Behavioral Treatment Approaches Research Articles

2．プライマリ・ケアからみた糖尿病診療（行動変容アプローチ）

2．プライマリ・ケアからみた糖尿病診療（行動変容アプローチ）

The Impact of Cancer and its Treatment on the Growth and Development of the Pediatric Patient.

Cancer treatment can have profound effects on the growth and development of pediatric patients. Different models of psychosocial development and behavioral treatment approaches aid children receiving medical treatment. Providing education, anticipatory guidance, and individualized support to child and their families is a psychosocial standard. Clarify the different models of psychosocial development and applicable psychosocial interventions to better prepare and tailor cancer treatment to pediatric patients. Authors reviewed existing evidenced-based literature in oncology, psychology, developmental, and psychiatric while drawing on case examples and expert knowledge to illustrate the impact of cancer treatment on pediatric patients, analyze developmentally individualized needs, and describe facilitative interventions. Pediatric patients of all ages cope and adjust better to all phases of treatment when their care is delivered in a developmentally-informed and psychosocially thoughtful way. Providers can comprehensively prepare their patients and families for treatment better by utilizing a psychosocially- and developmentally-informed framework while meeting individualized unique needs of patients. An integrated multidisciplinary psychosocial support team is facilitative in anticipating and meeting the needs of pediatric cancer patients and has recently become a psychosocial standard of care.

Reward circuits and apathy in schizophrenia: neuroimaging and treatment strategies

Approximately 50% of patients with schizophrenia shows deficits in motivation and initiation of goal-directed behavior, which are suggestive of reward system dysfunction. We conducted a meta-analysis of neuroimaging studies reporting on the neural correlates of reward processing and negative symptoms in schizophrenia. A significant mean weighted correlation was observerd, revealing deficits in activation of reward neurocircuitry. A more specific findings is comprised activation of the ventral striatum, involved in anticipation of reward, and structures that play a critical role in the ability to represent the value of outcomes and plans. In a study of VTA connectivity in the resting state in a large group of patients with schizophrenia, we found reduced connectivity with lateral prefrontal, temporal and parietal regions to be associated with higher degrees of apathy. Apathy belongs to the most debilitating symptoms of schizophrenia and represents a significant unmet need in its treatment. Quantitative integration of published findings suggests that treatment with noninvasive magnetic brain stimulation can improve negative symptoms. Previous PET-studies have shown that such stimulation may target circuits with dopaminergic innervation. A behavioral treatment approach that may also target reward-related circuits will also be discussed briefly. It can be concluded that recent results regarding reward and motivated behavior in schizophrenia have clinical implications and may help develop novel treatment strategies.Disclosure of interestAA received speaker fees from Lundbeck.

Efficacy of environmental and acceptance-based enhancements to behavioral weight loss treatment: The ENACT trial.

ObjectiveThis study was designed to compare weight loss with a traditional behavioral treatment approach (BT), an approach that integrated skills for managing the obesogenic food environment (BT+E), and an approach that integrated environmental and acceptance-based skills (BT+EA). Moderators were examined as an exploratory aim.MethodsAdults (n =283) were randomly assigned to treatment condition and provided with 26 group-based sessions over the course of 12 months. Weight was measured in the clinic at months 0, 6, and 12.ResultsChange in weight over time did not significantly differ by condition. However, race significantly moderated the effect of condition on weight loss (p= .04), such that African-American participants lost less weight than non-Hispanic white participants in the BT (6.2% vs. 11.5%) and BT+E conditions (6.6% vs. 12.2%), but weight loss in these two groups was similar in the BT+EA condition (9.4% vs. 11.5%). Among African-Americans, rates of achieving a clinically significant weight loss (i.e., >5%) at 12 months were higher in BT+EA (80%) than BT (57%) or BT+E (48%) (p = .04).ConclusionsThis innovative behavioral approach shows promise for treatment of African-Americans, which is notable given the lack of progress to date addressing racial disparities in obesity intervention efficacy.

Same, Same But Different? Cognitive Behavioural Treatment Approaches for Paediatric CFS/ME and Depression.

Approximately one in three children and young people with chronic fatigue syndrome (CFS/ME) also have probable depression. Cognitive behaviour therapy (CBT) has a growing evidence base as an effective treatment approach for CFS/ME and for depression in this population. Given the high degree of co-morbidity, this discussion paper aims to compare and contrast CBT for CFS/ME and CBT for depression in children and young people. The existing literature on CBT for depression and CBT for CFS/ME, in relation to children and young people was reviewed. Whilst there are commonalities to both treatments, the cognitive behavioural model of CFS/ME maintenance includes different factors and has a different emphasis to the cognitive behavioural model of depression, resulting in different intervention targets and strategies in a different sequence. A collaborative, formulation-driven approach to intervention should inform the intervention targets and treatment strategies.

Should bariatric surgery be performed in adolescents?

Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.

Internalized stigma of mental illness: Changes and associations with treatment outcomes.

Internalized stigma of mental illness is associated with poor mental health and represents a prominent barrier to accessing treatment. Few studies have investigated the effects of cognitive–behavioral treatment approaches on internalized stigma, particularly without a targeted stigma intervention. T

Recent Trends in Endoscopic Bariatric Therapies.

Obesity and its associated metabolic diseases including diabetes mellitus are severe medical problems that are increasing in prevalence worldwide and result in significant healthcare expenses. While behavioral and pharmacological treatment approaches are partly effective in the short term, their effects are not long-lasting. Although previous studies have described bariatric surgery as the most effective treatment for obesity, it is associated with morbidity, mortality, and economic burden. Endoluminal interventions performed entirely using gastrointestinal flexible endoscopy offer alternative approaches to the treatment of obesity that are safer and more cost-effective than current surgical approaches. The use of endoluminal techniques in the field of metabolic obesity disease has diverse promising applications including endoscopic gastroplasty, intragastric balloon, endoluminal malabsorptive bariatric procedures, and gastric electrical stimulation (GES) for the modulation of gastric emptying. This review discusses recent trends and roles in endoscopic bariatric therapies using the currently available endoluminal and transgastric technologies.

Patterns of Response and Remission Following a One-Session Treatment for Blood-Injection-Injury Phobia in Youth

ABSTRACTBlood-Injection-Injury (BII) Phobia is a severe and impairing disorder that has been understudied in youth. The present study aimed to define patterns of response and remission following a modified One-Session Treatment (OST) including an e-therapy maintenance program for children and adolescents with BII Phobia. Moreover, characteristics of different responder groups were examined in order to determine correlates of a poorer response. Youth (n = 20; 8–18 years) were categorized into four responder groups (e.g., immediate remitter, delayed remitter, partial responder, and nonresponder) based upon defined criteria for remission. Immediate remitters to treatment were more likely to have a primary diagnosis of injection phobia, rather than a combined blood and injection phobia. Nonresponders reported significantly greater disgust sensitivity at pretreatment and were more likely to have a comorbid diagnosis of Social Phobia. In regards to within session change, youth who achieved the exposure goal of having a blood test during treatment had a significantly stronger treatment response. These preliminary findings may assist clinicians in the planning and delivering of intensive Cognitive Behavioral Treatment (CBT) approaches for BII Phobia in youth.

An outcome evaluation of the Methodist Home for Children’s value-based therapeutic environment model

Objectives This study presents an outcome evaluation of the Value-Based Therapeutic Environment model, a multipurpose, cognitive–behavioral treatment approach for juvenile offenders.

Sexual Addiction: Definitions and Interventions

Sexual addiction is an unfamiliar disorder to many social workers, who, consequently, are uncomfortable when treating clients who exhibit such problems. This literature review provides a summary of the ongoing discussions on how to define sexual addiction, and describes two behavioral treatment approaches, cognitive behavioral therapy and covert sensitization, for working with such clients. Because most social workers might not be familiar with covert sensitization, examples are offered showing how this treatment modality can be implemented in therapy when working with clients with sexual addiction. More empirical studies, including the use of single-subject designs, are needed to help address a gap in the literature.

SBIRT-Based Interventions to Improve Pediatric Oral Health Behaviors and Outcomes: Considerations for Future Behavioral SBIRT Interventions in Dentistry.

Dental caries is the most common chronic disease in children and is caused by poor oral health behaviors. These behaviors include high-sugar diet, inadequate exposure to topical fluorides, and irregular use of professional dental care services. A number of behavioral intervention approaches have been used to modify health behaviors. One example is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, which has been widely used to reduce substance abuse in both adults and children. SBIRT is a promising behavior change approach that could similarly be used to address problematic oral health behaviors. In this paper, we will review oral health studies that have adopted SBIRT components, assess if these interventions improved oral health behaviors and outcomes, and outline considerations for researchers interested in developing and testing future oral health-related SBIRT interventions in dentistry.

Decreasing PTSD and Depression Symptom Barriers to Weight Loss Using an Integrated CBT Approach

This is a single-case study of an obese African American female Veteran who has posttraumatic stress disorder (PTSD) and depression. Her presenting psychological symptoms included clinically significant night terrors, insomnia, low self-worth, low motivation, and social isolation. Poor dietary and physical activity responses to her psychological symptoms contributed to her weight gain, as well as interfered with weight-loss efforts. A telephone-based cognitive behavioral treatment integrating mental and behavioral health principles was provided. Over the course of eight sessions, the Veteran learned psychological symptom and behavioral monitoring, thought stopping, cognitive restructuring, deep breathing, calming thoughts, social support, sleep hygiene, and problem-solving skills. Client-centered PTSD and weight-management treatment goals were integrated into each session. The client evidenced weight loss, improved dietary and physical activity habits, and experienced a reduction in PTSD and depression symptoms. This case study demonstrates that an integrated cognitive behavioral treatment approach can be beneficial for decreasing PTSD and depression barriers to weight loss.

Primary Pulmonary Salivary Gland-type Tumors: A Review and Update.

Pulmonary salivary gland-type tumors (SGT) comprise a very small proportion of primary lung neoplasms. The most common tumors among this group are mucoepidermoid carcinoma and adenoid cystic carcinoma. Contrary to the head and neck region, benign SGT such as pleomorphic adenomas are exceedingly rare in the pulmonary system. More recently, 2 additional SGT, namely hyalinizing clear cell carcinoma and salivary duct-like carcinoma were recognized as primary lung tumors expanding the spectrum of SGT that have been described to originate in the tracheobronchial system. Primary pulmonary SGT must be clinically excluded from metastatic salivary gland neoplasms as their morphology is indistinguishable from that of their salivary gland counterparts. Little is known about the clinical behavior and best treatment approach for these unusual tumors. In this review, we provide a comprehensive summary of primary pulmonary SGT with particular emphasis on morphologic characteristics and latest developments in terms of immunohistochemical and molecular techniques.

Sex differences in associations between cannabis craving and neural responses to cannabis cues: Implications for treatment.

Preclinical and clinical research indicates that there are sex differences in how men and women initiate, progress, respond to, and withdraw from cannabis use; however, neurophysiological differences, such as neural responses to cannabis cues, are not well understood. Using functional MRI and an event-related blood oxygen level-dependent backward-masking task, we compared neural responses to backward-masked cannabis cues to neutral cues in treatment-seeking, cannabis-dependent adults (N = 44; 27 males) and examined whether sex differences exist. In addition, functional MRI findings were correlated with cannabis craving. Backward-masked cannabis cues elicited greater neural responses than neutral cues in reward-related brain regions, including the striatum, hippocampus/amygdala, insula, anterior cingulate cortex, and lateral orbitofrontal cortex, p < .01, k > 121 voxels. Although no significant sex differences in neural responses to cannabis cues emerged, women showed a positive correlation between neural responses to cannabis cues in the bilateral insula and cannabis craving and an inverse correlation between neural responses to cannabis cues in the left lateral orbitofrontal cortex and cannabis craving. Men, however, showed a positive correlation between neural responses to cannabis cues in the striatum and cannabis craving. Given that cues and craving are important triggers and the focus on many behavioral treatment approaches, these findings suggest that treatment-seeking, cannabis-dependent men and women may benefit from sex-specific and tailored cannabis use disorder treatments.

The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers.

BackgroundWhile obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.Methods/designThis is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).DiscussionThis study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.Trial registrationClinicalTrials.gov NCT01792531 Registered February 14, 2013.

Physical Health Conditions and Intimate Partner Violence Perpetration Among Offenders With Alcohol Use Diagnoses.

Intimate partner violence (IPV) is prevalent among samples with diagnosed alcohol use disorders (AUDs), but few studies have evaluated the factors that account for this increased risk, and none have systematically evaluated the risk posed by comorbid physical health conditions. The present study evaluated the likelihood of perpetrating IPV among alcohol diagnosed offenders with medical health problems relative to healthy counterparts. Physical health and partner violence data provided by 655 criminal offenders with AUDs diagnosed during a court-ordered substance abuse evaluation were examined. One third of participants (35.3%) endorsed a physical health condition, and 46.4% reported perpetrating physical IPV. The odds of perpetrating IPV among participants with a physical health condition were 2.29 times larger than among healthy participants. Specific conditions emerged as risk factors for IPV, including brain injury, cardiac issues, chronic pain, liver issues, gastrointestinal symptoms, hepatitis, and recent injury. Findings highlight the importance of identifying and managing physical health conditions that may complicate IPV treatment efforts. Integrated behavioral and medical health treatment approaches may increase treatment compliance and reduce the risk of future partner violence among offenders with co-occurring issues, such as mental illness, addiction, and physical health conditions.

A study on clustering of Cardiovascular Risk Factors among a rural adult population in Tamil Nadu

Background: In India, Cardiovascular diseases (CVDs) are the leading cause of death among both males and females and in urban as well as rural areas. Studies indicate that the risk of adverse health outcome increases with more number of unhealthy behaviors and moreover the behavioral risk factors often manifest themselves in specific pattern of combinations. Objectives: To study the pattern of clustering or combination of CVD risk factors in the study population and their associated factors. Results: In this study, 544 adults over the age of 20 years were included. Among them, 211(38.8%, 95%CI 32.3- 45.3)) had none of the risk factors for CVD, 215(39.5%, 95%CI 33.0%-46.0%) had single risk factors and 118(21.7%, 95%CI 14.3-29.1) had clustering of CVD risk factors. The overall clustering of CVD risk factors was higher for adults over the age of 40 years (78.0%) compared to adults less than 40 years (22%) and this difference was found statistically significant (p=0.01). The overall prevalence of clustering was higher among men [29.5%, 95%CI 22.2%-36.8%] than women [18.7%, 95%CI 14.8%-22.6%]. Age, male gender, alcoholism, physical inactivity, family income, educational status and occupation were positively associated with clustering of CVD risk factors. Conclusion: A sound community based comprehensive behavioral and life style intervention approach should be established to reduce the modifiable risk factors of CVD. In addition we should design a strategy to incorporate primordial prevention in the school education such as advocating healthy lifestyle (dietary habits, importance of exercise, avoiding smoking and alcohol etc). Key words: Clustering, Cardiovascular diseases, Risk factors, Rural population, Prevalence.

Treatment of clozapine-associated weight gain: a systematic review.

Clozapine is an antipsychotic drug with superior efficacy in treatment-resistant schizophrenia. Clozapine is associated with a low likelihood of extrapyramidal symptoms and other neurological side-effects but a high propensity to induce weight gain and general metabolic dysregulation. Various pharmacological and behavioral treatment approaches for reducing clozapine-associated weight gain exist in the literature; however, there are currently no clear clinical guidelines as to which method is preferred. The aim of the current review is to systematically summarize studies that have studied both pharmacological and non-pharmacological interventions to attenuate or reverse clozapine-associated weight gain. A systematic review of EMBASE and MEDLINE databases of all articles published prior to January 2014 was conducted. Seventeen studies were identified as meeting inclusion criteria and included in the review. Aripiprazole, fluvoxamine, metformin, and topiramate appear to be beneficial; however, available data are limited to between one and three randomized controlled trials per intervention. Orlistat shows beneficial effects, but in males only. Behavioral and nutritional interventions also show modest effects on decreasing clozapine-associated weight gain, although only a small number of such studies exist. While a number of pharmacological interventions can produce modest weight loss, each may be associated with negative side effects, which should be considered before beginning treatment. Given the pressing need to improve cardiometabolic health in most clozapine-treated patients, substantially more research is needed to develop sound clinical practice guidelines for the treatment of clozapine-associated weight gain.

Structured Dispositional Matrix for Court Recommendations Made by Juvenile Probation Officers

Historically, community corrections suffered from a lack of research that identified proven methods of improving public safety. Recent research efforts based on meta-analysis (syntheses of data from many research studies) (Andrews and Dowden, 2006; Burke, Arkowitz, and Menchola, 2003; Landenberger and Lipsey, 2005; McGuire, 2002; Sherman et al., 1998) have broken through this barrier and are now providing the field with guidance on how to reduce reoffending and support offenders on the path to productive citizenship. One of the most impactful reforms to the juvenile justice system was the incorporation of evidence-based practices (EBPs) for the treatment and rehabilitation of juvenile offenders. EBPs moved probation case management from a monitoring and control model, toward a behavioral change and treatment approach. EBP refers to approaches and interventions that have been proven effective at reducing offender risk to reoffend. When replicated with fidelity and matched to the offender's risk and needs profile, using EBPs provides more assurance for improved outcomes and reduced recidivism for juvenile offenders.... KEYWORDS: Juvenile justice Language: en