Psychosocial concerns in burn survivors and their families: A narrative review.

Cognitive Behavior Therapy (CBT) has come a long way since its inception in the 1960s. The approach has effectively treated various psychological disorders, from anxiety and depression to post-traumatic stress disorder and substance abuse. However, as we move further into the 21st century, the future of CBT is poised to undergo significant innovation. Cognitive Behavior Therapy (CBT) is evolving rapidly, and its future holds exciting new developments. Emerging trends in CBT include the use of digital and mobile applications to increase access to mental health services and the development of personalized treatment plans based on an individual’s unique needs. These transdiagnostic approaches treat underlying mechanisms that cut across different disorders, the integration of new technologies, and the emphasis on self-help strategies. These innovative approaches offer promising new ways to treat mental health disorders more effectively and efficiently and are likely to shape the future of CBT.1 Here briefly discuss the emerging trends that could shape the future of CBT: Digital and Mobile Applications; with the rise of telehealth and digital mental health platforms, CBT is being integrated into mobile and online applications. These platforms enable greater access to mental health services, reaching individuals who may not have access to traditional in-person therapy. Personalized Treatment; CBT is moving beyond a one-size-fits-all approach. Customized treatment plans can be developed using assessment data and digital monitoring tools. This approach considers an individual’s unique circumstances, symptoms, and treatment preferences to create a more effective and targeted treatment plan. Transdiagnostic Approaches: In the past, CBT has primarily focused on treating specific disorders. However, the transdiagnostic approach is gaining attraction, emphasizing treating underlying mechanisms that cut across different disorders. This approach may enable the treatment of comorbid conditions more efficiently and effectively.2 Incorporating New Technologies; The use of new technologies, such as virtual reality and brain stimulation techniques, has shown promise in treating a range of psychological disorders.3 Incorporating these tools into CBT may offer more effective treatment options for individuals who are unresponsive to traditional therapies. Emphasizing Self-Help Strategies; CBT’s future may rely on empowering individuals to control their mental health through self-help strategies. By utilizing mobile applications, online resources, and telehealth, individuals may gain access to resources that can help them manage their symptoms more effectively. The future of Cognitive Behavior Therapy (CBT) in Pakistan is bright, as the country is experiencing a growing demand for mental health services. There is a need for effective, evidence-based treatments like CBT, which have demonstrated efficacy in treating various psychological disorders. However, several challenges need to be addressed to increase the availability and accessibility of CBT in Pakistan.4 One of the major challenges is the shortage of mental health professionals, particularly those trained in CBT. To address this issue, there is a need for increased investment in mental health education and training and initiatives to attract and retain mental health professionals. Another challenge is the cultural context in which CBT is delivered in Pakistan. Cultural sensitivity and adaptation of CBT are crucial to its success, and this can be achieved through collaboration with local experts and stakeholders to tailor the approach to the local context. To fill the gap in CBT training, a 6-month postgraduate certificate training program was started in 2017 at Khyber Medical College Peshawar, affiliated with Khyber medical university Peshawar. This training attracted mental health professionals from all over the country, and so far, about 100 mental health professionals (psychiatrists and psychologists) have been trained in CBT. CBT training has been further enhanced, and a one-year postgraduate diploma training program was started in 2022 at Bashir Psychiatric Hospital and Institute in collaboration with Gandhara University Peshawar. This training program covers the treatment of a broad range of psychiatric disorders, including depression, various anxiety states such as panic anxiety, social anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), conversion disorder, personality disorder, drug addiction and psychosis. In conclusion, using technology and telehealth can greatly enhance the availability and accessibility of CBT in Pakistan. With the increasing adoption of digital technologies in the country, mobile applications and online resources can expand the reach of mental health services to underserved populations.

Reclaiming Normal Life: Mothers' Stages of Recovery From Drug Use

BackgroundReintegrating to society is a significant challenge during burn survivors’ rehabilitation.AimThis study aims to describe what Iranian female survivors from unintentional severe burns experience as enablers and barriers of social reintegration (SR).MethodsFourteen adult female burn survivors whose burns were unintentional participated in this qualitative study. Data were gathered through semi-structured face-to-face or telephone interviews and analyzed using inductive content analysis.ResultsThirteen subcategories and six categories were emerged. Categories and subcategories of enablers content area were as follows: positive impact of society on SR (normal treatment of society, instrumental support), positive impact of family on SR (magnifying personal abilities assets, empathy and emotional support), and positive impact of personal characteristics on SR (coping with others stares, right to have a normal social life). Categories and subcategories of Barriers content area were as follows: negative impact of society on SR (being questioned in public, incorrect judgment about intent of burns, burns as a contagious disease), negative impact of family on SR (embarrassment of appearing in public with the survivor, family mistrust), and negative impact of intra-personal factors on SR (exaggeration of the post-burn changes, being over-sensitive to the others looks). From the deep interpretation of the data two overarching themes were emerged: “acceptance of the new normal by the society and the individual” and “being encompassed by misconceptions and mistreatments”.ConclusionsSociety, family and the individual characteristics have a dual role to play in the success of social reintegration in Iranian female unintentional burn survivors.

Self-Administered Cognitive Behavior Therapy for Moderate to Severe Irritable Bowel Syndrome: Clinical Efficacy, Tolerability, Feasibility

Cognitive behavior therapy (CBT) is a pragmatic, action-oriented treatment approach that has become a widely used psychotherapy for major mental disorders. CBT methods were initially developed for depression and anxiety disorders (1–3), and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse; they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder (3, 4–7). This article delineates the core principles of CBT, describes procedures used in clinical practice, and notes some of the recent advances that have been made in this treatment method. The extensive research supporting the efficacy of CBT is briefly reviewed.

Perceived stigma in burn survivors: Associations with resourcefulness and alexithymia

Burn trauma is a clinical condition accompanied by muscle wasting that severely impedes rehabilitation in burn survivors. Mitochondrial uncoupling protein 3 (UCP3) is uniformly expressed in myoskeletal mitochondria and its expression has been found to increase in other clinical syndromes that, like burn trauma, are associated with muscle wasting (e.g., starvation, fasting, cancer, sepsis). The aim of this study was to explore the effects of burn trauma on UCP3 expression, intramyocellular lipids, and plasma-free fatty acids. Mice were studied at 6 h, 1 d and 3 d after nonlethal hindlimb burn trauma. Intramyocellular lipids in hindlimb skeletal muscle samples collected from burned and normal mice were measured using 1H NMR spectroscopy on a Bruker 14.1 Tesla spectrometer at 4 degrees C. UCP3 mRNA and protein levels were also measured in these samples. Plasma-free fatty acids were measured in burned and normal mice. Local burn trauma was found to result in: 1) upregulation of UCP3 mRNA and protein expression in hindlimb myoskeletal mitochondria by 6 h postburn; 2) increased intramyocellular lipids; and 3) increased plasma-free fatty acids. Our findings show that the increase in UCP3 after burn trauma may be linked to burn-induced alterations in lipid metabolism. Such a link could reveal novel insights into how processes related to energy metabolism are controlled in burn and suggest that induction of UCP3 by burn in skeletal muscle is protective by either activating cellular redox signaling and/or mitochondrial uncoupling.

Background: Persons with mental health and substance abuse disorders (MHD/SUD) make up a highly vulnerable target group, particularly affected by social exclusion. Many experience stigmatization, powerlessness and disconnectedness and thus are marginalized when it comes to social participation. A Recovery oriented approach within field of mental health care entails a focus on enabling individuals to connect and interact with their social surroundings, and aid persons striving with mental health, substance abuse or social functioning impairments to full and contributing lives as active citizens. However, many lack knowledge, skills, and abilities to engage in their recovery process and utilize their social and community opportunities.
 Virtual Reality technology (VRT) shows a promising potential for simulating social environments and interactions to mitigate social impairments and marginalization for persons in recovery from MHD/SUD. However, it is still unclear how the ecological validity of VRT can be harnessed in more sophisticated interventions that target complex social situations.
 The overall goal of this project is to provide lived-experience based knowledge on how software development and new programming can broaden the range of VRT-based social environments and interactions. Thus, our study aims to explore how service users in MHD/SUD recovery experience social functioning impairments (SFI) and how these affect social participation and citizenship in their daily living.
 Method: This study is part of the project «Virtual Reality as a facilitator for participation in society among persons with mental health and substance use disorders » which received funding from the Research Council of Norway. User driven innovation is a fundamental principle of the overall project. This entails close collaboration with persons who have lived-experience with MHD/SUD. A peer researcher has participated in developing interview guides, interviews and analysis. We have conducted 2 focus group interviews with municipal service providers and 10 in-depth, semi-structured individual interviews with service user in MHD/SUD municipal services. 
 Preliminary Results: First analysis of the focus groups with service providers suggest, that the particular needs of social functioning training varies across the stages of recovery.
 The needs of SFI interventions vary from basic instrumental functioning training, such as household skills, personal management, and responsible decision making to more complex social situations, such as work related interactions (customer service, colleague collaboration, leadership), job interviews and engage in meaningful activities in the company of persons without MHD/ SUD experience. Furthermore, our findings suggests needs for basic cognitive training, targeting mentalization capacity, executive functions, emotional regulation and cognitive flexibility.
 
 Conclusion: This study will provide knowledge on what hinders or promotes participation in society among persons with MHD/SUD within their recovery process. This understanding will facilitate development of tailored recovery measures, and measures to prevent persons with MHD/SUD being marginalized. Based on the results of this study, VR-designers and peer support researchers jointly develop in the second part of the overall project a VR-prototype, which will be finally evaluated within an RCT. Our study is the first to dedicate VR to persons with MHD/SUD.

Virtual reality (VR) and augmented reality (AR) stand on the edge of reality, transforming sectors like gaming, organization management, education, promotions, health services, and veterans' recovery. This chapter meticulously explores their therapeutic potential, underscoring their vital role in mental health assessment. The literature review identifies research gaps and spans applications in rehabilitation, emotional regulation, Autism, ADHD, PTSD, coping skills, cognitive behavioral therapy, stress reduction, pain management, chronic diseases, and mental health apps. A well-crafted entrepreneurial plan addresses technical, physical, social, and financial challenges, integrating ethical considerations, device limitations, cost efficiency, and data security. Forward-looking, it delves into future research trends, estimating their impact on the health industry and pivotal fields, concluding with a summary of transformative prospects in mental health through VR and AR. The future promises enriched well-being via cutting-edge technologies and innovative interventions.

BackgroundBurns constitute a major global health challenge, causing not only physical trauma, but also significant psychosocial and emotional disturbances. The complexity of these injuries requires comprehensive rehabilitation programs that address both the physical and psychosocial aspects of recovery. Despite advances in medical care, there is a lack of standardized, accessible, and sustainable psychosocial interventions for burn survivors, particularly in the transition from hospital to home. This study aimed to develop and evaluate a nurse-led psychosocial empowerment intervention for early adjustment among burn survivors after hospital discharge.MethodsThe study adopted a quasi-experimental framework. A convenient sample of 80 adult burn survivors was randomly divided into an intervention group, receiving the psychosocial empowerment program, and a control group, continuing standard care from November 2022 to May 2023. The effectiveness of the program was evaluated using various tools that measure satisfaction with appearance, coping abilities, and symptoms of post-traumatic stress disorder (PTSD). The intervention focused on enhancing resilience, self-efficacy, and adaptive coping, through targeted skill building in stress management, adaptability to coping, social reintegration, emotion regulation, and problem-solving.ResultsParticipants in the intervention group demonstrated significant improvements in body image satisfaction, coping abilities, and symptoms of PTSD compared to the control group.ConclusionsThe psychosocial empowerment program effectively addressed the psychosocial needs of burn survivors and enhanced their early adjustment after hospital discharge. The findings highlight the critical role of psychosocial support in the rehabilitation of burn survivors and underscore the need to integrate such interventions into standard post-discharge care. Future research should focus on the long-term effects of these interventions and their applicability in diverse settings.

Introduction Burn injuries can result in profound, long-lasting effects that span physical, psychological, and social domains. Traditionally, research on long-term outcomes for burn survivors has concentrated on measurable physical impairments, psychological trauma, and difficulties in resuming work. However, there is a notable gap in understanding how survivors themselves perceive these impacts, especially concerning their sense of disability and priorities for ongoing research. This study aims to bridge this gap by directly querying burn survivors to gather their perspectives on disability and identify key areas of research that should be prioritized. Methods A cross-sectional anonymous survey targeting burn survivors was conducted from January to April of 2023. The survey gathered data on demographics, burn injury characteristics (location, % total body surface area (TBSA), visibility of burn scars), and long-term functional status in the context of their burn injury. Primary outcomes included physical and psychological impact on a scale of 0-10 and work-related changes/challenges. Results A total of 128 survey responses were received after distribution. Survey demographic and summary statistics regarding patients’ burns and burn-related disability can be found in Table 1. Multivariate regression analysis identified that greater %TBSA, older age when burned, visible burns, and facial burn scars were significantly associated with increased odds of disability/self-perception of feeling disabled (p< 0.05). When controlling for covariates, multiple logistic regression demonstrated that older age when burned and facial burns were significant predictors of poorer physical but not psychological impact (p< 0.05). Neither gender nor ethnicity was significantly associated with an increased odds of disability. Conclusions This study highlights that a substantial number of burn survivors self-identify as disabled, with key factors such as higher TBSA, older age at injury, visible burns, and facial scars significantly contributing to this perception. Additionally, nearly all respondents indicated a need for work-related modifications due to their injuries; however, many did not receive the necessary accommodations. These findings emphasize the critical need for tailored interventions and comprehensive support systems that address both the disability perception and the practical challenges faced by burn survivors, particularly in the workplace. Applicability of Research to Practice These findings emphasize the need for healthcare providers to address both physical and psychological aspects of disability in burn survivors, that considers both functional and social challenges, especially for those with large, visible, or facial burns. Increased advocacy for workplace accommodations is essential to support survivors in maintaining employment and improving their quality of life. Funding for the Study N/A

Introduction Burn injuries have negative impact on both burn survivors and their loved ones. As family members usually care for burn survivors, it is very critical to understand the concerns of family caregivers and their needs for social services during the process of recovery. The purpose of this study is to assess 1) a broad range of difficulties among family caregivers of adult burn survivors, 2) the frequency of use of social service programs and satisfaction with these services, and 3) the needs of caregivers of burn survivors on the service provision. Methods We used a cross-sectional survey design with purpose sampling. We conducted both online and face-to-face surveys from November 2021 to February 2022. A total of 92 family caregivers aged 20 years or older participated in the survey. We measured 1) physical (e.g. chronic diseases such as pain and hypertension), psychological (e.g., family conflicts, communication issues with a burn survivor), financial (e.g., medical expenses, living costs), and social & environmental problems (e.g., living environment, education, discrimination or prejudice due to burn scars and disabilities), 2) the use of social service programs and the level of service satisfaction, and 3) the needs of social service programs (e.g., counseling services for PTSD treatment, financial support, and discharge planning). We used SPSS 24.0 for all data analyses. Results The most challenging problems were financial matters followed by psychological, and social & environmental ones among study participants. Study respondents used social service programs to resolve their psychological, financial, and discharge related difficulties. Those who used social service programs showed higher satisfaction with an average of 3 out of 5 points. More than 50% of study participants reported that it was necessary to receive social services on psychosocial, financial, and discharge related problems and they were willing to receive these services in future. Conclusions These findings imply that it is necessary to develop and provide needs-based social services for caregivers of burn survivors and that the provision of social services should be expanded further. Applicability of Research to Practice Findings of this study demonstrate that social service programs can relieve the burden of caregivers and improve the quality of life of both burn survivors and their caregivers.

This multicenter randomized controlled trial investigated whether interactive virtual reality enhanced effectiveness of Cognitive Behavioral Therapy (CBT) to reduce children's aggressive behavior problems. Boys with aggressive behavior problems (N = 115; Mage = 10.58, SD = 1.48; 95.7% born in Netherlands) were randomized into three groups: CBT with virtual reality, CBT with roleplays, or care-as-usual. Bayesian analyses showed that CBT with virtual reality more likely reduced aggressive behavior compared to care-as-usual for six of seven outcomes (ds 0.19-0.95), and compared to CBT with roleplays for four outcomes (ds 0.14-0.68). Moreover, compared to roleplays, virtual reality more likely enhanced children's emotional engagement, practice immersion, and treatment appreciation. Thus, virtual reality may be a promising tool to enhance CBT effectiveness for children with aggressive behavior problems.

The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry.

A survey of burn professionals regarding the mental health services available to burn survivors in the United States and United Kingdom