful treatment for reducing compliance with harmful command hallucinations. The purpose of this trial was to evaluate whether CBT augmented with acceptance-based strategies from Acceptance and Commitment Therapy could more broadly reduce the negative impact of command hallucinations. Forty-three participants with problematic command hallucinations were randomized to receive 15 sessions of the intervention "TORCH" (Treatment of Resistant Command Hallucinations) or the control, Befriending, then followed up for 6 months. A sub-sample of 17 participants was randomized to a waitlist control before being allocated to TORCH or Befriending. Participants engaged equally well with both treatments. Despite TORCH participants subjectively reporting greater improvement in command hallucinations compared to Befriending participants, the study found no significant group differences in primary and secondary outcome measures based on blinded assessment data. Within-group analyses and comparisons between the combined treatments and waitlist suggested, however, that both treatments were beneficial with a differential pattern of outcomes observed across the two conditions. Copyright © 2011 Elsevier Ltd. All rights reserved.

Cognitive-behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: Results of a randomized clinical trial.

PubMed

Losada, Andrés; Márquez-González, María; Romero-Moreno, Rosa; Mausbach, Brent T; López, Javier; Fernández-Fernández, Virginia; Nogales-González, Celia

2015-08-01

The differential efficacy of acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) for dementia family caregivers' is analyzed through a randomized controlled trial. Participants were 135 caregivers with high depressive symptomatology who were randomly allocated to the intervention conditions or a control group (CG). Pre-, postintervention, and follow-up measurements assessed depressive symptomatology, anxiety, leisure, dysfunctional thoughts, and experiential avoidance. Depression: Significant effects of interventions compared with CG were found for CBT (p < .001, d = 0.98, number needed to treat [NNT] = 3.61) and ACT (p < .001, d = 1.17, NNT = 3.53) at postintervention, but were maintained only at follow-up for CBT (p = .02, d = 0.74, NNT = 9.71). Clinically significant change was observed in 26.7% participants in CBT, 24.2% in ACT, and 0% in CG. At follow-up, 10.53% in CBT and 4% in ACT were recovered (0% CG). Anxiety: At postintervention, ACT participants showed lower anxiety than CBT participants (p < .05, d = 0.50) and CG participants (p < .01, d = 0.79, NNT = 3.86), with no effects at follow-up. At postintervention, 23.33% in CBT, 36.36% in ACT, and 6.45% in CG showed clinically significant change. At follow-up, 26.32% in CBT, 36% in ACT, and 13.64% in CG were recovered. Significant changes at postintervention were found in leisure and dysfunctional thoughts in both ACT and CBT, with changes in experiential avoidance only for ACT. Similar results were obtained for ACT and CBT. ACT seems to be a viable and effective treatment for dementia caregivers. (c) 2015 APA, all rights reserved).

Facing Your Fears in Adolescence: Cognitive-Behavioral Therapy for High-Functioning Autism Spectrum Disorders and Anxiety

PubMed Central

Reaven, Judy; Blakeley-Smith, Audrey; Leuthe, Eileen; Moody, Eric; Hepburn, Susan

2012-01-01

Adolescents with high-functioning autism spectrum disorders (ASDs) are at high risk for developing psychiatric symptoms, with anxiety disorders among the most commonly cooccurring. Cognitive behavior therapies (CBTs) are considered the best practice for treating anxiety in the general population. Modified CBT approaches for youth with high-functioning ASD and anxiety have resulted in significant reductions in anxiety following intervention. The purpose of the present study was to develop an intervention for treating anxiety in adolescents with ASD based on a CBT program designed for school-aged children. The Facing Your Fears-Adolescent Version (FYF-A) program was developed; feasibility and acceptability data were obtained, along with initial efficacy of the intervention. Twenty-four adolescents, aged 13–18, completed the FYF-A intervention. Results indicated significant reductions in anxiety severity and interference posttreatment, with low rates of anxiety maintained at 3-month follow-up. In addition, nearly 46% of teen participants met criteria for a positive treatment response on primary diagnosis following the intervention. Initial findings from the current study are encouraging and suggest that modified group CBT for adolescents with high-functioning ASD may be effective in reducing anxiety symptoms. Limitations include small sample size and lack of control group. Future directions are discussed. PMID:23091719

[Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin].

PubMed

Agustí, Cristina; Martín-Rabadán, María; Zarco, José; Aguado, Cristina; Carrillo, Ricard; Codinachs, Roger; Carmona, Jose Manuel; Casabona, Jordi

2018-03-01

To estimate the prevalence of HIV infection in patients diagnosed with an indicator condition (IC) for HIV and/or risk behavior for their acquisition and/or coming from high prevalence countries. To determine the acceptability and feasibility of offering HIV testing based on IC and behavioral and origin criteria in Primary Care (PC). Cross-sectional study in a convenience sample. Six PC centers in Spain. The inclusion criteria were: patients between 16 and 65years old who presented at least one of the proposed ICs and/or at least one of the proposed behavioral and/or origin criteria. A total of 388 patients participated. HIV serology was offered to all patients who met the inclusion criteria. Description of IC frequency, behavioral and origin criteria. Prevalence of HIV infection. Level of acceptability and feasibility of the HIV screening based on IC and behavioral and origin criteria. A total of 174 patients had an IC (44.84%). The most common behavioral criterion was: having unprotected sex at some time in life with people who did not know their HIV status (298; 76.8%). Four HIV+ patients (1.03%) were diagnosed. All had an IC and were men who had sex with men. The level of acceptability in PC was high. Offering HIV testing to patients with IC and behavioral criteria is feasible and effective in PC. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Understanding occupational therapy students' attitudes, intentions, and behaviors regarding community service.

PubMed

Hoppes, Steve; Hellman, Chan M

2007-01-01

Community-based practice has always been a central domain of occupational therapy, and evidence supporting its increasing importance is growing. Preparing occupational therapy students for community practice has received considerable attention in professional literature, but students' voices have seldom been heard concerning this issue. This study sought to investigate attitudes, intentions, and behaviors regarding community service among occupational therapy students enrolled in one professional program using the Community Service Attitudes Survey. We present the Theory of Planned Behavior as a conceptual framework linking students' attitudes and intentions with behaviors. Results indicate that these occupational therapy students' attitudes and intentions regarding community service tended to be more strongly positive than those of their counterparts in other allied health disciplines; however, the community service behaviors of occupational therapy students were not significantly different from those of other allied health students, possibly because occupational therapy students perceived high costs to community service.

Incremental Validity and Informant Effect from a Multi-Method Perspective: Assessing Relations between Parental Acceptance and Children’s Behavioral Problems

PubMed Central

Izquierdo-Sotorrío, Eva; Holgado-Tello, Francisco P.; Carrasco, Miguel Á.

2016-01-01

This study examines the relationships between perceived parental acceptance and children’s behavioral problems (externalizing and internalizing) from a multi-informant perspective. Using mothers, fathers, and children as sources of information, we explore the informant effect and incremental validity. The sample was composed of 681 participants (227 children, 227 fathers, and 227 mothers). Children’s (40% boys) ages ranged from 9 to 17 years (M = 12.52, SD = 1.81). Parents and children completed both the Parental Acceptance Rejection/Control Questionnaire (PARQ/Control) and the check list of the Achenbach System of Empirically Based Assessment (ASEBA). Statistical analyses were based on the correlated uniqueness multitrait-multimethod matrix (model MTMM) by structural equations and different hierarchical regression analyses. Results showed a significant informant effect and a different incremental validity related to which combination of sources was considered. A multi-informant perspective rather than a single one increased the predictive value. Our results suggest that mother–father or child–father combinations seem to be the best way to optimize the multi-informant method in order to predict children’s behavioral problems based on perceived parental acceptance. PMID:27242582

Incremental Validity and Informant Effect from a Multi-Method Perspective: Assessing Relations between Parental Acceptance and Children's Behavioral Problems.

PubMed

Izquierdo-Sotorrío, Eva; Holgado-Tello, Francisco P; Carrasco, Miguel Á

2016-01-01

This study examines the relationships between perceived parental acceptance and children's behavioral problems (externalizing and internalizing) from a multi-informant perspective. Using mothers, fathers, and children as sources of information, we explore the informant effect and incremental validity. The sample was composed of 681 participants (227 children, 227 fathers, and 227 mothers). Children's (40% boys) ages ranged from 9 to 17 years (M = 12.52, SD = 1.81). Parents and children completed both the Parental Acceptance Rejection/Control Questionnaire (PARQ/Control) and the check list of the Achenbach System of Empirically Based Assessment (ASEBA). Statistical analyses were based on the correlated uniqueness multitrait-multimethod matrix (model MTMM) by structural equations and different hierarchical regression analyses. Results showed a significant informant effect and a different incremental validity related to which combination of sources was considered. A multi-informant perspective rather than a single one increased the predictive value. Our results suggest that mother-father or child-father combinations seem to be the best way to optimize the multi-informant method in order to predict children's behavioral problems based on perceived parental acceptance.

Adherence and competence in two manual-guided therapies for co-occurring substance use and posttraumatic stress disorders: clinician factors and patient outcomes.

PubMed

Meier, Andrea; McGovern, Mark P; Lambert-Harris, Chantal; McLeman, Bethany; Franklin, Anna; Saunders, Elizabeth C; Xie, Haiyi

2015-01-01

The challenges of implementing and sustaining evidence-based therapies into routine practice have been well-documented. This study examines the relationship among clinician factors, quality of therapy delivery, and patient outcomes. Within a randomized controlled trial, 121 patients with current co-occurring substance use and posttraumatic stress disorders were allocated to receive either manualized Integrated Cognitive Behavioral Therapy (ICBT) or Individual Addiction Counseling (IAC). Twenty-two clinicians from seven addiction treatment programs were trained and supervised to deliver both therapies. Clinician characteristics were assessed at baseline; clinician adherence and competence were assessed over the course of delivering both therapies; and patient outcomes were measured at baseline and 6-month follow-up. Although ICBT was delivered at acceptable levels, clinicians were significantly more adherent to IAC (p < 0.05). At session 1, clinical female gender (p < 0.05) and lower education level (p < 0.05) were predictive of increased clinician adherence and competence across both therapies. Adherence and competence at session 1 in either therapy were significantly predictive of positive patient outcomes. ICBT adherence (p < 0.05) and competence (p < 0.01) were predictive of PTSD symptom reduction, whereas IAC adherence (p < 0.01) and competence (p < 0.01) were associated with decreased drug problem severity. The differential impact of adherence and competence for both therapy types is consistent with their purported primary target: ICBT for PTSD and IAC for substance use. These findings also suggest the benefits of considering clinician factors when implementing manual-guided therapies. Future research should focus on diverse clinician samples, randomization of clinicians to therapy type, and prospective designs to evaluate models of supervision and quality monitoring.

Rational Constraints and the Evolution of Fairness in the Ultimatum Game.

PubMed

Tomlin, Damon

2015-01-01

Behavior in the Ultimatum Game has been well-studied experimentally, and provides a marked contrast between the theoretical model of a self-interested economic agent and that of an actual human concerned with social norms such as fairness. How did such norms evolve, when punishing unfair behavior can be costly to the punishing agent? The work described here simulated a series of Ultimatum Games, in which populations of agents earned resources based on their preferences for proposing and accepting (or rejecting) offers of various sizes. Two different systems governing the acceptance or rejection of offers were implemented. Under one system, the probability that an agent accepted an offer of a given size was independent of the probabilities of accepting the other possible offers. Under the other system, a simple, ordinal constraint was placed on the acceptance probabilities such that a given offer was at least as likely to be accepted as a smaller offer. For simulations under either system, agents' preferences and their corresponding behavior evolved over multiple generations. Populations without the ordinal constraint came to emulate maximizing economic agents, while populations with the constraint came to resemble the behavior of human players.

[Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline].

PubMed

Köllner, V; Häuser, W; Klimczyk, K; Kühn-Becker, H; Settan, M; Weigl, M; Bernardy, K

2012-06-01

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. Cognitive behavioral therapy combined with aerobic exercise (multicomponent therapy) is strongly recommended. Relaxation as single therapy should not be applied. The English full-text version of this article is available at SpringerLink (under "Supplemental").

The future of music in therapy and medicine.

PubMed

Thaut, Michael H

2005-12-01

The understanding of music's role and function in therapy and medicine is undergoing a rapid transformation, based on neuroscientific research showing the reciprocal relationship between studying the neurobiological foundations of music in the brain and how musical behavior through learning and experience changes brain and behavior function. Through this research the theory and clinical practice of music therapy is changing more and more from a social science model, based on cultural roles and general well-being concepts, to a neuroscience-guided model based on brain function and music perception. This paradigm shift has the potential to move music therapy from an adjunct modality to a central treatment modality in rehabilitation and therapy.

Optimizing Cognitive-Behavioral Therapy for Childhood Psychiatric Disorders

ERIC Educational Resources Information Center

Piacentini, John

2008-01-01

Reports that expand the understanding of the treatment of childhood obsessive-compulsive disorder by using exposure-based cognitive-behavioral therapy in the age group of 5 to 8-year-olds are presented. A model for collecting the common core elements of evidence-based psychosocial treatments for childhood disorders is also presented.

Targeting Fear of Spiders with Control-, Acceptance-, and Information-Based Approaches

ERIC Educational Resources Information Center

Wagener, Alexandra L.; Zettle, Robert D.

2011-01-01

The relative impact of control-, acceptance-, and information-based approaches in targeting a midlevel fear of spiders among college students was evaluated. Participants listened to a brief protocol presenting one of the three approaches before completing the Perceived-Threat Behavioral Approach Test (PT-BAT; Cochrane, Barnes-Holmes, &…

Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder: A Pilot Study.

PubMed

Greenberg, Jennifer L; Mothi, Suraj Sarvode; Wilhelm, Sabine

2016-03-01

Body dysmorphic disorder (BDD) is a relatively common and severe disorder that typically onsets in adolescence, but often goes unrecognized. Despite BDD's severity and early onset, treatment outcome research on adolescent BDD is scarce. Cognitive-behavioral therapy is the gold-standard psychosocial treatment for BDD in adults and has shown promise in adolescents. The current study examined the development and testing of a new CBT for adolescents with BDD. We tested feasibility, acceptability, and treatment outcome in a sample of 13 adolescents (mean age 15.23years, range: 13-17) with primary BDD. Treatment was delivered in 12-22 weekly individual sessions. Standardized clinician ratings and self-report measures were used to assess BDD and related symptoms pre- and posttreatment and at 3- and 6-months follow-up. At posttreatment, BDD and related symptoms (e.g., insight, mood) were significantly improved. Scores on the Yale-Brown Obsessive Compulsive Scale for BDD indicated a 50% (intent-to-treat) and 68% (completer) improvement in BDD symptoms. Seventy-five percent of adolescents who started treatment and 100% of completers were considered treatment responders. Treatment gains were maintained at follow-up. High patient satisfaction ratings and patient feedback indicated that treatment was acceptable. This represents the largest study of a psychosocial treatment for adolescent BDD. Copyright © 2015. Published by Elsevier Ltd.

The Empirically Supported Status of Acceptance and Commitment Therapy: An Update

ERIC Educational Resources Information Center

Smout, Matthew F.; Hayes, Louise; Atkins, Paul W. B.; Klausen, Jessica; Duguid, James E.

2012-01-01

Acceptance and commitment therapy (ACT) is a transdiagnostic cognitive behavioural therapy that predominantly teaches clients acceptance and mindfulness skills, as well as values clarification and enactment skills. Australian treatment guideline providers have been cautious in recognising ACT as empirically supported. This article reviews evidence…

A Review and Empirical Comparison of Two Treatments for Adolescent Males with Conduct and Personality Disorder: Mode Deactivation Therapy and Cognitive Behavior Therapy

ERIC Educational Resources Information Center

Apsche, Jack A.; Bass, Christopher K.; Jennings, Jerry L.; Siv, Alexander M.

2005-01-01

This research study compared the efficacy of two treatment methodologies for adolescent males in residential treatment with conduct disorders and/or personality dysfunctions and documented problems with physical and sexual aggression. The results showed that Mode Deactivation Therapy, an advanced form of cognitive behavioral therapy based on…

Empirical Comparison of Three Treatments for Adolescent Males with Physical and Sexual Aggression: Mode Deactivation Therapy, Cognitive Behavior Therapy and Social Skills Training

ERIC Educational Resources Information Center

Apsche, Jack A.; Bass, Christopher K.; Jennings, Jerry L.; Murphy, Christopher J.; Hunter, Linda A.; Siv, Alexander M.

2005-01-01

This research study compared the efficacy of three treatment methodologies for adolescent males in residential treatment with conduct disorders and/or personality dysfunctions and documented problems with physical and sexual aggression. The results showed that Mode Deactivation Therapy, an advanced form of cognitive behavioral therapy based on…

The Effect of Emotional Feedback on Behavioral Intention to Use Computer Based Assessment

ERIC Educational Resources Information Center

Terzis, Vasileios; Moridis, Christos N.; Economides, Anastasios A.

2012-01-01

This study introduces emotional feedback as a construct in an acceptance model. It explores the effect of emotional feedback on behavioral intention to use Computer Based Assessment (CBA). A female Embodied Conversational Agent (ECA) with empathetic encouragement behavior was displayed as emotional feedback. More specifically, this research aims…

A single-arm pilot study of guided self-help treatment based cognitive behavioral therapy for bulimia nervosa in Japanese clinical settings.

PubMed

Setsu, R; Asano, K; Numata, N; Tanaka, M; Ibuki, H; Yamamoto, T; Uragami, R; Matsumoto, J; Hirano, Y; Iyo, M; Shimizu, E; Nakazato, M

2018-04-25

Guided self-help treatments based on cognitive behavioral therapy (CBT-GSH) are regarded as a first-line effective treatment for bulimia nervosa (BN). With limited application for CBT-GSH in Japanese clinical settings, we conducted a single arm pilot study in order to confirm the acceptability and availability of CBT-GSH in Japan. 25 women with BN received 16-20 sessions of face-to-face CBT-GSH. Primary outcomes were the completion rate of intervention and abstinence rates from objective bingeing and purging as assessed by the Eating Disorder Examination. Secondary outcomes were other self-report measurements of the frequency of bingeing and purging, and characteristic psychopathologies of eating disorders. Assessments were conducted before CBT as baseline as well as after CBT. 92% (23/25) of the participants completed the CBT sessions. After CBT-GSH, 40% (10/25) of the participants (intention-to-treat) achieved symptom abstinence. The mean binge and purge episodes during the previous 28 days improved from 21.88 to 10.96 (50% reduction) and from 22.44 to 10.88 (52% reduction), each (before CBT-GSH to after CBT-GSH), and the within-group effect sizes were medium (Cohen's d = 0.67, 0.65, each). Our study provided a preliminary evidence about the feasibility of CBT-GSH in Japanese clinical settings for the future. Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 10, 2013 (registration ID: UMIN000011120).

Memory modification as an outcome variable in anxiety disorder treatment.

PubMed

Tryon, Warren W; McKay, Dean

2009-05-01

Learning and memory are interdependent processes. Memories are learned, and cumulative learning requires memory. It is generally accepted that learning contributes to psychopathology and consequently to pertinent memory formation. Neuroscience and psychological research have established that memory is an active reconstructive process that is influenced by thoughts, feelings, and behaviors including post-event information. Recent research on the treatment of anxiety disorders using medications (i.e., d-cyclcloserine) to alter neurological systems associated with memory used in conjunction with behavior therapy suggests that memory is part of a central mechanism in the etiology and maintenance of these conditions. The main thesis of this article is that learning-based interventions create new memories that may modify existing ones. This raises the possibility of using such memory modifications to measure intervention outcome. A connectionist context for understanding this phenomenon and informing intervention is provided, with specific reference to post-traumatic stress disorder, obsessive-compulsive disorder, and generalized anxiety disorder. Recommendations for future research examining the role of memory change in treatment outcome are suggested.

Altering impulsive decision making with an acceptance-based procedure.

PubMed

Morrison, Kate L; Madden, Gregory J; Odum, Amy L; Friedel, Jonathan E; Twohig, Michael P

2014-09-01

Delay discounting is one facet of impulsive decision making and involves subjectively devaluing a delayed outcome. Steeply discounting delayed rewards is correlated with substance abuse and other problematic behaviors. To the extent that steep delay discounting underlies these clinical disorders, it would be advantageous to find psychosocial avenues for reducing delay discounting. Acceptance-based interventions may prove useful as they may help to decrease the distress that arises while waiting for a delayed outcome. The current study was conducted to determine if a 60-90 minute acceptance-based training would change delay discounting rates among 30 undergraduate university students in comparison to a waitlist control. Measures given at pre- and posttraining included a hypothetical monetary delay discounting task, the Acceptance and Action Questionnaire-II (AAQ-II), and the Distress Tolerance Scale. Those assigned to the treatment group decreased their discounting of delayed money, but not distress intolerance or psychological inflexibility when compared to the waitlist control group. After the waiting period, the control group received the intervention. Combining all participants' pre- to posttreatment data, the acceptance-based treatment significantly decreased discounting of monetary rewards and increased distress tolerance. The difference in AAQ-II approached significance. Acceptance-based treatments may be a worthwhile option for decreasing delay discounting rates and, consequently, affecting the choices that underlie addiction and other problematic behaviors. Copyright © 2014. Published by Elsevier Ltd.

Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder

ERIC Educational Resources Information Center

Lindenboim, Noam; Comtois, Katherine Anne; Linehan, Marsha M.

2007-01-01

Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients' practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according…

Introduction to "The Behavior-Analytic Origins of Constraint-Induced Movement Therapy: An Example of Behavioral Neurorehabilitation"

ERIC Educational Resources Information Center

Schaal, David W.

2012-01-01

This article presents an introduction to "The Behavior-Analytic Origins of Constraint-Induced Movement Therapy: An Example of Behavioral Neurorehabilitation," by Edward Taub and his colleagues (Taub, 2012). Based on extensive experimentation with animal models of peripheral nerve injury, Taub and colleagues have created an approach to overcoming…

[Acceptance and commitment therapy (ACT) and addiction: a literature review].

PubMed

De Groot, F; Morrens, M; Dom, G

2014-01-01

Acceptance and commitment therapy (ACT) is a recent form of cognitive behavioural therapy, based on the relational frame theory (RFT). act is being used to treat a wide range of problems, including addiction. To review the literature on the use of act to treat addiction. We searched the literature systematically using PubMed en Psycinfo. We found 16 studies, 10 of which were rct's. Eight studies dealt with drug problems or mixed substance problems, 7 studies focused on cigarette smoking, and only 1 publication concerned alcohol treatment. The majority of studies reported positive results for act following treatment and at follow-up. Although more research is needed, act is shown itself to be a promising treatment for addiction.

Gold Nanoparticles as a Photothermal Agent in Cancer Therapy: The Thermal Ablation Characteristic Length.

PubMed

Grosges, Thomas; Barchiesi, Dominique

2018-05-31

In cancer therapy, the thermal ablation of diseased cells by embedded nanoparticles is one of the known therapies. It is based on the absorption of the energy of the illuminating laser by nanoparticles. The resulting heating of nanoparticles kills the cell where these photothermal agents are embedded. One of the main constraints of this therapy is preserving the surrounding healthy cells. Therefore, two parameters are of interest. The first one is the thermal ablation characteristic length, which corresponds to an action distance around the nanoparticles for which the temperature exceeds the ablation threshold. This critical geometric parameter is related to the expected conservation of the body temperature in the surroundings of the diseased cell. The second parameter is the temperature that should be reached to achieve active thermal agents. The temperature depends on the power of the illuminating laser, on the size of nanoparticles and on their physical properties. The purpose of this paper is to propose behavior laws under the constraints of both the body temperature at the boundary of the cell to preserve surrounding cells and an acceptable range of temperature in the target cell. The behavior laws are deduced from the finite element method, which is able to model aggregates of nanoparticles. We deduce sensitivities to the laser power and to the particle size. We show that the tuning of the temperature elevation and of the distance of action of a single nanoparticle is not significantly affected by variations of the particle size and of the laser power. Aggregates of nanoparticles are much more efficient, but represent a potential risk to the surrounding cells. Fortunately, by tuning the laser power, the thermal ablation characteristic length can be controlled.

Long-term cost-effectiveness of cognitive behavioral therapy versus psychodynamic therapy in social anxiety disorder.

PubMed

Egger, Nina; Konnopka, Alexander; Beutel, Manfred E; Herpertz, Stephan; Hiller, Wolfgang; Hoyer, Juergen; Salzer, Simone; Stangier, Ulrich; Strauss, Bernhard; Willutzki, Ulrike; Wiltink, Joerg; Leibing, Eric; Leichsenring, Falk; König, Hans-Helmut

2016-12-01

To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective. This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves. In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs. If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential. © 2016 Wiley Periodicals, Inc.

Life-crossroads on stage: integrating life review and drama therapy for older adults.

PubMed

Keisari, Shoshi; Palgi, Yuval

2017-10-01

This paper examines the contribution of a new group of therapeutic interventions for older adults, based on a rudimentary life-review intervention. The intervention includes narrative elements together with drama therapy. The current study examines the influence of this therapeutic intervention on key indicators of mental health and psychological well-being among older adults. Fifty-five people (n = 55), ranging in age from 62 to 93, participated in a before-after study design. The following indices - meaning in life, self-acceptance, relationships with others, depressive symptoms, and experience of successful aging - were compared between an intervention group (n = 27) and a care-as-usual control group (n = 28). Repeated measures analyses of variance showed a significant improvement over time in the experimental group. In addition, results also showed time-group interaction regarding the treatment's effectiveness for self-acceptance, relationships with others, sense of meaning in life, sense of successful aging, and depressive symptoms. Our findings confirm that the new therapeutic intervention, which integrates life-review with drama therapy, increases self-acceptance, relationships with others, sense of meaning in life, and sense of successful aging; in turn, it also decreases depressive symptoms among older adults. The contribution of this research is based on the development of a therapeutic intervention that combines narrative together with drama therapy tools, which can be used in focused and short-term group treatments with the elderly.

The effect of acceptance training on psychological and physical health outcomes in elders with chronic conditions.

PubMed

McDonald, Patricia E; Zauszniewski, Jaclene A; Bekhet, Abir K; DeHelian, Laura; Morris, Diana L

2011-12-01

This pilot trial investigated the short and long-term effects of Acceptance Training (ACT) intervention on acceptance, perceived health, functional status, anxiety, and depression in elders with chronic conditions living in retirement communities (RCs). The ACT intervention combined Rational Emotive Behavior Therapy with music, relaxation, and guided imagery during six weekly 2-hour sessions. Face-to-face interviews were conducted with 16 African-American and 46 White elders across four data collection points in six randomly selected RCs using well-established measures of perceived health, functional status, anxiety, and depression, and a measure of acceptance of chronic conditions adapted from a previous measure of acceptance of diabetes. While changes were found in perceived health, functional status, anxiety, and depression, the most significant changes occurred in the elders' acceptance of chronic conditions immediately after the intervention (t = -2.62, p < .02), and these changes persisted for 6 and 12 weeks (t's = -2.74, -3.32, p's < .01), respectively. Although a 40% attrition rate reduced the sample size from 62 (N = 62) to 37 (N = 37), the significant increases in acceptance over time provide initial evidence for the fidelity of the ACT intervention.

The Effect of Acceptance Training on Psychological and Physical Health Outcomes in Elders with Chronic Conditions

PubMed Central

McDonald, Patricia E.; Zauszniewski, Jaclene A.; Bekhet, Abir K.; DeHelian, Laura; Morris, Diana L.

2012-01-01

This pilot trial investigated the short and long-term effects of Acceptance Training (ACT) intervention on acceptance, perceived health, functional status, anxiety, and depression in elders with chronic conditions living in retirement communities (RCs). The ACT intervention combined Rational Emotive Behavior Therapy with music, relaxation, and guided imagery during six weekly 2-hour sessions. Face-to-face interviews were conducted with 16 African-American and 46 White elders across four data collection points in six randomly selected RCs using well-established measures of perceived health, functional status, anxiety, and depression, and a measure of acceptance of chronic conditions adapted from a previous measure of acceptance of diabetes. While changes were found in perceived health, functional status, anxiety, and depression, the most significant changes occurred in the elders’ acceptance of chronic conditions immediately after the intervention (t = −2.62, p < .02), and these changes persisted for 6 and 12 weeks (t’s = −2.74, −3.32, p’s < .01), respectively. Although a 40% attrition rate reduced the sample size from 62 (N = 62) to 37 (N = 37), the significant increases in acceptance over time provide initial evidence for the fidelity of the ACT intervention. PMID:23061175

Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems in outpatient child and adolescent mental health services in New Zealand: study protocol for a randomized controlled trial.

PubMed

Lucassen, Mathijs F G; Stasiak, Karolina; Crengle, Sue; Weisz, John R; Frampton, Christopher M A; Bearman, Sarah Kate; Ugueto, Ana M; Herren, Jennifer; Cribb-Su'a, Ainsleigh; Faleafa, Monique; Kingi-'Ulu'ave, Denise; Loy, Jik; Scott, Rebecca M; Hartdegen, Morgyn; Merry, Sally N

2015-10-12

Mental health disorders are common and disabling for young people because of the potential to disrupt key developmental tasks. Implementation of evidence-based psychosocial therapies in New Zealand is limited, owing to the inaccessibility, length, and cost of training in these therapies. Furthermore, most therapies address one problem area at a time, although comorbidity and changing clinical needs commonly occur in practice. A more flexible approach is needed. The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is designed to overcome these challenges; it provides a range of treatment modules addressing different problems, within a single training program. A clinical trial of MATCH-ADTC in the USA showed that MATCH-ADTC outperformed usual care and standard evidence-based treatment on several clinical measures. We aim to replicate these findings and evaluate the impact of providing training and supervision in MATCH-ADTC to: (1) improve clinical outcomes for youth attending mental health services; (2) increase the amount of evidence-based therapy content; (3) increase the efficiency of service delivery. This is an assessor-blinded multi-site effectiveness randomized controlled trial. Randomization occurs at two levels: (1) clinicians (≥60) are randomized to intervention or usual care; (2) youth participants (7-14 years old) accepted for treatment in child and adolescent mental health services (with a primary disorder that includes anxiety, depression, trauma-related symptoms, or disruptive behavior) are randomly allocated to receive MATCH-ADTC or usual care. Youth participants are recruited from 'mainstream', Māori-specific, and Pacific-specific child and adolescent mental health services. We originally planned to recruit 400 youth participants, but this has been revised to 200 participants. Centralized computer randomization ensures allocation concealment. The primary outcome measures are: (i) the difference in trajectory of change of clinical severity between groups (using the parent-rated Brief Problem Monitor); (ii) clinicians' use of evidence-based treatment procedures during therapy sessions; (iii) total time spent by clinicians delivering therapy. If MATCH-ADTC demonstrates effectiveness it could offer a practical efficient method to increase access to evidence-based therapies, and improve outcomes for youth attending secondary care services. Australian and New Zealand Clinical Trials Registry ACTRN12614000297628 .

Occupational Therapy in the Neonatal Intensive Care Unit for a Neonate with Perinatal Stroke: A Case Report.

PubMed

Roan, Cecilia; Bell, Alison

2017-08-01

This case report describes an occupational therapy intervention based on synactive theory for a neonate born full-term with a diagnosis of perinatal stroke. Occupational therapy was provided 4-5 times a week for 3 weeks. The focus was improving infant state regulation and motor skills to support developmentally appropriate behaviors through environmental modifications, positioning, guided progression of sensory stimulation, and promotion of motor and postural skills. At discharge on day 24, the infant had improved state regulation, behavioral organization, and motor performance. Occupational therapy based on synactive theory was an effective therapeutic approach for improving the behavioral and motor organization of a full term infant diagnosed with perinatal stroke.

A Review and Empirical Comparison of Three Treatments for Adolescent Males with Conduct and Personality Disorder: Mode Deactivation Therapy, Cognitive Behavior Therapy and Social Skills Training

ERIC Educational Resources Information Center

Apsche, Jack A.; Bass, Christopher K.

2006-01-01

This research study compared the efficacy of three treatment methodologies for adolescent males in residential treatment with conduct disorders and/or personality dysfunctions and documented problems with physical and sexual aggression. The results showed that Mode Deactivation Therapy, an advanced form of cognitive behavioral therapy based on…

Cognitive-Behavioral Therapy for Adolescents with Inflammatory Bowel Disease and Subsyndromal Depression

ERIC Educational Resources Information Center

Szigethy, Eva; Kenney, Elyse; Carpenter, Johanna; Hardy, Diana M.; Fairclough, Diane; Bousvaros, Athos; Keljo, David; Weisz, John; Beardslee, William R.; Noll, Robert; DeMaso, David Ray

2007-01-01

Objective: To examine the feasibility and efficacy of a manual-based cognitive-behavioral therapy (CBT) in reducing depressive symptomatology in adolescents with inflammatory bowel disease (IBD). Primary and Secondary Control Enhancement Therapy-Physical Illness(PASCET-PI) modified for youths with IBD was compared to treatment as usual (TAU), plus…

Pilot Evaluation of the Feasibility and Acceptability of StressOFF Strategies: A Single-Session School-Based Stress Management Program for Adolescents

ERIC Educational Resources Information Center

Shapiro, Amy J.; Heath, Nancy L.; Carsley, Dana

2016-01-01

The present study reports the pilot evaluation of the feasibility and acceptability of StressOFF Strategies, a "single-session" (45 min) adolescent-targeted, school-based psychoeducational program, which introduces cognitive behavioral techniques and mindfulness-based techniques. Five hundred and sixty-five Grade 9 students (57% female;…

Experiential Therapy with Troubled Youth: The Ropes Course for Adolescent Inpatients.

ERIC Educational Resources Information Center

Blanchard, Charles W.

This paper provides information about conducting adventure-based counseling using a ropes course with adolescent psychiatric inpatients. Active learning in the process of therapy is widely accepted, but it is not clear how the complex nature of that relationship works and how programs should be structured to facilitate change. Theoretical…

Advantages and Challenges of A Village Doctor-Based Cognitive Behavioral Therapy for Late-Life Depression in Rural China: A Qualitative Study

PubMed Central

Tang, Tan; Yang, Xuemei; Zhang, Weijun; Wang, Xiaohua; Ji, Li; Xiao, Yun; Ma, Kun; Wang, Ying; Kong, Xianglei; Wang, Jianping; Liu, Jun; Xu, Qian; Tian, Donghua; Qu, Zhiyong

2015-01-01

Background The delivery of mental health services in rural China has been notably limited due to lack of qualified mental health professionals among other impeding factors. A village doctor-based cognitive behavioral therapy intervention may be one way of improving accessibility. The purpose of this study was to explore the advantages and challenges of implementing this intervention, as delivered by trained village doctors, to treat late-life depression in rural China. Methods We conducted one focus group discussion with 10 village doctors, 10 individual interviews with each of the village doctors, and individual interviews with 19 older adults. The topic guides were advantages and challenges of the intervention program from the perspective of the village doctors and older adults. Interviews were audio-recorded, transcribed, coded using NVivo 8, and analyzed using thematic analysis. Results The village doctors stressed the importance of role-playing and using instructive manuals in the training. Proper supervision was also a key component of the program. The benefits received from the intervention for the village doctors and the elders were positive such that both the doctors and the older adults were willing to implement/receive this intervention. Cultural and political factors (renqing and perceived policy consideration) facilitated the elders’ access to mental health services. Challenges included a lack of real therapy (in contrast to role-playing) demonstrated in the training and lack of a step-by-step manual based on different types of problems encountered. Other impediments to the successful implementation of the intervention included the time constraints of village doctors and the presence of other people when conducting the intervention. Conclusions The present study has demonstrated that the intervention program is likely to be an acceptable geriatric depression intervention in rural China if several challenges are appropriately addressed. PMID:26371473

The Effectiveness of the Harm Reduction Group Therapy Based on Bandura's Self-Efficacy Theory on Risky Behaviors of Drug-Dependent Sex Worker Women.

PubMed

Rabani-Bavojdan, Marjan; Rabani-Bavojdan, Mozhgan; Rajabizadeh, Ghodratollah; Kaviani, Nahid; Bahramnejad, Ali; Ghaffari, Zohreh; Shafiei-Bafti, Mehdi

2017-07-01

The aim of this study was to investigate the effectiveness of the harm reduction group therapy based on Bandura's self-efficacy theory on risky behaviors of sex workers in Kerman, Iran. A quasi-experimental two-group design (a random selection with pre-test and post-test) was used. A risky behaviors questionnaire was used to collect. The sample was selected among sex workers referring to drop-in centers in Kerman. Subjects were allocated to two groups and were randomly classified into two experimental and control groups. The sample group consisted of 56 subjects. The experimental design was carried out during 12 sessions, and the post-test was performed one month and two weeks after the completion of the sessions. The results were analyzed statistically. By reducing harm based on Bandura's self-efficacy theory, the risky behaviors of the experimental group, including injection behavior, sexual behavior, violence, and damage to the skin, were significantly reduced in the pre-test compared to the post-test (P < 0.010). The harm reduction group therapy based on Bandura's self-efficacy theory can reduce the risky behaviors of sex workers.

Adapting cognitive behavioral therapy for psychosis for case managers: increasing access to services in a community mental health agency.

PubMed

Montesano, Vicki L; Sivec, Harry J; Munetz, Mark R; Pelton, Jeremy R; Turkington, Douglas

2014-03-01

The purpose of this article is twofold: (a) to describe the adaptation of an evidence-based practice and, (b) using a dissemination framework, to describe the process of implementing the practice at a community mental health agency. The authors describe the training concept and dissemination framework of implementing an emerging practice: high-yield cognitive behavioral techniques for psychosis, which is rooted in cognitive behavioral therapy. Thirteen case managers who represented teams from across the agency delivered the adapted practice at a community mental health agency. Implementation required buy in from all stakeholders, communication across disciplines, persistence, and flexibility. It appears that the use of a dissemination framework that is grounded in the literature, yet flexible, eases the process of implementing an adapted practice. Further research focusing on the effectiveness of this approach, along with the impact of implementing a full spectrum of cognitive behavioral therapy services for individuals with persistent psychotic symptoms, based on cognitive behavioral therapy principles, is indicated.

Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study.

PubMed

Apolinário-Hagen, Jennifer; Harrer, Mathias; Kählke, Fanny; Fritsche, Lara; Salewski, Christel; Ebert, David Daniel

2018-05-15

Internet interventions have been proposed to improve the accessibility and use of evidence-based psychological treatments. However, little is known about attitudes toward such treatments, which can be an important barrier to their use. This study aimed to (1) determine attitudes toward guided internet interventions, (2) assess its acceptability compared with other internet-based formats, and (3) explore predictors of acceptance. A convenience-sample Web-based survey (N=646) assessed attitudes toward guided internet therapies (ie, perceived usefulness and helpfulness, and advantage relative to face-to-face therapy), preferences for delivery modes (ie, e-preference: guided internet interventions, unguided internet interventions, or videoconferencing psychotherapy), and potential predictors of attitudes and preferences: sociodemographics, help-seeking-related variables, attachment style, and perceived stress. Although most participants perceived internet interventions as useful or helpful (426/646, 65.9%), a few indicated their advantage relative to face-to-face therapy (56/646, 8.7%). Most participants preferred guided internet interventions (252/646, 39.0%) over videoconferencing psychotherapy (147/646, 22.8%), unguided internet interventions (124/646, 19.2%), and not using internet interventions (121/646, 18.8%; missing data: 1/646, 0.2%). Attachment avoidance and stress were related to e-preference (all P<.05). Moreover, preference for therapist-guided internet interventions was higher for individuals who were aware of internet-based treatment (χ 2 6 =12.8; P=.046). Participants assessed therapist-guided internet interventions as helpful, but not equivalent to face-to-face therapies. The vast majority (523/646, 81.0%) of the participants were potentially willing to use internet-based approaches. In lieu of providing patients with only one specific low-intensity treatment, implementation concepts should offer several options, including guided internet interventions, but not limited to them. Conversely, our results also indicate that efforts should focus on increasing public knowledge about internet interventions, including information about their effectiveness, to promote acceptance and uptake. ©Jennifer Apolinário-Hagen, Mathias Harrer, Fanny Kählke, Lara Fritsche, Christel Salewski, David Daniel Ebert. Originally published in JMIR Mental Health (http://mental.jmir.org), 15.05.2018.

[Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family].

PubMed

Bohnacker, Isabelle; Goldbeck, Lutz

2017-10-01

Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family The possibility and relevance of a joint trauma-therapy with siblings has yet received little attention in research and clinical practice. The following case study presents a joint family-based trauma-focused therapy process with a refugee family. All three siblings suffered from post-traumatic stress disorder (PTSD) before treatment. The treatment followed the manual of Trauma Focused Cognitive Behavioral Therapy (TF-CBT; Cohen, Mannarino, Deblinger, 2009). Measures were the short version of the Child and Adolescent Trauma Screen (CATS 7-17), as well as the Teacher's Report Form (TRF). After 18 treatment sessions together with the mother, all three children did no longer meet PTSD criteria. Benefits of the joint therapy were for all three siblings to be sharing and imitating each other's coping strategies. Furthermore, the protective factor of social support after experiencing a traumatic event became evident. The apprehension of the therapist not being sufficiently neutral towards all three siblings was not observed.

The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study

PubMed Central

Nararro-Haro, Maria V.; Hoffman, Hunter G.; Garcia-Palacios, Azucena; Sampaio, Mariana; Alhalabi, Wadee; Hall, Karyn; Linehan, Marsha

2016-01-01

Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resources. Most patients with BPD never receive DBT®. Incorporating computer technology into the DBT® could help increase dissemination. Immersive Virtual Reality technology (VR) is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly “floating down” a 3D computer-generated river while listening to DBT® mindfulness training audios. Urges to commit suicide, urges to self harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session and VR mindfulness was well accepted/liked by the patient. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT® skills treatment modules would reduce cost and increase dissemination. PMID:27853437

The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study.

PubMed

Nararro-Haro, Maria V; Hoffman, Hunter G; Garcia-Palacios, Azucena; Sampaio, Mariana; Alhalabi, Wadee; Hall, Karyn; Linehan, Marsha

2016-01-01

Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resources. Most patients with BPD never receive DBT®. Incorporating computer technology into the DBT® could help increase dissemination. Immersive Virtual Reality technology (VR) is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly "floating down" a 3D computer-generated river while listening to DBT® mindfulness training audios. Urges to commit suicide, urges to self harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session and VR mindfulness was well accepted/liked by the patient. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT® skills treatment modules would reduce cost and increase dissemination.

Behavioural therapies versus other psychological therapies for depression

PubMed Central

Churchill, Rachel; Caldwell, Deborah; Moore, Theresa HM; Davies, Philippa; Jones, Hannah; Lewis, Glyn; Hunot, Vivien

2014-01-01

This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all BT approaches compared with all other psychological therapy approaches for acute depressionTo examine the effectiveness and acceptability of different BT approaches (behavioural therapy, behavioural activation, social skills training and relaxation training) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all BT approaches compared with different psychological therapy approaches (psychodynamic, humanistic, integrative, cognitive-behavioural and third wave CBT) for acute depression. PMID:25067905

Sleep Disorders in Patients with Post-Traumatic Stress Disorder.

PubMed

El-Solh, Ali A; Riaz, Usman; Roberts, Jasmine

2018-04-20

A growing body of evidence supports a bidirectional relationship between post-traumatic stress disorder (PTSD) and sleep disturbances. Fragmented sleep induced by sleep-related breathing disorders, insomnia, and nightmares impacts recovery and treatment outcomes and worsens PTSD symptoms. Despite recent attention, management of these disorders has been unrewarding in the setting of PTSD. This review summarizes the evidence for empirically supported treatments of these sleep ailments as it relates to PTSD including psychotherapeutic and pharmacologic interventions. Recent advances in positive airway pressure technology have made treatment of OSA more acceptable however adherence to CPAP represents a significant challenge. The presence of concomitant insomnia, which engenders psychiatric and medical conditions including depression, suicide, alcohol and substance abuse, can be managed with cognitive behavioral therapy (CBT). Hypnotic agents are considered an alternative therapy but concerns about adverse events and lack of high level evidence supporting their efficacy in PTSD have limited their use to resistant cases or as adjunct to behavioral therapy when the response is less than desirable. Intrusion of nightmares can complicate PTSD treatment and exert serious strain on social, occupational and marital relations. Image rehearsal therapy has shown significant reduction in nightmares intensity and frequency. The success of noradrenergic blocking agents has not been consistent among studies with half reporting treatment failure. An integrated stepped care approach that includes components of both behavioral and pharmacologic interventions customized to patients sleep maladaptive behaviors may offer a solution to delivering accessible, effective, and efficient services for individuals with PTSD. Copyright © 2018. Published by Elsevier Inc.

Telephone-Administered Cognitive Behavioral Therapy for Veterans Served by Community-Based Outpatient Clinics

ERIC Educational Resources Information Center

Mohr, David C.; Carmody, Timothy; Erickson, Lauren; Jin, Ling; Leader, Julie

2011-01-01

Objective: Multiple trials have found telephone-administered cognitive behavioral therapy (T-CBT) to be effective for the treatment of depression. The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics (CBOCs) outside of major urban areas. Method: Eighty-five veterans…

The Effects of a Brief Acceptance-Based Behavioral Treatment Versus Traditional Cognitive-Behavioral Treatment for Public Speaking Anxiety: An Exploratory Trial Examining Differential Effects on Performance and Neurophysiology.

PubMed

Glassman, Lisa H; Forman, Evan M; Herbert, James D; Bradley, Lauren E; Foster, Elizabeth E; Izzetoglu, Meltem; Ruocco, Anthony C

2016-09-01

Individuals with public speaking anxiety (PSA) experience fear and avoidance that can cause extreme distress, impaired speaking performance, and associated problems in psychosocial functioning. Most extant interventions for PSA emphasize anxiety reduction rather than enhancing behavioral performance. We compared the efficacy of two brief cognitive-behavioral interventions, a traditional cognitive-behavior treatment (tCBT) and an acceptance-based behavior treatment (ABBT), on public speaking performance and anxiety in a clinical sample of persons with PSA. The effects of treatment on prefrontal brain activation were also examined. Participants (n = 21) were randomized to 90 min of an ABBT or a tCBT intervention. Assessments took place at pre- and post-treatment and included self-rated anxiety and observer-rated performance measures, a behavioral assessment, and prefrontal cortical activity measurements using functional near-infrared spectroscopy (fNIRS). Exploratory results indicated that participants in the ABBT condition experienced greater improvements in observer-rated performance relative to those in the tCBT condition, while those in the tCBT condition experienced greater reductions in subjective anxiety levels. Individuals in the ABBT condition also exhibited a trend toward greater treatment-related reductions in blood volume in the left dorsolateral prefrontal cortex relative to those who received tCBT. Overall, these findings preliminarily suggest that acceptance-based treatments may free more cognitive resources in comparison with tCBT, possibly resulting in greater improvements in objectively rated behavioral performances for ABBT interventions. © The Author(s) 2016.

User-controlled photographic animations, photograph-based questions, and questionnaires: three Internet-based instruments for measuring drivers' risk-taking behavior.

PubMed

Horswill, M S; Coster, M E

2001-02-01

The Internet has been exploited successfully in the past as a medium for behavioral research. This paper presents a series of studies designed to assess Internet-based measures of drivers' risk-taking behavior. First, we compared responses from an Internet sample with a traditional pencil-and-paper sample using established questionnaire measures of risk taking. No significant differences were found. Second, we assessed the validity of new Internet-based instruments, involving photographs and photographic animations, that measured speed, gap acceptance, and passing. Responses were found to reflect known demographic patterns of actual behavior to some degree. Also, a roadside survey of speeds was carried out at the locations depicted in the photographic measure of speeding and, with certain exceptions, differences between the two appeared to be constant. Third, a between-subject experimental manipulation involving the photographic animation measure of gap acceptance was used to demonstrate one application of these techniques.

The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: associations to symptom severity, treatment course, and outcome.

PubMed

Helbig-Lang, Sylvia; Richter, Jan; Lang, Thomas; Gerlach, Alexander L; Fehm, Lydia; Alpers, Georg W; Ströhle, Andreas; Kircher, Tilo; Deckert, Jürgen; Gloster, Andrew T; Wittchen, Hans-Ulrich

2014-12-01

The potentially detrimental effects of safety behaviors during exposure therapy are still subject to debate. Empirical findings are inconsistent, and few studies have investigated effects of idiosyncratic safety behavior manifestations during exposure or in everyday life. These limitations might be due to a lack of appropriate measures that address individual safety behaviors. We examined psychometric properties and predictive value of the Texas Safety Maneuver Scale (TSMS), a questionnaire specifically targeting safety behaviors in panic disorder and agoraphobia. Effects of safety behavior use, both during everyday life and during therapy, were examined using data from a multicenter RCT of N=268 patients that aimed at evaluating efficacy and mechanisms of action of two variants of an exposure-based therapy. The TSMS total score demonstrated good internal consistency (α=0.89), and it showed significant correlations with selected measures of baseline anxiety and impairment. The proposed factor structure could not be replicated. Frequent safety behavior use at baseline was associated with actual safety behavior during exposure exercises. Pronounced in-situ safety behavior, but not baseline safety behavior was associated to detrimental treatment outcome. The results underline the relevance of a rigorous safety behavior assessment in therapy. The actual relationship between safety behavior use and treatment outcome is yet to determine. Copyright © 2014 Elsevier Ltd. All rights reserved.

Neural correlates of emotion acceptance vs worry or suppression in generalized anxiety disorder

PubMed Central

Barlow, David H.; Whitfield-Gabrieli, Susan; Gabrieli, John D.E.; Deckersbach, Thilo

2017-01-01

Abstract Recent emotion dysregulation models of generalized anxiety disorder (GAD) propose chronic worry in GAD functions as a maladaptive attempt to regulate anxiety related to uncertain or unpredictable outcomes. Emotion acceptance is an adaptive emotion regulation strategy increasingly incorporated into newer cognitive behavioral therapy (CBT) approaches to GAD to counter chronic worry. The current study explores the mechanisms of emotion acceptance as an alternate emotion regulation strategy to worry or emotion suppression using functional magnetic resonance imaging. Twenty-one female participants diagnosed with GAD followed counterbalanced instructions to regulate responses to personally relevant worry statements by engaging in either emotion acceptance, worry or emotion suppression. Emotion acceptance resulted in lower ratings of distress than worry and was associated with increased dorsal anterior cingulate cortex (dACC) activation and increased ventrolateral prefrontal cortex (VLPFC)-amygdala functional connectivity. In contrast, worry showed significantly greater distress ratings than acceptance or suppression and was associated with increased precuneus, VLPFC, amygdala and hippocampal activation. Suppression did not significantly differ from acceptance in distress ratings or amygdala recruitment, but resulted in significantly greater insula and VLPFC activation and decreased VLPFC-amygdala functional connectivity. Emotion acceptance closely aligned with activation and connectivity patterns reported in studies of contextual extinction learning and mindful awareness. PMID:28402571

Neural reorganization accompanying upper limb motor rehabilitation from stroke with virtual reality-based gesture therapy.

PubMed

Orihuela-Espina, Felipe; Fernández del Castillo, Isabel; Palafox, Lorena; Pasaye, Erick; Sánchez-Villavicencio, Israel; Leder, Ronald; Franco, Jorge Hernández; Sucar, Luis Enrique

2013-01-01

Gesture Therapy is an upper limb virtual reality rehabilitation-based therapy for stroke survivors. It promotes motor rehabilitation by challenging patients with simple computer games representative of daily activities for self-support. This therapy has demonstrated clinical value, but the underlying functional neural reorganization changes associated with this therapy that are responsible for the behavioral improvements are not yet known. We sought to quantify the occurrence of neural reorganization strategies that underlie motor improvements as they occur during the practice of Gesture Therapy and to identify those strategies linked to a better prognosis. Functional magnetic resonance imaging (fMRI) neuroscans were longitudinally collected at 4 time points during Gesture Therapy administration to 8 patients. Behavioral improvements were monitored using the Fugl-Meyer scale and Motricity Index. Activation loci were anatomically labelled and translated to reorganization strategies. Strategies are quantified by counting the number of active clusters in brain regions tied to them. All patients demonstrated significant behavioral improvements (P < .05). Contralesional activation of the unaffected motor cortex, cerebellar recruitment, and compensatory prefrontal cortex activation were the most prominent strategies evoked. A strong and significant correlation between motor dexterity upon commencing therapy and total recruited activity was found (r2 = 0.80; P < .05), and overall brain activity during therapy was inversely related to normalized behavioral improvements (r2 = 0.64; P < .05). Prefrontal cortex and cerebellar activity are the driving forces of the recovery associated with Gesture Therapy. The relation between behavioral and brain changes suggests that those with stronger impairment benefit the most from this paradigm.

Pilot Study of Community-Based Cognitive Behavioral Group Therapy for Adolescents with Social Phobia.

ERIC Educational Resources Information Center

Baer, Susan; Garland, E. Jane

2005-01-01

Objective: A pilot study to evaluate the efficacy of a cognitive-behavioral group therapy program for adolescents with social phobia, simplified both in terms of time and labor intensity from a previously studied program (Social Effectiveness Therapy for Children and Adolescents) to be more appropriate for a community outpatient psychiatric…

Child- And Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorder: Development and Preliminary Results.

ERIC Educational Resources Information Center

Pavuluri, Mani N.; Graczyk, Patricia A.; Henry, David B.; Carbray, Julie A.; Heidenreich, Jodi; Miklowitz, David J.

2004-01-01

Objective: To describe child- and family-focused cognitive-behavioral therapy (CFF-CBT), a new developmentally sensitive psychosocial intervention for pediatric bipolar disorder (PBD) that is intended for use along with medication. CFF-CBT integrates principles of family-focused therapy with those of CBT. The theoretical framework is based on (1)…

Speech-language pathology telehealth in rural and remote schools: the experience of school executive and therapy assistants.

PubMed

Fairweather, Glenn C; Lincoln, Michelle A; Ramsden, Robyn

2017-01-01

Difficulties in accessing allied health services, especially in rural and remote areas, appear to be driving the use of telehealth services to children in schools. The objectives of this study were to investigate the experiences and views of school executive staff and therapy assistants regarding the feasibility and acceptability of a speech-language pathology telehealth program for children attending schools in rural and remote New South Wales, Australia. The program, called Come N See, provided therapy interventions remotely via low-bandwidth videoconferencing, with email follow-up. Over a 12-week period, children were offered therapy blocks of six fortnightly sessions, each lasting a maximum of 30 minutes. School executives (n=5) and therapy assistants (n=6) described factors that promoted or threatened the program's feasibility and acceptability, during semistructured interviews. Thematic content analysis with constant comparison was applied to the transcribed interviews to identify relationships in the data. Emergent themes related to (a) unmet speech pathology needs, (b) building relationships, (c) telehealth's advantages, (d) telehealth's disadvantages, (e) anxiety replaced by joy and confidence in growing skills, and (f) supports. School executive staff and therapy assistants verified that the delivery of the school-based telehealth service was feasible and acceptable. However, the participants saw significant opportunities to enhance this acceptability through building into the program stronger working relationships and supports for stakeholders. These findings are important for the future development of allied health telehealth programs that are sustainable as well as effective and fit the needs of all crucial stakeholders. The results have significant implications for speech pathology clinical practice relating to technology, program planning and teamwork within telehealth programs.

Assessing fidelity to evidence-based practices in usual care: the example of family therapy for adolescent behavior problems.

PubMed

Hogue, Aaron; Dauber, Sarah

2013-04-01

This study describes a multimethod evaluation of treatment fidelity to the family therapy (FT) approach demonstrated by front-line therapists in a community behavioral health clinic that utilized FT as its routine standard of care. Study cases (N=50) were adolescents with conduct and/or substance use problems randomly assigned to routine family therapy (RFT) or to a treatment-as-usual clinic not aligned with the FT approach (TAU). Observational analyses showed that RFT therapists consistently achieved a level of adherence to core FT techniques comparable to the adherence benchmark established during an efficacy trial of a research-based FT. Analyses of therapist-report measures found that compared to TAU, RFT demonstrated strong adherence to FT and differentiation from three other evidence-based practices: cognitive-behavioral therapy, motivational interviewing, and drug counseling. Implications for rigorous fidelity assessments of evidence-based practices in usual care settings are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

The effectiveness of training acceptance / commitment and training emotion regulation on high-risk behaviors of students with dyscalculia.

PubMed

Narimani, Mohammad; Abbasi, Moslem; Abolghasemi, Abbas; Ahadi, Batoul

2013-09-01

Now a days the utilization of Acceptance / Commitment and Emotion Regulation Strategy as a comprehensive treatment plan has been discussed in both the prevention and the control of destructive and risky behaviors. Treatment based on Acceptance/Commitment and Emotion Regulation was effective in both the improvement and the control of high-risk behaviors of students with dyscalculia. The purpose of this study was to investigate the effectiveness of Acceptance and Commitment, and Emotional Regulation training in high-risk behaviors of students with dyscalculia. This research was experimental, with pre-test, post-test and a control group. The statistical universe of this study included all sixth-grade male students in Ardabil city in the academic year of 2012-2013 (A.H.). The subjects of this study involved 800 sixth-grade elementary students in Ardabil province, selected using a multi-stage cluster sampling. From among them, 60 students with dyscalculia were selected using random sampling method after the initial diagnosis by structured clinical interview and the Keymath Mathematic test. Twenty pupil were selected for either the experimental or the control group. To collect data, the questionnaires of "Keymath Mathematic test" and High-risk Behavior" were used. The results of Multivariate Analysis of Variance (MANOVA) showed that "Acceptance / Commitment and Emotion Regulation" treatment trainings were effective in reducing high-risk behaviors, in a manner that they led to a reduction in negative emotions, self-destructive and impulsive behaviors of students with math disorder (dyscalculia). It can be concluded that teaching these skills to the students has been influential in enhancing awareness level and change or positive attitude creation in the subjects. Therefore, it is essential to design and implement interventions based on "prevention caused by the peer group, in collaboration with the parents either at the school or at home among the family members".

Study protocol for a randomized, controlled, superiority trial comparing the clinical and cost- effectiveness of integrated online mental health assessment-referral-care in pregnancy to usual prenatal care on prenatal and postnatal mental health and infant health and development: the Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT).

PubMed

Kingston, Dawn; Austin, Marie-Paule; Hegadoren, Kathy; McDonald, Sheila; Lasiuk, Gerri; McDonald, Sarah; Heaman, Maureen; Biringer, Anne; Sword, Wendy; Giallo, Rebecca; Patel, Tejal; Lane-Smith, Marie; van Zanten, Sander Veldhuyzen

2014-03-06

Stress, depression, and anxiety affect 15 to 25% of pregnant women. However, fewer than 20% of prenatal care providers assess and treat mental health problems and fewer than 20% of pregnant women seek mental healthcare. For those who seek treatment, the lack of health system integration and existing barriers frequently prevent treatment access. Without treatment, poor prenatal mental health can persist for years and impact future maternal, child, and family well-being. The purpose of this randomized controlled trial is to evaluate the effectiveness of an integrated process of online psychosocial assessment, referral, and cognitive behavior therapy (CBT) for pregnant women compared to usual prenatal care (no formal screening or specialized care). The primary outcome is self-reported prenatal depression, anxiety, and stress symptoms at 6 to 8 weeks postrandomization. Secondary outcomes are postpartum depression, anxiety, and stress symptoms; self-efficacy; mastery; self-esteem; sleep; relationship quality; coping; resilience; Apgar score; gestational age; birth weight; maternal-infant attachment; infant behavior and development; parenting stress/competence; and intervention cost-effectiveness, efficiency, feasibility, and acceptability. Pregnant women are eligible if they: 1) are <28 weeks gestation; 2) speak/read English; 3) are willing to complete email questionnaires; 4) have no, low, or moderate psychosocial risk on screening at recruitment; and 5) are eligible for CBT. A sample of 816 women will be recruited from large, urban primary care clinics and allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment, and those with mild or moderate depression, anxiety, or stress symptoms then complete six interactive cognitive behavior therapy modules. All women will complete email questionnaires at 6 to 8 weeks postrandomization and at 3, 6, and 12 months postpartum. Clinic-based providers and researchers conducting chart abstraction and analysis are blinded. Qualitative interviews with 8 to 10 healthcare providers and 15 to 30 intervention group women will provide data on feasibility and acceptability of the intervention. Results of this trial will determine the feasibility and effectiveness of an integrated approach to prenatal mental healthcare and the use of highly accessible computer-based psychosocial assessment and CBT on maternal, infant, and family-based outcomes. ClinicalTrials.gov Identifier: NCT01901796.

Study protocol for a randomized, controlled, superiority trial comparing the clinical and cost- effectiveness of integrated online mental health assessment-referral-care in pregnancy to usual prenatal care on prenatal and postnatal mental health and infant health and development: the Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT)

PubMed Central

2014-01-01

Background Stress, depression, and anxiety affect 15 to 25% of pregnant women. However, fewer than 20% of prenatal care providers assess and treat mental health problems and fewer than 20% of pregnant women seek mental healthcare. For those who seek treatment, the lack of health system integration and existing barriers frequently prevent treatment access. Without treatment, poor prenatal mental health can persist for years and impact future maternal, child, and family well-being. Methods/Design The purpose of this randomized controlled trial is to evaluate the effectiveness of an integrated process of online psychosocial assessment, referral, and cognitive behavior therapy (CBT) for pregnant women compared to usual prenatal care (no formal screening or specialized care). The primary outcome is self-reported prenatal depression, anxiety, and stress symptoms at 6 to 8 weeks postrandomization. Secondary outcomes are postpartum depression, anxiety, and stress symptoms; self-efficacy; mastery; self-esteem; sleep; relationship quality; coping; resilience; Apgar score; gestational age; birth weight; maternal-infant attachment; infant behavior and development; parenting stress/competence; and intervention cost-effectiveness, efficiency, feasibility, and acceptability. Pregnant women are eligible if they: 1) are <28 weeks gestation; 2) speak/read English; 3) are willing to complete email questionnaires; 4) have no, low, or moderate psychosocial risk on screening at recruitment; and 5) are eligible for CBT. A sample of 816 women will be recruited from large, urban primary care clinics and allocation is by computer-generated randomization. Women in the intervention group will complete an online psychosocial assessment, and those with mild or moderate depression, anxiety, or stress symptoms then complete six interactive cognitive behavior therapy modules. All women will complete email questionnaires at 6 to 8 weeks postrandomization and at 3, 6, and 12 months postpartum. Clinic-based providers and researchers conducting chart abstraction and analysis are blinded. Qualitative interviews with 8 to 10 healthcare providers and 15 to 30 intervention group women will provide data on feasibility and acceptability of the intervention. Results of this trial will determine the feasibility and effectiveness of an integrated approach to prenatal mental healthcare and the use of highly accessible computer-based psychosocial assessment and CBT on maternal, infant, and family-based outcomes. Trial registration ClinicalTrials.gov Identifier: NCT01901796 PMID:24597683

Autism and Mind-Body Therapies: A Systematic Review.

PubMed

Hourston, Sarah; Atchley, Rachel

2017-05-01

Mind-body therapies are often used by people with autism spectrum disorders (ASD). However, there has been little examination into which types of mind-body therapies have been investigated for people with ASD and for what purposes. A systematic review was conducted to evaluate the existing evidence for mind-body therapies for people with ASD, particularly to determine the types of mind-body therapies used and the outcomes that are targeted. PubMed, PsychInfo, and Scopus were searched using terms for ASD and mind-body therapies. Sixteen studies were selected for review; these studies tested interventions using mindfulness, meditation, yoga, Nei Yang Gong, and acceptance commitment therapy. Most study outcomes targeted behavior, psychological symptoms, and quality of life for children and adults with ASD as well as their parents. There was little overlap between studies on the types of mind-body therapies used and associated outcomes, and only three of the studies were randomized controlled trials. Most studies were small and uncontrolled. Some studies modified the mind-body therapies to increase accessibility for people with ASD. The evidence for mind-body therapies for people with ASD is limited and would benefit from larger randomized controlled trials.

Autism and Mind–Body Therapies: A Systematic Review

PubMed Central

2017-01-01

Abstract Background: Mind–body therapies are often used by people with autism spectrum disorders (ASD). However, there has been little examination into which types of mind–body therapies have been investigated for people with ASD and for what purposes. A systematic review was conducted to evaluate the existing evidence for mind–body therapies for people with ASD, particularly to determine the types of mind–body therapies used and the outcomes that are targeted. Methods: PubMed, PsychInfo, and Scopus were searched using terms for ASD and mind–body therapies. Sixteen studies were selected for review; these studies tested interventions using mindfulness, meditation, yoga, Nei Yang Gong, and acceptance commitment therapy. Most study outcomes targeted behavior, psychological symptoms, and quality of life for children and adults with ASD as well as their parents. Results: There was little overlap between studies on the types of mind–body therapies used and associated outcomes, and only three of the studies were randomized controlled trials. Most studies were small and uncontrolled. Some studies modified the mind–body therapies to increase accessibility for people with ASD. Conclusion: The evidence for mind–body therapies for people with ASD is limited and would benefit from larger randomized controlled trials. PMID:28437148

Editorial--Avoiding Unethical Helicobacter pylori Clinical Trials: Susceptibility-Based Studies and Probiotics as Adjuvants.

PubMed

Graham, David Y

2015-10-01

As a general rule, any clinical study where the result is already known or when the investigator(s) compares an assigned treatment against another assigned treatment known to be ineffective in the study population (e.g., in a population with known clarithromycin resistance) is unethical. As susceptibility-based therapy will always be superior to empiric therapy in any population with a prevalence of antimicrobial resistance >0%, any trial that randomizes susceptibility-based therapy with empiric therapy would be unethical. The journal Helicobacter welcomes susceptibility or culture-guided studies, studies of new therapies, and studies of adjuvants and probiotics. However, the journal will not accept for review any study we judge to be lacking clinical equipoise or which assign subjects to a treatment known to be ineffective, such as a susceptibility-based clinical trial with an empiric therapy comparator. To assist authors, we provide examples and suggestions regarding trial design for comparative studies, for susceptibility-based studies, and for studies testing adjuvants or probiotics. © 2015 John Wiley & Sons Ltd.

Editorial - Avoiding unethical Helicobacter pylori clinical trials: Susceptibility-based studies and probiotics as adjuvants

PubMed Central

Graham, David Y.

2016-01-01

As a general rule, any clinical study where the result is already known or when the investigator(s) compares an assigned treatment against another assigned treatment known to be ineffective in the study population (e.g. in a population with known clarithromycin resistance) is unethical. Since susceptibility-based therapy will always be superior to empiric therapy in any population with a prevalence of antimicrobial resistance greater than 0%, any trial that randomizes susceptibility-based therapy with empiric therapy would be unethical. The journal Helicobacter welcomes susceptibility or culture-guided studies, studies of new therapies and of adjuvants and probiotics. However, the Journal will not accept for review any study we judge to be lacking clinical equipoise or which assign subjects to a treatment known to be ineffective, such as a susceptibility-based clinical trial with an empiric therapy comparator. To assist authors we provide examples and suggestion regarding trial design for comparative studies, for susceptibility-based studies, and for studies testing adjuvants or probiotics. PMID:26123529

Pilot Study to Gauge Acceptability of a Mindfulness-Based, Family-Focused Preventive Intervention

ERIC Educational Resources Information Center

Duncan, Larissa G.; Coatsworth, J. Douglas; Greenberg, Mark T.

2009-01-01

The purpose of the present study was to conduct a test of acceptability of a new model for family-focused drug prevention programs for families of early adolescents. An existing evidence-based behavioral intervention, the Strengthening Families Program: For Parents and Youth 10-14 (SFP), was adapted to include concepts and activities related to…

Hungry for an intervention? Adolescents' ratings of acceptability of eating-related intervention strategies.

PubMed

Stok, F Marijn; de Ridder, Denise T D; de Vet, Emely; Nureeva, Liliya; Luszczynska, Aleksandra; Wardle, Jane; Gaspar, Tania; de Wit, John B F

2016-01-05

Effective interventions promoting healthier eating behavior among adolescents are urgently needed. One factor that has been shown to impact effectiveness is whether the target population accepts the intervention. While previous research has assessed adults' acceptance of eating-related interventions, research on the opinion of adolescents is lacking. The current study addressed this gap in the literature. Two thousand seven hundred sixty four adolescents (aged 10-17 years) from four European countries answered questions about individual characteristics (socio-demographics, anthropometrics, and average daily intake of healthy and unhealthy foods) and the acceptability of ten eating-related intervention strategies. These strategies varied in type (either promoting healthy eating or discouraging unhealthy eating), level of intrusiveness, setting (home, school, broader out-of-home environment), and change agent (parents, teacher, policy makers). Based on adolescents' acceptability ratings, strategies could be clustered into two categories, those promoting healthy eating and those discouraging unhealthy eating, with acceptability rated significantly higher for the former. Acceptability of intervention strategies was rated moderate on average, but higher among girls, younger, overweight and immigrant adolescents, and those reporting healthier eating. Polish and Portuguese adolescents were overall more accepting of strategies than UK and Dutch adolescents. Adolescents preferred intervention strategies that promote healthy eating over strategies that discourage unhealthy eating. Level of intrusiveness affected acceptability ratings for the latter type of strategies only. Various individual and behavioral characteristics were associated with acceptability. These findings provide practical guidance for the selection of acceptable intervention strategies to improve adolescents' eating behavior.

Breaking the Patriarchal Vision of Social Science: Lessons from a Family Therapy Model.

ERIC Educational Resources Information Center

McNamee, Sheila

The Milan model of systemic family therapy, developed in Italy and based on G. Bateson's cybernetic epistemology, can help meet the goals of a feminist/systemic epistemology in research by accepting data in its "traditional" form yet also connecting it to the act of researching, itself, thereby merging a feminist perspective with the…

The influence of program acceptability on the effectiveness of public health policy: a study of directly observed therapy for tuberculosis.

PubMed Central

Heymann, S J; Sell, R; Brewer, T F

1998-01-01

OBJECTIVES: This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis. METHODS: Decision and sensitivity analyses were used in assessing influences. RESULTS: If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range: 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% (range: 27% to 38%) of patients avoid seeking care. CONCLUSIONS: Patient acceptability must be taken into consideration before selecting public health strategies. PMID:9518978

Boosting Quality Registries with Clinical Decision Support Functionality*. User Acceptance of a Prototype Applied to HIV/TB Drug Therapy.

PubMed

Wannheden, Carolina; Hvitfeldt-Forsberg, Helena; Eftimovska, Elena; Westling, Katarina; Ellenius, Johan

2017-08-11

The care of HIV-related tuberculosis (HIV/TB) is complex and challenging. Clinical decision support (CDS) systems can contribute to improve quality of care, but more knowledge is needed on factors determining user acceptance of CDS. To analyze physicians' and nurses' acceptance of a CDS prototype for evidence-based drug therapy recommendations for HIV/TB treatment. Physicians and nurses were involved in designing a CDS prototype intended for future integration with the Swedish national HIV quality registry. Focus group evaluation was performed with ten nurses and four physicians, respectively. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to analyze acceptance. We identified several potential benefits with the CDS prototype as well as some concerns that could be addressed by redesign. There was also concern about dependence on physician attitudes, as well as technical, organizational, and legal issues. Acceptance evaluation at a prototype stage provided rich data to improve the future design of a CDS prototype. Apart from design and development efforts, substantial organizational efforts are needed to enable the implementation and maintenance of a future CDS system.

A New Look at the Science of Weight Control: How Acceptance and Commitment Strategies Can Address the Challenge of Self-Regulation

PubMed Central

Forman, Evan M.; Butryn, Meghan L.

2014-01-01

Despite decades of work, behavioral interventions for obesity are not yet able to facilitate long-term weight loss maintenance for most participants. The current manuscript proposes an acceptance-based, self-regulation framework for understanding the challenge of maintaining changes in weight-related behavior and describes how this framework can be integrated into the behavioral treatment of obesity. According to this framework, intrinsic drives to consume palatable, high-calorie food interact with a modern environment in which high calorie foods are easily accessible. This combination produces a chronic desire to eat unhealthy foods that exists in opposition to individuals’ weight control goals. Similarly, energy expenditure requirements in the modern environment are limited, and people’s innate preferences to conserve energy typically prevent the concerted effort that would be necessary to engage in lifestyle activity and structured activity. Both external (e.g., sight of food) and internal (e.g., an aversive emotion) cues motivate overeating and sedentary behavior. However, individuals vary in their responsivity to these cues. While standard behavior skills may enable those lower in responsivity to successfully achieve weight control, we suggest that those higher in responsivity need specialized self-regulatory skills to maintain healthy eating and exercise behaviors. These skills include an ability to tolerate uncomfortable internal reactions to triggers and a reduction of pleasure, behavioral commitment to clearly-defined values, and metacognitive awareness of decision-making processes. So-called “acceptance-based” interventions based on these skills have so far proven efficacious for weight control, especially for those who are the most susceptible to eating in response to internal and external cues (as predicted by the model). Despite the current empirical support for the postulated model and for the interventions which stem from it, much remains to be learned including whether acceptance-based interventions will prove efficacious in the longer-term. PMID:25445199

Public Attitudes on the Ethics of Deceptively Planting False Memories to Motivate Healthy Behavior

PubMed Central

Berkowitz, Shari R.; Roche, Simon

2016-01-01

Summary Researchers have proposed that planting false memories could have positive behavioral consequences. The idea of deceptively planting ‘beneficial’ false memories outside of the laboratory raises important ethical questions, but how might the general public appraise this moral dilemma? In two studies, participants from the USA and UK read about a fictional ‘false‐memory therapy’ that led people to adopt healthy behaviors. Participants then reported their attitudes toward the acceptability of this therapy, via scale‐rating (both studies) and open‐text (study 2) responses. The data revealed highly divergent responses to this contentious issue, ranging from abject horror to unqualified enthusiasm. Moreover, the responses shed light on conditions that participants believed would make the therapy less or more ethical. Whether or not deceptively planting memories outside the lab could ever be justifiable, these studies add valuable evidence to scientific and societal debates on neuroethics, whose relevance to memory science is increasingly acute. Copyright © 2016 The Authors Applied Cognitive Psychology Published by John Wiley & Sons Ltd. PMID:28111495

Daily Behavior Report Cards with and without Home-Based Consequences: Improving Classroom Behavior in Low Income, African American Children with ADHD

ERIC Educational Resources Information Center

Jurbergs, Nichole; Palcic, Jennette L.; Kelley, Mary L.

2010-01-01

Daily Behavior Report Cards (DBRC), which typically require teachers to evaluate students' daily behavior and parents to provide contingent consequences, are an effective and acceptable method for improving children's classroom behavior. The current study evaluated whether parent involvement is an essential treatment component or whether teacher…

Cognitive-Behavioral Therapy Plus Hypnosis for Distress During Breast Radiotherapy: A Randomized Trial.

PubMed

Montgomery, Guy H; Sucala, Madalina; Dillon, Matthew J; Schnur, Julie B

2017-10-01

Radiotherapy is a common and effective treatment for women with breast cancer. However, radiotherapy has also been shown to adversely affect patients' emotional well-being. Currently, few mind-body interventions are designed to improve patients' quality of life during radiotherapy. One intervention which has demonstrated clinical efficacy in the breast cancer radiotherapy setting is Cognitive-Behavioral Therapy plus Hypnosis. The goal of this study was to investigate the impact of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress in women with breast cancer undergoing radiotherapy. One hundred patients were randomly assigned to either the Cognitive-Behavioral Therapy plus Hypnosis (n = 50) or Attention Control (n = 50) group. Results revealed significant benefits of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress at the mid-point (d = 0.54), the conclusion (d = 0.64), and 4 weeks following the conclusion (d = 0.65) of radiotherapy (all ps < 0.05). In summary, results support further study of Cognitive-Behavioral Therapy plus Hypnosis as an evidence-based intervention to reduce emotional distress in women with breast cancer. Cognitive-Behavioral Therapy plus Hypnosis has the benefits of being brief, noninvasive, lacking side-effects, and producing beneficial effects which last beyond the conclusion of radiotherapy. Given these strengths, we propose that Cognitive-Behavioral Therapy plus Hypnosis is a strong candidate for greater dissemination and implementation in cancer populations.

A new approach in psychotherapy: ACT (acceptance and commitment therapy).

PubMed

McHugh, Louise

2011-09-01

Acceptance and commitment therapy (ACT) focuses on enhancing psychological flexibility in the service of achieving core life values. One thing that distinguishes ACT from other psychotherapies is its grounding in empirical behavioural science. The results of the latter suggest that the capacity for human language can produce seriously negative psychological effects under certain circumstances. ACT is a therapeutic approach in which the negative effects of human language are undermined so as to support flexible values based living. ACT therapeutic work involves six key processes proposed under the "hexaflex" model. ACT has received considerable empirical support at a number of different levels of analysis.

Feasibility of an acceptance and commitment therapy adjunctive web-based program for counseling centers.

PubMed

Levin, Michael E; Pistorello, Jacqueline; Hayes, Steven C; Seeley, John R; Levin, Crissa

2015-07-01

Web-based adjunctive tools provide a promising method for addressing the challenges college counseling centers face in meeting the mental health needs of students. The current study tested an initial adjunctive prototype based on acceptance and commitment therapy (ACT) in a pre-post open trial with 30 counselors and 82 student clients across 4 counseling centers. Results indicated high ratings of program satisfaction and usability with counselors and students. The majority of students completed at least part of the program. Significant improvements were found across almost all outcome and ACT process measures with student clients. Improvements in student outcomes were predicted by both changes in psychological inflexibility and how often counselors discussed the program with students. Results are discussed in relation to support for and future development of a flexible, adjunctive ACT program for counseling centers. (c) 2015 APA, all rights reserved).

Treatment acceptability among mexican american parents.

PubMed

Borrego, Joaquin; Ibanez, Elizabeth S; Spendlove, Stuart J; Pemberton, Joy R

2007-09-01

There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for differences in treatment acceptability. Mexican American parents found response cost, a punishment-based technique, more acceptable than positive reinforcement-based techniques (e.g., differential attention). Results suggest that Mexican American parents' acculturation has little impact on acceptability of child management interventions. No association was found between mothers' acculturation and treatment acceptability. However, more acculturated Mexican American fathers viewed token economy as more acceptable than less acculturated fathers. Results are discussed in the context of clinical work and research with Mexican Americans.

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

10 CFR 35.457 - Therapy-related computer systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Therapy-related computer systems. 35.457 Section 35.457... Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning system of therapy-related computer systems in accordance with published protocols accepted by nationally...

A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD).

PubMed

King, Anthony P; Erickson, Thane M; Giardino, Nicholas D; Favorite, Todd; Rauch, Sheila A M; Robinson, Elizabeth; Kulkarni, Madhur; Liberzon, Israel

2013-07-01

"Mindfulness-based" interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in trauma-exposed individuals. Mindfulness-based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD). Consecutive patients seeking treatment for chronic PTSD at a VA outpatient clinic were enrolled in 8-week MBCT groups, modified for PTSD (four groups, n = 20) or brief treatment-as-usual (TAU) comparison group interventions (three groups, n = 17). Pre and posttherapy psychological assessments with clinician administered PTSD scale (CAPS) were performed with all patients, and self-report measures (PTSD diagnostic scale, PDS, and posttraumatic cognitions inventory, PTCI) were administered in the MBCT group. Intent to treat analyses showed significant improvement in PTSD (CAPS (t(19) = 4.8, P < .001)) in the MBCT condition but not the TAU conditions, and a significant Condition × Time interaction (F[1,35] = 16.4, P < .005). MBCT completers (n = 15, 75%) showed good compliance with assigned homework exercises, and significant and clinically meaningful improvement in PTSD symptom severity on posttreatment assessment in CAPS and PDS (particularly in avoidance/numbing symptoms), and reduced PTSD-relevant cognitions in PTCI (self blame). These data suggest group MBCT as an acceptable brief intervention/adjunctive therapy for combat PTSD, with potential for reducing avoidance symptom cluster and PTSD cognitions. Further studies are needed to examine efficacy in a randomized controlled design and to identify factors influencing acceptability and efficacy. © 2013 Wiley Periodicals, Inc.

Evaluating Nicotine Replacement Therapy and Stage-Based Therapies in a Population-Based Effectiveness Trial

ERIC Educational Resources Information Center

Velicer, Wayne F.; Friedman, Robert H.; Fava, Joseph L.; Gulliver, Suzy B.; Keller, Stefan; Sun, Xiaowu; Ramelson, Harley; Prochaska, James O.

2006-01-01

Pharmacological interventions for smoking cessation are typically evaluated using volunteer samples (efficacy trials) but should also be evaluated in population-based trials (effectiveness trials). Nicotine replacement therapy (NRT) alone and in combination with behavioral interventions was evaluated on a population of smokers from a New England…

Internet-Delivered Cognitive Behavior Therapy for Adolescents with Obsessive-Compulsive Disorder: An Open Trial

PubMed Central

Lenhard, Fabian; Vigerland, Sarah; Andersson, Erik; Rück, Christian; Mataix-Cols, David; Thulin, Ulrika; Ljótsson, Brjánn; Serlachius, Eva

2014-01-01

Background International guidelines recommend Cognitive Behavior Therapy (CBT) as the first line treatment for pediatric obsessive-compulsive disorder (OCD). However, a substantial proportion of patients do not have access to such treatment. We developed and tested the feasibility, efficacy and acceptability of a novel therapist-guided, Internet-delivered CBT (ICBT) platform for adolescents with OCD. Methods An interactive, age-appropriate ICBT platform (“BiP OCD”) was developed. Twenty-one adolescents (12–17 years) with a DSM-IV diagnosis of OCD and their parents were enrolled in the study. All participants received 12 weeks of ICBT with therapist support. The primary outcome measure was the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Acceptability was assessed at post-treatment. Results Participants completed on average 8.29 (SD = 3.0) of the 12 treatment chapters. Treatment yielded significant improvements on all clinician-, parent- and most self-administered outcome measures, with a large effect size of d = 2.29 (95% CI 1.5–3.07) on the CY-BOCS. Patients continued to improve at follow-up. At 6-month follow-up, 71% were classified as responders (≥35% decrease on the CY-BOCS) and 76% as being in remission (CY-BOCS score ≤12). Average clinician support time was less than 20 minutes per patient per week. The majority of participants felt that BiP OCD was age-appropriate and rated the treatment as good or very good. Conclusions ICBT could be efficacious, acceptable, and cost-effective for adolescents with OCD. More rigorously controlled studies are needed to further evaluate the treatment. Trial Registration ClinicalTrials.gov; NCT01809990. PMID:24949622

Homework compliance counts in cognitive-behavioral therapy.

PubMed

Lebeau, Richard T; Davies, Carolyn D; Culver, Najwa C; Craske, Michelle G

2013-01-01

Prior research has demonstrated that there is some association between treatment engagement and treatment outcome in behavioral therapy for anxiety disorders. However, many of these investigations have been limited by weak measurement of treatment engagement variables, failure to control for potentially important baseline variables, and failure to consider various treatment engagement variables simultaneously. The purpose of the present study is to examine the relationship between two treatment engagement variables (treatment expectancy and homework compliance) and the extent to which they predict improvement from cognitive-behavioral therapy (CBT) for anxiety disorders. 84 adults with a DSM-IV-defined principal anxiety disorder took part in up to 12 sessions of CBT or acceptance and commitment therapy. Pre- and post-treatment disorder severity was assessed using clinical severity ratings from a semi-structured diagnostic interview. Participants made ratings of treatment expectancy after the first session. Homework compliance was assessed each session by the treating clinician. Contrary to hypotheses, treatment expectancy and homework compliance were poorly correlated. Regression analyses revealed that homework compliance, but not treatment expectancy, predicted a significant portion of the variance in treatment outcome (10%). The present research suggests that although treatment expectation and homework compliance likely represent unique constructs of treatment engagement, homework compliance may be the more important treatment engagement variable for outcomes. The present research suggests that improvement of homework compliance has the potential to be a highly practical and effective way to improve clinical outcomes in CBT targeting anxiety disorders.

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms.

PubMed

Safren, Steven A; Otto, Michael W; Sprich, Susan; Winett, Carol L; Wilens, Timothy E; Biederman, Joseph

2005-07-01

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p < .01) and global severity (p < .002), as well as self-reported ADHD symptoms (p < .0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's < .04), lower IE-rated depression (p < .01), and a trend to have lower self-reported depression (p = .06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p < .02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.

Problem That Piles Up: When Hoarding Is a Disorder

MedlinePlus

... studies are in progress. Tolin says, “Right now, cognitive behavioral therapy is the only evidence-based treatment we have ... differently to situations. Tolin’s team hopes to improve cognitive behavioral therapy so that it’s even better at helping people ...

Evaluation of Two Mobile Health Apps in the Context of Smoking Cessation: Qualitative Study of Cognitive Behavioral Therapy (CBT) Versus Non-CBT-Based Digital Solutions

PubMed Central

Amin, Nima; Chadha, Mehak; Jain, Minal; Karia, Kishan; Kothari, Varun; Patel, Tejus; Suseeharan, Melanie; Ahmed, Maroof; Sherwani, Yusuf; Siddiqui, Sarim; Lin, Yuting

2018-01-01

Background Mobile health (mHealth) apps can offer users numerous benefits, representing a feasible and acceptable means of administering health interventions such as cognitive behavioral therapy (CBT). CBT is commonly used in the treatment of mental health conditions, where it has a strong evidence base, suggesting that it represents an effective method to elicit health behavior change. More importantly, CBT has proved to be effective in smoking cessation, in the context of smoking-related costs to the National Health Service (NHS) having been estimated to be as high as £2.6bn in 2015. Although the evidence base for computerized CBT in mental health is strong, there is limited literature on its use in smoking cessation. This, combined with the cost-effectiveness of mHealth interventions, advocates a need for research into the effectiveness of CBT-based smoking cessation apps. Objective The objective of this study was, first, to explore participants’ perceptions of 2 mHealth apps, a CBT-based app, Quit Genius, and a non-CBT-based app, NHS Smokefree, over a variety of themes. Second, the study aimed to investigate the perceptions and health behavior of users of each app with respect to smoking cessation. Methods A qualitative short-term longitudinal study was conducted, using a sample of 29 smokers allocated to one of the 2 apps, Quit Genius or Smokefree. Each user underwent 2 one-to-one semistructured interviews, 1 week apart. Thematic analysis was carried out, and important themes were identified. Descriptive statistics regarding participants’ perceptions and health behavior in relation to smoking cessation are also provided. Results The thematic analysis resulted in five higher themes and several subthemes. Participants were generally more positive about Quit Genius’s features, as well as about its design and information engagement and quality. Quit Genius users reported increased motivation to quit smoking, as well as greater willingness to continue using their allocated app after 1 week. Moreover, these participants demonstrated preliminary changes in their smoking behavior, although this was in the context of our limited sample, not yet allowing for the finding to be generalizable. Conclusions Our findings underscore the use of CBT in the context of mHealth apps as a feasible and potentially effective smoking cessation tool. mHealth apps must be well developed, preferably with an underlying behavioral change mechanism, to promote positive health behavior change. Digital CBT has the potential to become a powerful tool in overcoming current health care challenges. The present results should be replicated in a wider sample using the apps for a longer period so as to allow for generalizability. Further research is also needed to focus on the effect of greater personalization on behavioral change and on understanding the psychological barriers to the adoption of new mHealth solutions. PMID:29669708

User acceptance of HIV TIDES--Tailored Interventions for Management of Depressive Symptoms in persons living with HIV/AIDS.

PubMed

Lai, Tsai-Ya; Larson, Elaine L; Rockoff, Maxine L; Bakken, Suzanne

2008-01-01

The Tailored Interventions for management of DEpressive Symptoms (TIDES) program was designed based on social cognitive theory to provide tailored, computer-based education on key elements and self-care strategies for depressive symptoms in persons living with HIV/AIDS (PLWHAs). Based on an extension of the Technology Acceptance Model (TAM), a cross-sectional design was used to assess the acceptance of the HIV TIDES prototype and explore the relationships among system acceptance factors proposed in the conceptual model. Thirty-two PLWHAs were recruited from HIV/AIDS clinics. The majority were African American (68.8%), male (65.6%), with high school or lower education (68.7%), and in their 40s (62.5%). PARTICIPANTS spent an average of 10.4 minutes (SD = 5.6) using HIV TIDES. The PLWHAs rated the system as easy to use (Mean = 9.61, SD = 0.76) and useful (Mean = 9.50, SD = 1.16). The high ratings of behavior intention to use (Mean = 9.47, SD = 1.24) suggest that HIV TIDES has the potential to be accepted and used by PLWHAs. Four factors were positively correlated with behavioral intention to use: perceived usefulness (r = 0.61), perceived ease of use (r = 0.61), internal control (r = 0.59), and external control (r = 0.46). Computer anxiety (r = -0.80), tailoring path (r = 0-.35) and depressive symptoms (r = -0.49) were negatively correlated with behavioral intention to use. The results of this study provide evidence of the acceptability of HIV TIDES by PLWHAs. Individuals are expected to be empowered through participating in the interactive process to generate their self-care plan. HIV TIDES enables information sharing about depression prevention and health promotion and has the potential to reframe the traditional patient-provider relationship.

An Empirical Examination of Symptom Substitution Associated with Behavior Therapy for Tourette's Disorder

PubMed Central

Peterson, Alan L.; McGuire, Joseph F.; Wilhelm, Sabine; Piacentini, John; Woods, Douglas W.; Walkup, John T.; Hatch, John P.; Villarreal, Robert; Scahill, Lawrence

2018-01-01

Over the past 6 decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a longstanding concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using 4 methods: (1) the onset of new tic symptoms; (2) the occurrence of adverse events; (3) change in tic medications; and (4) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of 8 sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the longstanding concern of symptom substitution in response to behavior therapy for individuals with Tourette's Disorder. PMID:26763495

Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives.

PubMed

McPherson, Kerri E; Kerr, Susan; Casey, Beth; Marshall, John

2017-10-01

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre-intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in 'real-world' settings. © 2017 American Association for Marriage and Family Therapy.

Treatment-Based Classification versus Usual Care for Management of Low Back Pain

DTIC Science & Technology

2014-08-01

Doctoral Fellowship in Orthopaedic Manual Physical Therapy , San Antonio Military Medical Center, Fort Sam Hous- ton, Texas. N.W. Gill, PT, DSc, OCS, FAAOMPT...US Army–Baylor Uni- versity Doctor of Physical Therapy Program, Fort Sam Houston, Texas. [Rhon DI, Deyle GD, Gill NW. Clin- ical reasoning and...1234–1243.] © 2013 American Physical Therapy Association Published Ahead of Print: February 7, 2013 Accepted: February 4, 2013 Submitted: March 30, 2012

Internet Searches About Therapies Do Not Impact Willingness to Accept Prescribed Therapy in Inflammatory Bowel Disease Patients.

PubMed

Feathers, Alexandra; Yen, Tommy; Yun, Laura; Strizich, Garrett; Swaminath, Arun

2016-04-01

A significant majority of patients with inflammatory bowel disease (IBD) search the Internet for information about their disease. While patients who search the Internet for disease or treatment information are believed to be more resistant to accepting medical therapy, no studies have tested this hypothesis. All IBD patients over a 3-month period across three gastroenterology practices were surveyed about their disease, treatments, websites visited, attitudes toward medications, and their willingness to accept prescribed therapies after disease-related Internet searches. Of 142 total patients, 91 % of respondents searched the Internet for IBD information. The vast majority (82 %) reported taking medication upon their doctor's recommendation and cited the desire to acquire additional information about their disease and prescribed therapies as their most important search motivator (77 %). Internet usage did not affect the willingness of 52 % of our cohort to accept prescribed medication. The majority of IBD patients who searched the Internet for disease and treatment-related information were not affected in their willingness to accept prescribed medical therapy.

Acceptance and Commitment Therapy for adults who stutter: psychosocial adjustment and speech fluency.

PubMed

Beilby, Janet M; Byrnes, Michelle L; Yaruss, J Scott

2012-12-01

The aim of the present study was to assess the effectiveness of an Acceptance and Commitment Therapy group intervention program for adults who stutter (N=20). The program consisted of 2-h therapeutic sessions conducted weekly for eight consecutive weeks. It was an integrated program designed to improve: (a) psychosocial functioning, (b) readiness for therapy and change, (c) utilisation of mindfulness skills and psychological flexibility, and (d) frequency of stuttering. The findings provide innovative evidence for Acceptance and Commitment Therapy as an effective intervention with statistically significant improvements in psychosocial functioning, preparation for change and therapy, utilisation of mindfulness skills, and overall speech fluency. Follow-up data collected at three months post-treatment revealed that therapeutic gains were successfully maintained over time. These findings enhance the understanding of the impact of stuttering on psychological wellbeing and offer a new perspective on what might constitute successful stuttering treatment. Further, clinical research support is provided for Acceptance and Commitment Therapy delivered in a group format as a promising and novel intervention for adults who stutter. The reader will be able to: (a) appreciate the potential for Acceptance and Commitment Therapy for adults who stutter; (b) identify the improvements participants experienced in psychosocial functioning and frequency of stuttered speech; (c) appreciate the six core processes of Acceptance and Commitment Therapy; and (d) appreciate the differences between an ACT model of intervention for adults who stutter compared to a CBT approach. Copyright © 2012 Elsevier Inc. All rights reserved.

An Open Trial of Intensive Family Based Cognitive-Behavioral Therapy in Youth with Obsessive-Compulsive Disorder Who Are Medication Partial Responders or Nonresponders

ERIC Educational Resources Information Center

Storch, Eric A.; Lehmkuhl, Heather D.; Ricketts, Emily; Geffken, Gary R.; Marien, Wendi; Murphy, Tanya K.

2010-01-01

This study reports an open-trial of family-based cognitive-behavioral therapy (CBT) in children and adolescents with obsessive-compulsive disorder (OCD). Thirty primarily Caucasian youth with OCD (range = 7-19 years; 15 girls) who were partial responders or nonresponders to two or more medication trials that were delivered either serially or…

Feasibility and Impact of Implementing Motivational Enhancement Therapy--Cognitive Behavioral Therapy as a Substance Use Treatment Intervention in School-Based Settings

ERIC Educational Resources Information Center

Belur, Vinetha; Dennis, Michael L.; Ives, Melissa L.; Vincent, Robert; Muck, Randolph

2014-01-01

The expansion of behavioral health services to school-based health centers under the Affordable Care Act (Public Law 111-148) presents an opportunity to improve access to substance use disorders treatment for youth and reduce their substance use, and emotional, health, and school problems. We explore the feasibility of implementing five to seven…

Evaluation of the Sustainability and Clinical Outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) in a Child Protection Center

ERIC Educational Resources Information Center

Kolko, David J.; Iselin, Anne-Marie R.; Gully, Kevin J.

2011-01-01

This paper examines the sustainability and outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as delivered by practitioners in a community-based child protection program who had received training in the model several years earlier. Formerly described as Abuse-Focused CBT, AF-CBT is an evidence-based treatment (EBT) for…

Game-Based Cognitive-Behavioral Therapy (GB-CBT) Group Program for Children Who Have Experienced Sexual Abuse: A Three-Month Follow-Up Investigation

ERIC Educational Resources Information Center

Springer, Craig; Misurell, Justin R.; Hiller, Atara

2012-01-01

This study examined the efficacy of a game-based cognitive-behavioral group therapy program for addressing problems typically found among elementary school-aged victims of child sexual abuse immediately after treatment and at three months following treatment. It was hypothesized that positive gains would be observed among the following domains:…

Feasibility Study of an Interactive Multimedia Electronic Problem Solving Treatment Program for Depression: A Preliminary Uncontrolled Trial

PubMed Central

Berman, Margit I.; Jr., Jay C. Buckey; Hull, Jay G.; Linardatos, Eftihia; Song, Sueyoung L.; McLellan, Robert K.; Hegel, Mark T.

2014-01-01

Computer-based depression interventions lacking live therapist support have difficulty engaging users. This study evaluated the usability, acceptability, credibility, therapeutic alliance and efficacy of a stand-alone multimedia, interactive, computer-based Problem Solving Treatment program (ePST™) for depression. The program simulated live treatment from an expert PST therapist, and delivered 6 ePST™ sessions over 9 weeks. Twenty-nine participants with moderate-severe symptoms received the intervention; 23 completed a mini mally adequate dose of ePST™ (at least 4 sessions). Program usability, acceptability, credibility, and therapeutic alliance were assessed at treatment midpoint and endpoint. Depressive symptoms and health-related functioning were assessed at baseline, treatment midpoint (4 weeks), and study endpoint (10 weeks). Depression outcomes and therapeutic alliance ratings were also compared to previously published research on live PST and computer-based depression therapy. Participants rated the program as highly usable, acceptable, and credible, and reported a therapeutic alliance with the program comparable to that observed in live therapy. Depressive symptoms improved significantly over time. These findings also provide preliminary evidence that ePST™ may be effective as a depression treatment. Larger clinical trials with diverse samples are indicated. PMID:24680231

Topical modalities for treatment and prevention of postsurgical hypertrophic scars.

PubMed

Foo, Chong Wee; Tristani-Firouzi, Payam

2011-08-01

There is no universally accepted treatment regimen and no evidence-based literature to guide management of hypertrophic scars. This article summarizes the existing literature regarding topical treatments such as silicone gel sheeting and ointment, onion extract, vitamin E, pressure garment therapy, massage therapy, and topical imiquimod 5% cream in the management of hypertrophic scars. 2011 Elsevier Inc. All rights reserved.

Are we ready for the ERAS protocol in colorectal surgery?

PubMed

Kisielewski, Michał; Rubinkiewicz, Mateusz; Pędziwiatr, Michał; Pisarska, Magdalena; Migaczewski, Marcin; Dembiński, Marcin; Major, Piotr; Rembiasz, Kazimierz; Budzyński, Andrzej

2017-01-01

Modern perioperative care principles in elective colorectal surgery have already been established by international surgical authorities. Nevertheless, barriers to the introduction of routine evidence-based clinical care and changing dogmas still exist. One of the factors is the surgeon. To assess perioperative care trends in elective colorectal surgery among general surgery consultants in surgical departments in Malopolska Voivodeship, Poland. An anonymous standardized 20-question questionnaire was developed based on ERAS principles and sent out to Malopolska Voivodeship general surgery departments. Answers of general surgery consultants showed the level of acceptance of elements of perioperative care. The overall response rate was 66%. Several elements (antibiotic and antithrombotic prophylaxis, postoperative oxygen therapy, no nasogastric tubes) had quite a high acceptance rate. On the other hand, most crucial surgical perioperative elements (lack of mechanical bowel preparation, preoperative oral carbohydrate loading, use of laparoscopy and lack of drains, early fluid and oral diet intake, early mobilization) were not followed according to evidence-based ERAS protocol recommendations. Surgeons were not willing to change their practice, but were supportive of changes in anesthesiologist-dependent elements of perioperative care, such as restrictive fluid therapy, use of transversus abdominis plane blocks, etc. Many elements of perioperative care in elective colorectal surgery in Malopolska Voivodeship are still dictated by dogma and are not evidence-based. The level of acceptance of many important ERAS protocol elements is low. Surgeons are ready to accept only changes that do not interfere with their practice.

Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression.

PubMed

Lopez-Gomez, Irene; Chaves, Covadonga; Hervas, Gonzalo; Vazquez, Carmelo

2017-09-01

There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI-D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty-eight women with a DSM-IV diagnosis of major depression or dysthymia were allocated to a 10-session IPPI-D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI-D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message This study sheds light on the client satisfaction and adherence to a positive intervention. For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations. Copyright © 2017 John Wiley & Sons, Ltd.

[Parent-child interaction therapy (PCIT)].

PubMed

Briegel, Wolfgang

2016-11-01

Parent-child interaction therapy (PCIT), a manualized evidence-based intervention, was originally developed to treat disruptive behavior problems in children aged 2–6 years. It is also considered to be an evidence-based intervention for physical abuse among children. Moreover, PCIT has proved to be effective for attention deficit hyperactivity disorder, autism spectrum disorder, separation anxiety disorder, and depression. Thus, it could become the first evidence-based, transdiagnostic intervention method for 2–6-year-old children. PCIT is based on attachment theory as well as learning theory, combining aspects of play therapy and behavior therapy. It consists of two treatment phases: child-directed interaction (CDI) and parent-directed interaction (PDI). In both phases parents are taught special skills. When interacting with their child parents practice these skills and are live coached by the therapist. CDI aims at improving the parent-child relationship and is the basis for PDI. In CDI, parents learn to follow their child’s lead as long as the child shows appropriate behavior. In PDI, parents practice effectively taking the lead wherever necessary. On average, it takes about 15–20 sessions to complete PCIT, which can be terminated as soon as the parents demonstrate a mastery of the skills, when child disruptive behavior has been reduced to clearly normal levels, and when the parents have become confident in managing child behavior on their own.

Factors that influence acceptance of web-based e-learning systems for the in-service education of junior high school teachers in Taiwan.

PubMed

Chen, Hong-Ren; Tseng, Hsiao-Fen

2012-08-01

Web-based e-learning is not restricted by time or place and can provide teachers with a learning environment that is flexible and convenient, enabling them to efficiently learn, quickly develop their professional expertise, and advance professionally. Many research reports on web-based e-learning have neglected the role of the teacher's perspective in the acceptance of using web-based e-learning systems for in-service education. We distributed questionnaires to 402 junior high school teachers in central Taiwan. This study used the Technology Acceptance Model (TAM) as our theoretical foundation and employed the Structure Equation Model (SEM) to examine factors that influenced intentions to use in-service training conducted through web-based e-learning. The results showed that motivation to use and Internet self-efficacy were significantly positively associated with behavioral intentions regarding the use of web-based e-learning for in-service training through the factors of perceived usefulness and perceived ease of use. The factor of computer anxiety had a significantly negative effect on behavioral intentions toward web-based e-learning in-service training through the factor of perceived ease of use. Perceived usefulness and motivation to use were the primary reasons for the acceptance by junior high school teachers of web-based e-learning systems for in-service training. Copyright © 2011 Elsevier Ltd. All rights reserved.

Integrating Dialectical Behavior Therapy and Prolonged Exposure to Treat Co-Occurring Borderline Personality Disorder and PTSD: Two Case Studies

ERIC Educational Resources Information Center

Harned, Melanie S.; Linehan, Marsha M.

2008-01-01

Despite the high rate of trauma and PTSD among individuals with borderline personality disorder (BPD), no studies have specifically evaluated the treatment of PTSD in a BPD population. These case studies illustrate the use of a protocol based on prolonged exposure therapy that can be integrated into standard dialectical behavior therapy to treat…

Effectiveness of Cognitive Behavioral and Supportive-Expressive Group Therapy for Women Diagnosed with Breast Cancer: A Review of the Literature

ERIC Educational Resources Information Center

Boutin, Daniel L.

2007-01-01

A review of the literature revealed 20 studies that examined the extent to which cognitive behavioral therapy (CBT), supportive-expressive group therapy (SEGT), and a combination of these two treatments impact women with breast cancer. Based on this review, it is determined that CBT and SEGT have repeated experimental support for positively…

Practice guidelines for music interventions with hospitalized pediatric patients.

PubMed

Stouffer, Janice W; Shirk, Beverly J; Polomano, Rosemary C

2007-12-01

Music therapy is an effective complementary approach that can achieve specific therapeutic outcomes in the clinical management of pediatric patients. Growing research on music interventions has generated scientific knowledge about how this modality benefits patients and has formed the basis for effective protocols that can be used in practice. Although it can be challenging to translate research-based protocols into routine clinical care at the bedside, it is essential that music therapy interventions be aligned with evidence-based information and that accepted standards be established by the music therapy discipline to achieve the greatest benefit. The importance of partnerships between nurses and music therapists is emphasized to enhance the success of music-based treatments. This discussion synthesizes research findings that can be used to design pediatric practice guidelines in the application of music therapy.

Structured Therapeutic Games for Nonoffending Caregivers of Children Who Have Experienced Sexual Abuse.

PubMed

Springer, Craig I; Colorado, Giselle; Misurell, Justin R

2015-01-01

Game-based cognitive-behavioral therapy group model for nonoffending caregivers utilizes structured therapeutic games to assist parents following child sexual abuse. Game-based cognitive-behavioral therapy group model is a manualized group treatment approach that integrates evidence-based cognitive-behavioral therapy components with structured play therapy to teach parenting and coping skills, provide psychoeducation, and process trauma. Structured therapeutic games were designed to allow nonoffending caregivers to process their children's abuse experiences and learn skills necessary to overcome trauma in a nonthreatening, fun, and engaging manner. The implementation of these techniques allow clinicians to address a variety of psychosocial difficulties that are commonly found among nonoffending caregivers of children who have experienced sexual abuse. In addition, structured therapeutic games help caregivers develop strengths and abilities that they can use to help their children cope with abuse and trauma and facilitates the development of positive posttraumatic growth. Techniques and procedures for treatment delivery along with a description of core components and therapeutic modules are discussed. An illustrative case study is provided.

The Coach2Move Approach: Development and Acceptability of an Individually Tailored Physical Therapy Strategy to Increase Activity Levels in Older Adults With Mobility Problems.

PubMed

de Vries, Nienke M; van Ravensberg, C Dorine; Hobbelen, Johannes S M; van der Wees, Philip J; Olde Rikkert, Marcel G M; Staal, J Bart; Nijhuis-van der Sanden, Maria W G

2015-01-01

Despite the positive effects of physical activity on numerous aspects of health, many older adults remain sedentary even after participating in physical activity interventions. Standardized exercise programs do not necessarily bring about the behavioral change that is necessary. Therefore, a patient-centered approach is needed. The purpose of this study was to develop and assess the acceptability and potential effectiveness of the Coach2Move strategy; a physical therapy (PT) approach aimed at improving the long-term level of physical activity in mobility-limited older adults. The Coach2Move strategy was developed on the basis of 2 systematic literature studies and expert consultations. Multiple focus group meetings and a Delphi procedure were organized to gain consensus on the Coach2Move strategy. Acceptability and potential effectiveness were studied in a pilot study with a pre-/postdesign in which 2 physical therapists and 12 patients participated. To assess acceptability, patients were interviewed, discussion were held with the involved physical therapists was held, and health records were studied. Potential effectiveness was tested measuring the level of physical activity, frailty, quality of life, and mobility before and after treatment. On the basis of the literature study and expert consultations, an algorithm based on the Hypothesis Oriented Algorithm for Clinicians Part II was developed: the Coach2Move approach. Key elements of the Coach2Move approach include an extensive intake using motivational interviewing, clinical reasoning, coaching to increase physical activity and self-management, focusing on meaningful activities, and working according to 3 patient-tailored intervention profiles with a predefined number of sessions. The pilot study showed high appraisal of the strategy by both physical therapists and patients. Moreover, a potential effect on the level of physical activity, frailty, quality of life, and mobility was observed. Because the pilot study was not randomized or controlled and included a small sample, no conclusions can be drawn about the effectiveness of the Coach2Move strategy. However, all suggestions made in this study were implemented in an ongoing, randomized controlled trial in which the Coach2Move strategy will be compared to usual care PT. In conclusion, the Coach2Move strategy can be considered acceptable in PT practice and showed potential benefits. The results on the (cost-)effectiveness of this strategy based on a large, randomized, controlled trial are expected in 2014.

Functional Analysis and Treatment of Multiply Controlled Inappropriate Mealtime Behavior

ERIC Educational Resources Information Center

Bachmeyer, Melanie H.; Piazza, Cathleen C.; Fredrick, Laura D.; Reed, Gregory K.; Rivas, Kristi D.; Kadey, Heather J.

2009-01-01

Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast,…

Investigating Students' Acceptance and Self-Efficacy of E-Learning at Al-Aqsa University Based on TAM Model

ERIC Educational Resources Information Center

Mahdi, Hasan Rebhi

2014-01-01

The study aimed at investigating the influence of E-learning Self-Efficacy (ELSE) on the acceptance of e-learning by using the Technology Acceptance Model (TAM). According to the TAM which used as the theoretical basis, both of the Perceived Usefulness (PU) and the Perceived Ease of Use (PEOU) influence directly the end user's Behavioral Intention…

[The acceptance of personal responsibility as a criterion in assigning health care benefits. An empirical study].

PubMed

Diederich, A; Schreier, M

2010-09-01

In order to accomplish broad acceptance of priority setting in healthcare, a public debate seems essential, in particular, including the preferences of the general public. In Germany, objections to public involvement are to some extent based on the perception that individuals have an inherent personal bias and cannot represent interests other than their own. The following excerpt from a more comprehensive study reports on the acceptance of personal responsibility as a criterion for prioritizing. A mixed-methods design is used for combining a qualitative interview study and a quantitative survey representative of the German public. Both the interview study and the survey demonstrate that behavior that is harmful to one's health is generally accepted as a criterion for posteriorizing patients, mostly regardless of self interest. In addition, the interview study shows reasons for acceptance or refusal of the self-inflicted behavior criterion.

Intervention Fidelity in Family-Based Prevention Counseling for Adolescent Problem Behaviors

ERIC Educational Resources Information Center

Hogue, Aaron; Liddle, Howard A.; Singer, Alisa; Leckrone, Jodi

2005-01-01

This study examined fidelity in multidimensional family prevention (MDFP), a family-based prevention counseling model for adolescents at high risk for substance abuse and related behavior problems, in comparison to two empirically based treatments for adolescent drug abuse: multidimensional family therapy (MDFT) and cognitive-behavioral therapy…

Development of a School-Wide Behavior Program in a Public Middle School: An Illustration of Deployment-Focused Intervention Development, Stage 1

ERIC Educational Resources Information Center

Molina, Brooke S. G.; Smith, Bradley H.; Pelham, William E., Jr.

2005-01-01

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The…

Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial.

PubMed

Ducasse, Déborah; Jaussent, Isabelle; Arpon-Brand, Véronique; Vienot, Marina; Laglaoui, Camelia; Béziat, Séverine; Calati, Raffaella; Carrière, Isabelle; Guillaume, Sébastien; Courtet, Philippe; Olié, Emilie

2018-06-06

The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = -1.88 [0.34] vs. -0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention. © 2018 S. Karger AG, Basel.

Dignity Therapy for People with Motor Neuron Disease and Their Family Caregivers: A Feasibility Study

PubMed Central

Chochinov, Harvey M.; Kristjanson, Linda J.

2015-01-01

Abstract Background: There are calls to explore psychological interventions to reduce distress in patients with motor neuron disease (MND) and their family caregivers. Dignity therapy is a short-term psychotherapy intervention shown to alleviate distress for people with life-limiting illnesses. Objectives: To assess the acceptability, feasibility, and effectiveness of dignity therapy to reduce distress in people with MND and their family caregivers. Methods: The study used a repeated-measures design pre- and post-intervention. Acceptability and feasibility were assessed using participants' ratings of the helpfulness of the intervention across several domains and time and resources required. Effectiveness measures for patients included: dignity-related distress, hopefulness, and spiritual well-being; and those for family caregivers included burden, hopefulness, anxiety, and depression. Results: Twenty-seven patients and 18 family caregivers completed the intervention. Dignity therapy was well accepted, including those patients who required assisted communication devices. The feasibility may be limited in small or not well-resourced services. There were no significant differences in all outcome measures for both groups. However, the high satisfaction and endorsement of dignity therapy by patients suggests it has influenced various important aspects of end-of-life experience. Family caregivers overwhelmingly agreed that the dignity therapy document is and will continue to be a source of comfort to them and they would recommend dignity therapy to others in the same situation. Conclusions: This is the first dignity therapy study to focus on MND and on home-based caregiving. Results established the importance of narrative and generativity for patients with MND and may open the door for other neurodegenerative conditions. PMID:25314244

Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial

PubMed Central

Vierhile, Molly

2017-01-01

Background Web-based cognitive-behavioral therapeutic (CBT) apps have demonstrated efficacy but are characterized by poor adherence. Conversational agents may offer a convenient, engaging way of getting support at any time. Objective The objective of the study was to determine the feasibility, acceptability, and preliminary efficacy of a fully automated conversational agent to deliver a self-help program for college students who self-identify as having symptoms of anxiety and depression. Methods In an unblinded trial, 70 individuals age 18-28 years were recruited online from a university community social media site and were randomized to receive either 2 weeks (up to 20 sessions) of self-help content derived from CBT principles in a conversational format with a text-based conversational agent (Woebot) (n=34) or were directed to the National Institute of Mental Health ebook, “Depression in College Students,” as an information-only control group (n=36). All participants completed Web-based versions of the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), and the Positive and Negative Affect Scale at baseline and 2-3 weeks later (T2). Results Participants were on average 22.2 years old (SD 2.33), 67% female (47/70), mostly non-Hispanic (93%, 54/58), and Caucasian (79%, 46/58). Participants in the Woebot group engaged with the conversational agent an average of 12.14 (SD 2.23) times over the study period. No significant differences existed between the groups at baseline, and 83% (58/70) of participants provided data at T2 (17% attrition). Intent-to-treat univariate analysis of covariance revealed a significant group difference on depression such that those in the Woebot group significantly reduced their symptoms of depression over the study period as measured by the PHQ-9 (F=6.47; P=.01) while those in the information control group did not. In an analysis of completers, participants in both groups significantly reduced anxiety as measured by the GAD-7 (F1,54= 9.24; P=.004). Participants’ comments suggest that process factors were more influential on their acceptability of the program than content factors mirroring traditional therapy. Conclusions Conversational agents appear to be a feasible, engaging, and effective way to deliver CBT. PMID:28588005

A Framework to Assist Health Professionals in Recommending High-Quality Apps for Supporting Chronic Disease Self-Management: Illustrative Assessment of Type 2 Diabetes Apps.

PubMed

Hale, Kelli; Capra, Sandra; Bauer, Judith

2015-09-14

This paper presents an approach to assist health professionals in recommending high quality apps for supporting chronic disease self-management. Most app reviews focus on popularity, aesthetics, functionality, usability, and information quality. There is no doubt these factors are important in selecting trustworthy apps which are appealing to users, but behavioral theory may be also be useful in matching the apps to user needs. The framework developed aims to be methodologically sound, capable of selecting popular apps which include content covered by evidence-based programs, consistent with behavioral theory, as well as a patient-centered approach for matching apps to patients' individual needs. A single disease-type 2 diabetes-was selected to illustrate how the framework can be applied as this was deemed to represent the types of strategies used in many chronic diseases. A systematic approach based on behavioral theory and recommendations from best practice guidelines was developed for matching apps to patients' needs. In March 2014, a series of search strategies was used to identify top-rated iPhone and Android health apps, representing 29 topics from five categories of type 2 diabetes self-management strategies. The topics were chosen from published international guidelines for the management of diabetes. The senior author (KH) assessed the most popular apps found that addressed these topics using the Behavioral Theory Content Survey (BTS), which is based on traditional behavioral theory. A tool to assist decision making when using apps was developed and trialed with health professionals for ease of use and understanding. A total of 14 apps were assessed representing all five topic categories of self-management. Total theoretical scores (BTS scores) were less than 50 on a 100-point scale for all apps. Each app scored less than 50% of the total possible BTS score for all four behavioral theories and for most of the 20 behavioral strategies; however, apps scored higher than 50% of the total possible BTS score for specific strategies related to their primary focus. Our findings suggest that the apps studied would be more effective when used in conjunction with therapy than as stand-alone apps. Apps were categorized according to topic and core intervention strategies. A framework for matching apps to identified patient needs was developed based on app categorization and principles of patient-centered care. The approach was well accepted and understood by a convenience sample of health practitioners. The framework presented can be used by health practitioners to better match apps with client needs. Some apps incorporate highly interactive strategies of behavioral theory, and when used as an adjunct may increase patient participation and the effectiveness of therapy.

Humanistic therapies versus treatment as usual for depression

PubMed Central

Davies, Philippa; Hunot, Vivien; Moore, Theresa HM; Caldwell, Deborah; Jones, Hannah; Lewis, Glyn; Churchill, Rachel

2014-01-01

This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all humanistic therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different humanistic therapy models (person-centred, gestalt, process-experiential, transactional analysis, existential and non-directive therapies) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all humanistic therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression. PMID:25408624

[General aspects of homeopathy].

PubMed

Avello L, Marcia; Avendaño O, Cristian; Mennickent C, Sigrid

2009-01-01

Homeopathic medicine is a type of therapy that appeared in Europe at the end of the eighteenth century. At the present time, it is widely accepted in developed countries as a form of alternative medicine. In Chile, health regulation includes homeopathy as pharmaceutical products and homeopathy is also considered a form of complementary medicine, that is well accepted by the public. The scientific rationale of homeopathy is based on an empiric type of thought that goes from the general to the particular. The symptoms that are valued are those that are particular to each sick individual. It uses diluted solutions of plants, minerals, animals and even venoms. There are basically two hypotheses to explain its mechanisms of action: The "immunological memory" and the "memory of water" or the transmission of electromagnetic information of the water. There still is needed to perform new studies to scientifically assess homeopathy and its usefulness, as an accepted alternative therapy.

Motivational Text Message Intervention for Eating Disorders: A Single-Case Alternating Treatment Design Using Ecological Momentary Assessment.

PubMed

Shingleton, Rebecca M; Pratt, Elizabeth M; Gorman, Bernard; Barlow, David H; Palfai, Tibor P; Thompson-Brenner, Heather

2016-05-01

This study tested a motivational text message treatment adjunct for individuals with eating disorders (EDs) who exhibited high dietary restraint/restriction. A replicated single-case alternating treatment design was used to examine (a) the feasibility of combining a brief motivational interview with subsequent text messages and (b) the influence of the text messages on eating behaviors and motivation to change in individuals with EDs (N=12). The protocol was 8weeks and the text messages were adjunctive to cognitive-behavioral therapy. The intervention was well accepted (mean rating=7/10) and feasible within the context of monetary compensation (mean daily monitoring compliance =91%). Text messages did not impact behavioral outcomes: dietary restraint and kilocalorie intake. They had mixed effects on motivation to change dietary restraint, measured by the Readiness and Motivation Questionnaire (RMQ). When receiving text messages, RMQ precontemplation scores (desire to restrict) significantly increased, indicating decreased motivation; however, action scores (effort toward reducing dietary restraint) significantly increased, indicating increased motivation. These effects were moderated by weight status. Underweight individuals (n=4; body mass index [BMI]<19.0) reported increased ambivalence-that is, an increased desire to restrict and increased action toward reducing restriction-in response to the text messages. Normal weight participants (n=8; BMI>19.0) reported only increased action toward reducing restriction in response to the text messages. These data demonstrate text messages are a potentially feasible and acceptable treatment adjunct and may be effective at increasing motivation to change for normal weight individuals, while their influence on underweight patients is more complex. These findings provide a foundation for future research in technology-based motivational interventions for EDs and offer preliminary evidence for using these methods among normal weight individuals. Copyright © 2016. Published by Elsevier Ltd.

Brief Strategic Family Therapy: Engaging Drug Using/Problem Behavior Adolescents and their Families into Treatment

PubMed Central

Szapocznik, José; Zarate, Monica; Duff, Johnathan; Muir, Joan

2013-01-01

Despite the efficacy of family-based interventions for improving outcomes for adolescent behavior problems such as substance use, engaging and retaining whole families in treatment is one of the greatest challenges therapists confront. This article illustrates how the Brief Strategic Family Therapy® (BSFT®) model, a family-based, empirically validated intervention designed to treat children and adolescents’ problem behaviors, can be used to increase engagement, improve retention, and bring about positive outcomes for families. Research evidence for efficacy and effectiveness is also presented. PMID:23731415

[The role of art therapy in the rehabilitation of psycho-socially disabled people].

PubMed

Simon, Lajos; Kovács, Emese

2015-01-01

The present review focuses on the generally accepted and applied community psychiatry based models of psycho-social rehabilitation. The basics of the Strenghts model and the Recovery based model are introduced in this paper. Both models can be assisted by art therapy in various ways. The forms and the therapeutic factors of art therapy are also discussed, as well as the effects of the creating experience during the art therapy sessions. The authors introduce the good practice of the Moravcsik Foundation with highlights in two special areas that are beyond the generally applied art therapy work and representing important support in reaching the goals set during the rehabilitation process. Further, the authors describe the Budapest Art Brut Gallery and the PsychArt24 art marathon project in details.

Attitudes toward integration of complementary and alternative medicine with hospital-based care.

PubMed

Lewis, D; Paterson, M; Beckerman, S; Sandilands, C

2001-12-01

To characterize those who have used, expect to use, or are opposed to the use of holistic therapies, especially in a conventional medical (hospital) setting. SAMPLE DESCRIPTION AND METHODS: Cross-sectional survey of a random sample of Hamilton-Wentworth residents between March and June 1998 (n = 416; response rate, 63%); analysis used logistic regression. Thirty-seven percent (37%) used at least one holistic therapy in the previous year: the three most common were chiropractic, massage, and herbal/phytology. The three most common reasons for use were general health, fatigue, and arthritis. Thirty-three percent (33%) would use holistic therapy in the future. Barriers to use were lack of information, perceived ineffectiveness, and cost; approximately 40% agreed they would only use holistic therapies with medical advice. Approximately 13% were opposed to holistic therapy and objected to its use in hospitals. Younger age, preference for holistic therapy over conventional medicine, and prior use of holism independently predicted high likelihood for future use. Lower income and high self-perceived health were associated with negative attitude toward use of holistic therapies in hospital. Most respondents would accept integration of holistic techniques into a hospital; therapies would be more acceptable if there were clear evidence of their efficacy. A few might find their opinion of a sponsoring hospital lowered by such integration.

What has psychotherapy inherited from Carl Rogers?

PubMed

Goldfried, Marvin R

2007-09-01

Rogers' classic article (see record 2007-14639-002) on the necessary and sufficient conditions for therapeutic change--now 50 years old--has made an indelible impact on the field. In his brief article, Rogers broke with the past, making a compelling case for the importance of subjecting our hypotheses about how therapy works to empirical test. Moreover, his emphasis on the importance of the therapy relationship is now routinely accepted as necessary, even if not sufficient for change to occur. Having moved beyond Rogers' necessary and sufficient conditions, the field of therapy now recognizes that as important as the therapy relationship might be, there are certain clinical problems that require the use of specific techniques to bring about change. Still, it is currently recognized that therapist acceptance is essential, that nondirective methods can be effective in improving client motivation, and perhaps most important, that the therapist needs to work toward the development of evidence-based interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Achieving cultural congruency in weight loss interventions: can a spirituality-based program attract and retain an inner-city community sample?

PubMed

Davis, Chad; Dutton, William Blake; Durant, Taryn; Annunziato, Rachel A; Marcotte, David

2014-01-01

Ethnic minorities continue to be disproportionately affected by obesity and are less likely to access healthcare than Caucasians. It is therefore imperative that researchers develop novel methods that will attract these difficult-to-reach groups. The purpose of the present study is to describe characteristics of an urban community sample attracted to a spiritually based, weight loss intervention. METHODS. Thirteen participants enrolled in a pilot version of Spiritual Self-Schema Therapy (3S) applied to disordered eating behavior and obesity. Treatment consisted of 12 one-hour sessions in a group therapy format. At baseline, participants were measured for height and weight and completed a battery of self-report measures. The sample was predominantly African-American and Hispanic and a large percentage of the sample was male. Mean baseline scores of the EDE-Q, YFAS, and the CES-D revealed clinically meaningful levels of eating disordered pathology and depression, respectively. The overall attrition rate was quite low for interventions targeting obesity. This application of a spiritually centered intervention seemed to attract and retain a predominantly African-American and Hispanic sample. By incorporating a culturally congruent focus, this approach may have been acceptable to individuals who are traditionally more difficult to reach.

Where Is the Evidence for "Evidence-Based" Therapy?

PubMed

Shedler, Jonathan

2018-06-01

The term evidence-based therapy is a de facto code word for manualized therapy, most often brief cognitive behavior therapy and its variants. It is widely asserted that "evidence-based" therapy is scientifically proven, superior to other forms of psychotherapy, and the gold standard of care. Research findings do not support such assertions. Research on evidence-based therapies demonstrates that they are weak treatments. They have not shown superiority to other forms of psychotherapy, few patients get well, and treatment benefits do not last. Questionable research practices create a distorted picture of the actual benefits of these therapies. Copyright © 2018 Jonathan Shedler. Published by Elsevier Inc. All rights reserved.

Treatment of phobic postural vertigo. A controlled study of cognitive-behavioral therapy and self-controlled desensitization.

PubMed

Holmberg, J; Karlberg, M; Harlacher, U; Rivano-Fischer, M; Magnusson, M

2006-04-01

In balance clinic practice, phobic postural vertigo is a term used to define a population with dizziness and avoidance behavior often as a consequence of a vestibular disorder. It has been described as the most common form of dizziness in middle aged patients in dizziness units. Anxiety disorders are common among patients with vestibular disorders. Cognitive-behavioral therapy is an effective treatment for anxiety disorders, and vestibular rehabilitation exercises are effective for vestibular disorders. This study compared the effect of additional cognitive-behavioral therapy for a population with phobic postural vertigo with the effect of self-administered vestibular rehabilitation exercises. 39 patients were recruited from a population referred for otoneurological investigation. Treatment effects were evaluated with the Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale. All patients had a self treatment intervention based on education about the condition and recommendation of self exposure by vestibular rehabilitation exercises. Every second patient included was offered additional cognitive behavioral therapy. Fifteen patients with self treatment and 16 patients with cognitive- behavioral treatment completed the study. There was significantly larger effect in the group who received cognitive behavioral therapy than in the self treatment group in Vertigo Handicap Questionnaire and the Hospital Anxiety and Depression scale and its subscales. Cognitive-behavioral therapy has an additional effect as treatment for a population with phobic postural vertigo. A multidisciplinary approach including medical treatment, cognitive-behavioral therapy and physiotherapy is suggested.

Supportive therapy for schizophrenia: possible mechanisms and implications for adjunctive psychosocial treatments.

PubMed

Penn, David L; Mueser, Kim T; Tarrier, Nick; Gloege, Andrew; Cather, Corrine; Serrano, Daniel; Otto, Michael W

2004-01-01

This article posits that the positive findings for supportive therapy (ST) in recent trials may indicate an important but undervalued aspect of psychosocial interventions for schizophrenia. In developing this thesis, we consider the possible mechanisms underlying the beneficial effects of ST observed in recent trials of cognitive behavioral therapy for schizophrenia. We place this evidence in the context of a review of psychological models of mental health, the therapeutic alliance, and research on social cognition and social support in schizophrenia. We conclude this article by describing a new theoretically driven intervention for schizophrenia, functional cognitive-behavioral therapy (FCBT), which improves functional outcomes by integrating evidence-based advances in cognitive behavioral therapy with the strengths of ST approaches.

Improving population management through pharmacist-primary care integration: a pilot study.

PubMed

Kennedy, Amanda G; Chen, Harry; Corriveau, Michele; MacLean, Charles D

2015-02-01

Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach.

Money: a therapeutic tool for couples therapy.

PubMed

Shapiro, Margaret

2007-09-01

This article addresses the therapeutic importance of discussing money at every stage of a couple's relationship, both as a concrete reality and as a metaphor for security, adequacy, competence, commitment, acceptance, and acknowledgment in a relationship. I will present a developmental schema looking at financial issues that couples confront at various stages in the adult life cycle and how these affect and reflect relationship problems. The article also presents a money questionnaire as a useful tool for exploring family-of-origin financial history, affect, and behavior.

Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding.

PubMed

Welch, Christie D; Polatajko, H J

2016-01-01

Occupational therapists strive to be mindful, competent practitioners and continuously look for ways to improve practice. Applied behavior analysis (ABA) has strong evidence of effectiveness in helping people with autism achieve goals, yet it does not seem to be implemented in occupational therapy practice. To better understand whether ABA could be an evidence-based option to expand occupational therapy practice, the authors conducted an iterative, multiphase investigation of relevant literature. Findings suggest that occupational therapists apply developmental and sensory approaches to autism treatment. The occupational therapy literature does not reflect any use of ABA despite its strong evidence base. Occupational therapists may currently avoid using ABA principles because of a perception that ABA is not client centered. ABA principles and occupational therapy are compatible, and the two could work synergistically. Copyright © 2016 by the American Occupational Therapy Association, Inc.

Developmental Therapy- Developmental Teaching: An Outreach Project for Young Children with Social-Emotional-Behavioral Disabilities (October 1, 1997-September 30, 2000). Final Performance Report.

ERIC Educational Resources Information Center

Georgia Univ., Athens. Coll. of Family and Consumer Sciences.

This outreach project is based on the validated Developmental Therapy-Developmental Teaching model originally designed for young children with severe emotional/behavioral problems and their families. It is an approach that emphasizes the teaching skills that foster a child's social-emotional-behavioral competence. The model has proven effective in…

Insights into the Feelings, Thoughts, and Behaviors of Children with Visual Impairments: A Focus Group Study Prior to Adapting a Cognitive Behavior Therapy-Based Anxiety Intervention

ERIC Educational Resources Information Center

Visagie, Lisa; Loxton, Helene; Stallard, Paul; Silverman, Wendy K.

2017-01-01

Introduction: Anxiety is the most common psychological problem reported among children with visual impairments. Although cognitive behavior therapy interventions have proven successful in treating childhood anxiety, it is unclear whether they are suitable and accessible for children who have visual impairments. This study aimed to determine if and…

'Feel the Feeling': Psychological practitioners' experience of acceptance and commitment therapy well-being training in the workplace.

PubMed

Wardley, Matt Nj; Flaxman, Paul E; Willig, Carla; Gillanders, David

2016-08-01

This empirical study investigates psychological practitioners' experience of worksite training in acceptance and commitment therapy using an interpretative phenomenological analysis methodology. Semi-structured interviews were conducted with eight participants, and three themes emerged from the interpretative phenomenological analysis data analysis: influence of previous experiences, self and others and impact and application The significance of the experiential nature of the acceptance and commitment therapy training is explored as well as the dual aspects of developing participants' self-care while also considering their own clinical practice. Consistencies and inconsistencies across acceptance and commitment therapy processes are considered as well as clinical implications, study limitations and future research suggestions. © The Author(s) 2014.

Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students.

PubMed

Fleming, Andrew P; McMahon, Robert J; Moran, Lyndsey R; Peterson, A Paige; Dreessen, Anthony

2015-03-01

ADHD affects between 2% and 8% of college students and is associated with broad functional impairment. No prior randomized controlled trials with this population have been published. The present study is a pilot randomized controlled trial evaluating dialectical behavior therapy (DBT) group skills training adapted for college students with ADHD. Thirty-three undergraduates with ADHD between ages 18 and 24 were randomized to receive either DBT group skills training or skills handouts during an 8-week intervention phase. ADHD symptoms, executive functioning (EF), and related outcomes were assessed at baseline, post-treatment, and 3-month follow-up. Participants receiving DBT group skills training showed greater treatment response rates (59-65% vs. 19-25%) and clinical recovery rates (53-59% vs. 6-13%) on ADHD symptoms and EF, and greater improvements in quality of life. DBT group skills training may be efficacious, acceptable, and feasible for treating ADHD among college students. A larger randomized trial is needed for further evaluation. © 2014 SAGE Publications.

Protocol evaluation for effective music therapy for persons with nonfluent aphasia.

PubMed

Kim, Mijin; Tomaino, Concetta M

2008-01-01

Although the notion of the language specificity of neural correlates has been widely accepted in the past (e.g., lefthemispheric dominance including Broca's and Wernike's area, N400 ERP component of semantic processing, and the P600 ERP component of syntactic processing, etc.), recent studies have shown that music and language share some important neurological aspects in their processing, both involving bilateral hemispheric activities. In line with this are the frequent behavioral clinical observations that persons with aphasia show improved articulation and prosody of speech in musically assisted phrases. Connecting recent neurological findings with clinical observations would not only inform clinical practice but would enhance understanding of the neurological mechanisms involved in the processing of speech/language and music. This article presents a music therapy treatment protocol study of 7 nonfluent patients with aphasia. The data and findings are discussed with regard to some of the recent focuses and issues addressed in the experimental studies using cognitive-behavioral, electrophysiological, and brain-imaging techniques.

Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

PubMed Central

Castelnuovo, Gianluca; Giusti, Emanuele M.; Manzoni, Gian Mauro; Saviola, Donatella; Gatti, Arianna; Gabrielli, Samantha; Lacerenza, Marco; Pietrabissa, Giada; Cattivelli, Roberto; Spatola, Chiara A. M.; Corti, Stefania; Novelli, Margherita; Villa, Valentina; Cottini, Andrea; Lai, Carlo; Pagnini, Francesco; Castelli, Lorys; Tavola, Mario; Torta, Riccardo; Arreghini, Marco; Zanini, Loredana; Brunani, Amelia; Capodaglio, Paolo; D'Aniello, Guido E.; Scarpina, Federica; Brioschi, Andrea; Priano, Lorenzo; Mauro, Alessandro; Riva, Giuseppe; Repetto, Claudia; Regalia, Camillo; Molinari, Enrico; Notaro, Paolo; Paolucci, Stefano; Sandrini, Giorgio; Simpson, Susan G.; Wiederhold, Brenda; Tamburin, Stefano

2016-01-01

Background: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. Objectives: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. Methods: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. Results: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive—Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post—Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. Conclusions: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper. PMID:26924998

Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation.

PubMed

Castelnuovo, Gianluca; Giusti, Emanuele M; Manzoni, Gian Mauro; Saviola, Donatella; Gatti, Arianna; Gabrielli, Samantha; Lacerenza, Marco; Pietrabissa, Giada; Cattivelli, Roberto; Spatola, Chiara A M; Corti, Stefania; Novelli, Margherita; Villa, Valentina; Cottini, Andrea; Lai, Carlo; Pagnini, Francesco; Castelli, Lorys; Tavola, Mario; Torta, Riccardo; Arreghini, Marco; Zanini, Loredana; Brunani, Amelia; Capodaglio, Paolo; D'Aniello, Guido E; Scarpina, Federica; Brioschi, Andrea; Priano, Lorenzo; Mauro, Alessandro; Riva, Giuseppe; Repetto, Claudia; Regalia, Camillo; Molinari, Enrico; Notaro, Paolo; Paolucci, Stefano; Sandrini, Giorgio; Simpson, Susan G; Wiederhold, Brenda; Tamburin, Stefano

2016-01-01

It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.

Trauma-Focused Cognitive Behavior Therapy for School Psychologists

ERIC Educational Resources Information Center

Fitzgerald, Monica M.; Cohen, Judith A.

2012-01-01

Schools are ideal settings for identifying children and adolescents who have been exposed to traumatic events. They are also ideal for providing evidence-based mental health services, such as trauma-focused cognitive behavioral therapy, to students affected by childhood posttraumatic stress disorder and co-occurring mental health and behavioral…

Alliance and Outcome in Cognitive-Behavioral Therapy for Adolescent Depression

ERIC Educational Resources Information Center

Shirk, Stephen R.; Gudmundsen, Gretchen; Kaplinski, Heather Crisp; McMakin, Dana L.

2008-01-01

This study examined predictive relations between therapeutic alliance and treatment outcomes in manual-guided, cognitive-behavioral therapy for adolescent depression. Fifty-four adolescents met criteria for a depressive disorder and were treated in school-based clinics. Alliance was measured after the third session from both therapist and…

School-Based Cognitive-Behavioral Therapy for Adolescent Depression: A Benchmarking Study

ERIC Educational Resources Information Center

Shirk, Stephen R.; Kaplinski, Heather; Gudmundsen, Gretchen

2009-01-01

The current study evaluated cognitive-behavioral therapy (CBT) for adolescent depression delivered in health clinics and counseling centers in four high schools. Outcomes were benchmarked to results from prior efficacy trials. Fifty adolescents diagnosed with depressive disorders were treated by eight doctoral-level psychologists who followed a…

Dialectical Behavior Therapy Modified for Adolescent Binge Eating Disorder: A Case Report

ERIC Educational Resources Information Center

Safer, Debra L.; Couturier, Jennifer L.; Lock, James

2007-01-01

Given the lack of empirically supported treatments available for adolescents with eating disorders, it is important to investigate the clinical utility of extending treatments for adults with eating disorders to younger populations. Dialectical behavior therapy for binge eating disorder, based on the affect-regulation model, conceptualizes binge…

Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial.

PubMed

Norlund, Fredrika; Olsson, Erik M G; Burell, Gunilla; Wallin, Emma; Held, Claes

2015-04-11

Major depression and depressive symptoms are common in patients with a recent myocardial infarction (MI), and depression is associated with adverse cardiovascular outcomes. Anxiety post-MI is less studied, but occurs commonly in patients with heart disease, and is also considered a risk factor for recurrence of cardiac events. Cognitive behavior therapy (CBT) is an established therapy for depression and anxiety disorders. To the best of our knowledge, there have not been any studies to determine if internet-based CBT (iCBT) can reduce the symptoms of depression and anxiety in patients with a recent MI. The main aim of the U-CARE Heart trial is to evaluate an iCBT intervention for patients with a recent MI. This is a randomized, controlled, prospective study with a multicenter design. A total of 500 participants will be randomized at a 1:1 ratio, around two months after an acute MI, to either iCBT or to a control group. Both groups will receive an optimal standard of care according to guidelines. The intervention consists of a self-help program delivered via the internet with individual online support from a psychologist. Treatment duration is 14 weeks. The primary outcome is change in patients' self-rated anxiety and depression symptoms from baseline to end of treatment. An internal pilot study was conducted indicating sufficient levels of study acceptability and engagement in treatment. The present study is designed to evaluate an iCBT intervention targeting symptoms of depression and anxiety in a post-MI population. If effective, iCBT has several advantages, and will potentially be implemented as an easily accessible treatment option added to modern standard of care. This trial was registered with Clinicaltrials.gov (identifier: NCT01504191 ) on 19 December 2011.

Combined Case of Blood-Injury-Injection Phobia and Social Phobia: Behavior Therapy Management and Effectiveness through Tilt Test

PubMed Central

Ferenidou, Fotini; Chalimourdas, Theodoros; Antonakis, Velissarios; Vaidakis, Nikolaos; Papadimitriou, Georgios

2012-01-01

The efficacy of behavior therapy based mainly on real-life exposure situations as well as applied tension was examined for a combined case of blood-injury-injection (BII) phobia and social anxiety disorder. Treatment involved 28 behavior therapy sessions, while applied tension technique was also described and practiced. The specific contribution of social skills techniques, fantasy, and real-life situations exposure was examined in a single case design. The subject was a 39-year-old male with anxiety symptoms when confronting an audience, as well as symptoms of the autonomic nervous system (bradycardia and syncope), which were better explained by BII. All self-report measures regarding fear, social phobia, and anxiety were reduced after behavior therapy and remained maintained at followup, while BII decreased further after applied tension techniques. The contribution of behavior therapy to the overall outcome of the case is considered significant for many reasons that are discussed in the pape. PMID:23304602

Using a digital game for training desirable behavior in cognitive-behavioral therapy of burnout syndrome: a controlled study.

PubMed

Zielhorst, Thomas; van den Brule, Daphne; Visch, Valentijn; Melles, Marijke; van Tienhoven, Sam; Sinkbaek, Helle; Schrieken, Bart; Tan, Eduard S-H; Lange, Alfred

2015-02-01

Burnout is a globally increasing illness, and as a result, many forms of burnout therapy have arisen. The use of digital games can be psychotherapeutically effective because they can transform exercises that are by themselves unattractive into intrinsically motivated action. This pilot study aims to test whether a specially designed game contributes to patients learning desired behavior and achieving other specific therapeutic goals in an online cognitive-behavioral therapy (CBT)-based burnout treatment context. In total, 101 participants took part in the experiment, under four conditions: (a) Game+Therapy, (b) Therapy Only, (c) Game Only, and (d) No Game+No Therapy. Pre- and postmeasures were taken online. Results showed that the two therapy conditions (Game+Therapy and Therapy Only) showed a greater decrease in complaints and disengagement, and a stronger increase in coping skills than the nontherapy conditions (Game Only and No Game+No Therapy). As expected, the Game+Therapy condition outperformed the Therapy Only condition on combined improvement measures of burnout symptoms. However, analyses of individual measures showed no effects. It can be cautiously concluded that the therapeutic digital game may be a useful tool when embedded in a therapeutic burnout treatment program and is probably more efficient than CBT, as it is used in current practice.

An Open Trial of Acceptance-based Separated Family Treatment (ASFT) for Adolescents with Anorexia Nervosa

PubMed Central

Timko, C. Alix; Zucker, Nancy L.; Herbert, James D.; Rodriguez, Daniel; Merwin, Rhonda M.

2016-01-01

Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12–18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed. PMID:25898341

Smoking-Related Behaviors and Effectiveness of Smoking Cessation Therapy Among Prisoners and Prison Staff.

PubMed

Turan, Onur; Turan, Pakize Ayse

2016-04-01

Smoking is a serious problem in prisons. This work aimed to assess smoking-related behaviors and the effectiveness of tobacco cessation therapy in prison. This study includes four visits to a prison in Bolvadin-Afyon, Turkey. Pharmacologic options for tobacco cessation were offered to the participants who wanted to quit smoking. One hundred seventy-nine subjects (109 prisoners and 70 prison staff) with 68.7% current smokers were included. There was an increase of cigarette smoking in 41.8% (the most common reason was stress) and decrease in 18.7% (the most common reason was health problems) of the participants after incarceration. Fifty-nine participants accepted the offered tobacco cessation treatment. Only 2 participants started their planned medications, but they could not quit smoking. The most common reason for failed attempts to quit was the high prices of cessation therapies. Factors like stress and being in prison may provoke smoking. A smoking ban does not seem to be a total solution for preventing tobacco use in prisons. Tobacco cessation programs may be a better option. Cost-free cessation medications may increase quitting rates among prisoners and prison staff. Copyright © 2016 by Daedalus Enterprises.

Self-acceptance of stuttering: A preliminary study.

PubMed

De Nardo, Thales; Gabel, Rodney M; Tetnowski, John A; Swartz, Eric R

2016-01-01

This study explored the relationship between self-acceptance of stuttering and (1) psychosocial factors (self-esteem, hostility towards others, emotional support, and perceived discrimination); (2) treatment history (support group participation, therapy duration, and perceived therapy success); and (3) previously reported variables in self-acceptance of stuttering, which include age and stuttering severity. Participants were 80 adults who stutter who were recruited with assistance from the National Stuttering Association and Board Certified Specialists in Fluency Disorders. Participants completed an electronic survey composed of an acceptance of stuttering scale, psychosocial scales, and a participant information questionnaire. Statistical analysis identified significant correlations between participants' reports of self-acceptance of stuttering and self-esteem, perceived discrimination, hostility towards others, and perceived therapy outcome. Self-esteem was positively correlated with self-acceptance, while hostility towards others and perceived discrimination was negatively correlated with self-acceptance. Participants who perceived their therapy outcome to be successful were significantly more likely to report higher levels of self-acceptance. No significant relationships were found between self-acceptance of stuttering and support group participation, emotional support, stuttering severity, and participant age. This exploratory investigation has provided a foundation for future studies on the self-acceptance of stuttering. The findings indicate common psychosocial variables in self-acceptance of stuttering and of other disabilities. The significant relationships between self-acceptance of stuttering and psychosocial and therapeutic variables found need to be further explored to identify its causalities and clinical implications. The reader will be able to (1) discuss the importance of assessing self-acceptance of stuttering, (2) summarize the literature on self-acceptance of disability, and (3) describe the significant findings related to self-acceptance of stuttering and psychosocial, therapeutic variables. Copyright © 2016 Elsevier Inc. All rights reserved.

Use and acceptability of unsupported online computerized cognitive behavioral therapy for depression and associations with clinical outcome.

PubMed

de Graaf, L Esther; Huibers, Marcus J H; Riper, Heleen; Gerhards, Sylvia A H; Arntz, Arnoud

2009-08-01

In a recent randomized trial, we were unable to confirm the previously reported high effectiveness of CCBT. Therefore, the aim of the current study was to have a closer look at usage and acceptability (i.e. expectancy, credibility, and satisfaction) of the intervention. Depressed participants (N=200) were given login codes for unsupported online CCBT. A track-and-trace system tracked which components were used. We used a 9-month follow-up period. Uptake was sufficient, but dropout was high. Many usage indices were positively associated with short-term depressive improvement, whereas only homework was related to long-term improvement. Acceptability was good and expectancy could predict long-term, but not short-term outcome. Associations between use of CCBT and improvement are merely correlational. Our sample was too depressed in relation to the scope of the intervention. We relied on online self-report measures. Analyses were exploratory in nature. Although CCBT might be a feasible and acceptable treatment for depression, means to improve treatment adherence are needed for moderately to severely depressed individuals.

Lost in translation? Moving contingency management and cognitive behavioral therapy into clinical practice.

PubMed

Carroll, Kathleen M

2014-10-01

In the treatment of addictions, the gap between the availability of evidence-based therapies and their limited implementation in practice has not yet been bridged. Two empirically validated behavioral therapies, contingency management (CM) and cognitive behavioral therapy (CBT), exemplify this challenge. Both have a relatively strong level of empirical support but each has weak and uneven adoption in clinical practice. This review highlights examples of how barriers to their implementation in practice have been addressed systematically, using the Stage Model of Behavioral Therapies Development as an organizing framework. For CM, barriers such as cost and ideology have been addressed through the development of lower-cost and other adaptations to make it more community friendly. For CBT, barriers such as relative complexity, lack of trained providers, and need for supervision have been addressed via conversion to standardized computer-assisted versions that can serve as clinician extenders. Although these and other modifications have rendered both interventions more disseminable, diffusion of innovation remains a complex, often unpredictable process. The existing specialty addiction-treatment system may require significant reforms to fully implement CBT and CM, particularly greater focus on definable treatment goals and performance-based outcomes. © 2014 New York Academy of Sciences.

Mental health service acceptability for the armed forces veteran community.

PubMed

Farrand, P; Jeffs, A; Bloomfield, T; Greenberg, N; Watkins, E; Mullan, E

2018-06-15

Despite developments in mental health services for armed forces veterans and family members, barriers to access associated with poor levels of acceptability regarding service provision remain. Adapting a Step 2 mental health service based on low-intensity cognitive behavioural therapy (CBT) interventions to represent a familiar context and meet the needs of the armed forces veteran community may serve to enhance acceptability and reduce help-seeking barriers. To examine acceptability of a Step 2 low-intensity CBT mental health service adapted for armed forces veterans and family members provided by a UK Armed Forces charity. Qualitative study using individual semi-structured interviews with armed forces veterans and family members of those injured or becoming unwell while serving in the British Armed Forces. Data analysis was undertaken using thematic alongside disconfirming case analysis. Adapting a Step 2 mental health service for armed forces veterans and family members enhanced acceptability and promoted help-seeking. Wider delivery characteristics associated with Step 2 mental health services within the Improving Access to Psychological Therapies (IAPT) programme also contributed to service acceptability. However, limitations of Step 2 mental health service provision were also identified. A Step 2 mental health service adapted for armed forces veterans and family members enhances acceptability and may potentially overcome help-seeking barriers. However, concerns remain regarding ways to accommodate the treatment of post-traumatic stress disorder and provide support for family members.

Online Cognitive Behavioral Therapy for Bulimic Type Disorders, Delivered in the Community by a Nonclinician: Qualitative Study

PubMed Central

McClay, Carrie-Anne; Waters, Louise; McHale, Ciaran; Schmidt, Ulrike

2013-01-01

Background Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user’s own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician. Objective To investigate participants’ experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Methods Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process. Results Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals’ thoughts on taking part in the online research study. Conclusions Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package. Trial Registration International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV) PMID:23502689

Online cognitive behavioral therapy for bulimic type disorders, delivered in the community by a nonclinician: qualitative study.

PubMed

McClay, Carrie-Anne; Waters, Louise; McHale, Ciaran; Schmidt, Ulrike; Williams, Christopher

2013-03-15

Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user's own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician. To investigate participants' experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process. Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals' thoughts on taking part in the online research study. Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package. International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV).

Parents' explanatory models and hopes for outcomes of occupational therapy using a sensory integration approach.

PubMed

Cohn, Ellen S; Kramer, Jessica; Schub, Jamie A; May-Benson, Teresa

2014-01-01

PURPOSE. To describe parents' concerns and hopes for their children who would be receiving occupational therapy using a sensory integration approach. METHOD. Content analysis of 275 parental responses to three open-ended questions on developmental-sensory history intake forms. FINDINGS. Parents' descriptions of why they sought for their children were categorized into four overarching concerns about their children's challenges: self-regulation, interacting with peers, participating in skilled motor activities, and self-confidence. Parents often linked these concerns together, revealing explanatory models of how they make sense of potential relationships among their children's challenges and how these challenges affect occupational performance. Parents hoped occupational therapy would help their children develop self-understanding and frustration tolerance to self-regulate their behavior in socially acceptable ways. IMPLICATIONS. Assessment and intervention should explicitly focus on links among self-regulation, social participation, skills, and perceived competence to address parents' expectations. Copyright © 2014 by the American Occupational Therapy Association, Inc.

An individually tailored behavioral medicine treatment in physical therapy for tension-type headache - two experimental case studies.

PubMed

Söderlund, Anne; Lagerlöf, Helena

2016-01-01

The aim of this study was to describe and evaluate the effect of an individually tailored behavioral medicine treatment in physical therapy, based on a functional behavioral analysis (FBA), for tension-type headache (TTH). Two case studies with A1-A2-B-A3 design of two patients with TTH was conducted. Outcome variables were headache frequency, headache index (mean intensity), consumption of analgesics, self-efficacy in headache management (Headache Management Self-efficacy Scale [HMSE]), disability, and perceived loss of happiness for activities with family and friends. The results showed that headache frequency and headache index decreased for one of the patients. Self-efficacy in headache management increased markedly for both patients. A behavioral medicine treatment in physical therapy based on an FBA can be a way for physical therapists to handle patients with TTH. Future investigations should focus on large group studies with longer observation periods.

Stigma and Postpartum Depression Treatment Acceptability Among Black and White Women in the First Six-Months Postpartum.

PubMed

Bodnar-Deren, Susan; Benn, E K T; Balbierz, Amy; Howell, E A

2017-07-01

Objective To measure stigma associated with four types of postpartum depression therapies and to estimate the association between stigma and the acceptance of these therapies for black and white postpartum mothers. Methods Using data from two postpartum depression randomized trials, this study included 481 black and white women who gave birth in a large urban hospital and answered a series of questions at 6-months postpartum. Survey items included socio demographic and clinical factors, attitudes about postpartum depression therapies and stigma. The associations between race, stigma, and treatment acceptability were examined using bivariate and multivariate analyses. Results Black postpartum mothers were less likely than whites to accept prescription medication (64 vs. 81%, p = 0.0001) and mental health counseling (87 vs. 93%, p = 0.001) and more likely to accept spiritual counseling (70 vs. 52%, p = 0.0002). Women who endorsed stigma about receipt of postpartum depression therapies versus those who did not were less likely to accept prescription medication, mental health and spiritual counseling for postpartum depression. Overall black mothers were less likely to report stigma associated with postpartum depression therapies. In adjusted models, black women versus white women remained less likely to accept prescription medication for postpartum depression (OR = 0.42, 95% CI 0.24-0.72) and stigma did not explain this difference. Conclusions Although treatment stigma is associated with lower postpartum depression treatment acceptance, stigma does not explain the lower levels of postpartum depression treatment acceptance among black women. More research is needed to understand treatment barriers for postpartum depression, especially among black women.

Opioid tolerance and dependence -- do they matter?

PubMed

Jage, Jürgen

2005-04-01

The use of opioids has long been accepted as the standard of care in patients with cancer and acute pain. Opioids can further be used effectively in specific subgroups of patients with chronic nonmalignant pain states. While the development of tolerance and physical dependence are known effects of opioids in cancer and noncancer pain populations, these patients can not be regarded as addicted. However, long-term therapy with short-acting opioids predisposes to tolerance and addiction. Recent research has confirmed the important role of psychopathologic and psychosocial conditions as predictors of failed opioid effectiveness in a significant number of noncancer pain subgroups. The clinical picture of failed therapy may be complicated by noncompliance, concealed consumption of psychotropic substances, and diversion of prescribed opioids for various purposes as, e.g., selling for profit, or sharing excess opioids with others. This article discusses the effects of opioid therapy, including tolerance, physical dependence, drug-aberrant behavior, drug history, psychopathology, and somatization.

Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study

PubMed Central

Nachega, Jean B; Skinner, Donald; Jennings, Larissa; Magidson, Jessica F; Altice, Frederick L; Burke, Jessica G; Lester, Richard T; Uthman, Olalekan A; Knowlton, Amy R; Cotton, Mark F; Anderson, Jean R; Theron, Gerhard B

2016-01-01

Objective To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). Design and methods A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18–30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life (“Option B+”) were interviewed about mobile phone access, SMS use, and potential treatment supporters. Setting A community primary care clinic in Cape Town, South Africa. Participants HIV-infected pregnant women. Main outcomes Acceptability and feasibility of mHealth and cDOT interventions. Results Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. Conclusion mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial. PMID:27175068