Active Participation In Treatment Research Articles

Working with hoarding vs. non-hoarding clients: A survey of professionals' attitudes and experiences

Eighty-four self-identified healthcare or service professionals (71% professional organizers, 19% healthcare workers, 10% social service workers) completed an internet survey of their experiences with, and attitudes toward, one hoarding and one non-hoarding client. When working with hoarding clients, professionals described feeling increasingly frustrated and irritated, reported poorer working alliance, and harbored greater patient rejection attitudes than when working with non-hoarding clients. Hoarding clients were described as having less insight and understanding, with a higher frequency of intervention–interfering behaviors, and diminished adherence. Working alliance and patient rejection attitudes were significantly predicted by clients' intra- and inter-session behaviors, particularly difficulty answering questions appropriately, poor insight, arguing, and lack of active participation in treatment. Recommendations for treatment modifications are intended to improve working alliance and decrease patient rejection attitudes for professionals working with hoarding clients.

Increasing Walking and Bright Light Exposure to Improve Sleep in Community‐Dwelling Persons with Alzheimer's Disease: Results of a Randomized, Controlled Trial

To test the effects of walking, light exposure, and a combination intervention (walking, light, and sleep education) on the sleep of persons with Alzheimer's disease (AD). Randomized, controlled trial with blinded assessors. Independent community living. One hundred thirty-two people with AD and their in-home caregivers. Participants were randomly assigned to one of three active treatments (walking, light, combination treatment) or contact control and received three or six in-home visits. Primary outcomes were participant total wake time based on wrist actigraphy and caregiver ratings of participant sleep quality on the Sleep Disorders Inventory (SDI). Secondary sleep outcomes included additional actigraphic measurements of sleep percentage, number of awakenings, and total sleep time. Participants in walking (P=.05), light (P=.04), and combination treatment (P=.01) had significantly greater improvements in total wake time at posttest (effect size 0.51-0.63) than controls but no significant improvement on the SDI. Moderate effect size improvements in actigraphic sleep percentage were also observed in active treatment participants. There were no significant differences between the active treatment groups and no group differences for any sleep outcomes at 6 months. Participants with better adherence (4 d/wk) to walking and light exposure recommendations had significantly less total wake time (P=.006) and better sleep efficiency (P=.005) at posttest than those with poorer adherence. Walking, light exposure, and their combination are potentially effective treatments for improving sleep in community-dwelling persons with AD, but consistent adherence to treatment recommendations is required.

A clinical study of extracorporeal shock waves (ESW) for treatment of chronic lateral epicondylitis

Background This clinical study was conducted to determine the safety and effectiveness of extracorporeal shock waves (ESW) to treat chronic lateral epicondylitis non-responsive to conservative treatment and persisting for at least 6 months. Methods Involved were seven test sites and 183 patients, divided between men and women with a mean age of 45.7 years. Test participants had a history of chronic lateral epicondylitis and were under the care of a physician. Participants were enrolled as nonrandomized and randomized to active treatment and placebo. Eight-week follow-up by blinded investigators determined baseline results of success criteria. Results Analysis showed that a single ESW treatment was effective in treating the condition when compared with placebo at 8 weeks. Long-term follow-up data showed maintenance of response in 8-week “success” patients. Of the active treatment participants who continued the study to long-term follow up, 40% met all success criteria compared with 24% of the placebo group (P=0.018). Conclusions It was concluded that the results of efficacy, which were adjusted for any differences between sites, were robust upon analysis. The data provide statistically significant outcomes indicating that ESW therapy is effective in the treatment of chronic lateral epicondylitis.

The Family Forum: Directions for the Implementation of Family Psychoeducation for Severe Mental Illness

The Family Forum: Directions for the Implementation of Family Psychoeducation for Severe Mental Illness

Understanding and Preventing Criminal Recidivism Among Adults With Psychotic Disorders

Understanding and Preventing Criminal Recidivism Among Adults With Psychotic Disorders

Informed consent to undergo treatment for substance abuse: a recommended approach

With more than 3 million persons receiving substance abuse treatment per year in the United States and with increasing interest in treatment outcomes, there is a need for closer attention to all aspects of the treatment process. However, minimal attention has been given to informed consent as a way of enlisting client engagement and active participation in treatment. Although there is some literature on informed consent in substance abuse research, the literature on informed consent to undergo substance abuse treatment is very limited. Incorporating informed consent into substance abuse treatment is recommended as part of motivational interviewing. Standard treatment consent issues include (1) the clinical characteristics of the problem, including diagnosis; (2) treatment recommendations; (3) the risks and benefits of treatment; (4) the financial costs of the intervention; (5) alternative services or interventions should a client refuse the recommended form of care; and (6) freedom to choose or refuse treatment. This article provides a background for informed consent procedures to facilitate client engagement in substance abuse treatment and suggests needs for future research on informed consent to undergo substance abuse treatment.

Intersession coping skill practice mediates the relationship between readiness for self-management treatment and goal accomplishment

Underlying pain self-management treatments is the expectation that patients must adhere to coping skill practice recommendations to obtain treatment benefits. Recently, a model of motivation for pain treatment has proposed that patients' readiness to adopt a self-management approach serves as a predictor of active participation in treatment, and ultimately, of improved outcomes. This study compared the ability of pain readiness to change, as measured by the Pain Stages of Change Questionnaire (PSOCQ), and self-efficacy (SE) ratings, to predict adherence and goal accomplishment in cognitive-behavioral therapy (CBT) for chronic pain. Further analyses tested the hypothesis that adherence mediated the relationship between readiness to change and goal accomplishment. Data were collected as part of a larger randomized controlled trial of primary care based CBT. Participants were 78 patients recruited from a VA primary care clinic. At pre-treatment Ss completed the PSOCQ to assess readiness to adopt a self-management approach to chronic pain and an SE measure to quantify certainty of achieving up to five behavioral treatment goals. Criteria were means of aggregated intersession adherence ratings and mean post-treatment goal accomplishment ratings. Pre-treatment PSOCQ variables significantly predicted intersession adherence and goal accomplishment. SE did not significantly predict either criterion. The statistical relationship between pre-treatment PSOCQ and behavioral goal accomplishment was significantly attenuated when intersession adherence was taken into account. These data provide support for a motivational model of pain treatment that asserts adherence to therapist recommendations for coping skill practice mediates readiness to change and self-reported goal attainments.

Nonsurgical Home Treatment of Middle Ear Effusion and Associated Hearing loss in Children. Part II: Validation Study

In this prospective follow-up investigation, we examined the efficacy of a modified Politzer device in the home treatment of persistent middle ear effusion (MEE) and associated hearing loss in children who had previously participated in a similar clinical trial. Our study group was made up of 38 patients who had been either (1) untreated control participants in the previous study whose hearing in one or both ears had not returned to normal within 11 weeks of their initial audiologic pretest ("former control group"; n = 30), or (2) active-treatment participants in the previous study whose hearing sensitivity in at least one ear had not improved to within normal limits after treatment and who elected to undergo a continuation of treatment ("extended-treatment group"; n = 8). Treatment efficacy was determined by comparing differences in pre- and posttreatment air-conduction thresholds and otoscopic findings. Following treatment, the former control group experienced significant improvements in hearing sensitivity at all frequencies; at the posttreatment test, hearing sensitivity was within normal limits in 43 of 60 ears (71.7%), and normal or moderate tympanic membrane mobility was observed in 30 of 34 otoscopically examined ears (88.2%). In the extended-treatment group, hearing sensitivity returned to within normal limits in 9 of 10 impaired ears (90.0%). These findings further substantiate the efficacy of our modified Politzer device in improving middle ear function and hearing sensitivity in children with MEE, and they support the reliability of the findings reported in our previous study. These results also indicate that many patients in whom initial treatment is not successful may benefit from extended treatment.

A Psychoeducational Program for Children with ADHD or Depression and their Families: Results from the CMAP Feasibility Study

For children and adolescents with behavioral and emotional disorders and their families, education about their disorders and the treatments is an essential component of a comprehensive approach to their care. Education can encourage active participation in treatment, enhance adherence to treatment regimens, and provide patients and families with important coping skills. Thus, the Children's Medication Algorithm Project (CMAP) incorporated a psychoeducational program into the medication algorithm created to improve treatment of children with ADHD and/or depression in the Texas public mental health sector. This article describes the process by which a comprehensive educational program was developed in partnership with parents and advocates. The final program is described, as well as a pilot study to examine the feasibility of implementation in four community clinics.

Multidisciplinary teaming to promote effective management of type 1 diabetes for adolescents.

Intensive diabetes therapy can reduce the long-term microvascular complications of Type 1 diabetes and improve glucose control. Managing the demands of intensive therapy however, often poses a burden on adolescents and their families. Through multidisciplinary teaming, the school health office can facilitate active participation in treatment, coordinate services, and maximize use of community resources. This paper presents a general overview of intensive diabetes therapy, psychosocial implications of chronic illness in adolescence, effects of chronic illness on the family, and behavior change strategies to improve adherence with disease management guidelines.

SELF-CARE REGIMENS FOR PATIENTS WITH INTERSTITIAL CYSTITIS

For those who suffer from interstitial cystitis, living with the condition is a challenge that requires creativity, patience, determination, and a sound set of coping mechanisms. Because of the high percentage of gynecologic and systemic manifestations of interstitial cystitis, a customized treatment regimen is often necessary to achieve the therapeutic goal of a remission in symptoms. Treatment philosophies should be based on the proposed causative mechanisms, and a multimodality approach to therapy is usually successful. Self-care regimens give the patient a sense of control by active participation in treatment, which often improves coping mechanisms. Treatment of the sequelae of chronic pain (anxiety and depression) often improves response to overall therapy. Remission is the goal, coping is the key, and creativity opens the door to treating this most perplexing of conditions.