Cognitive-behavioral Treatment Research Articles

Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial.

Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use-related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test-10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795.

The Feasibility and Acceptability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in a Rural Community Impacted by Environmental Trauma and Covid-19

The Feasibility and Acceptability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in a Rural Community Impacted by Environmental Trauma and Covid-19

Developing a Cognitive Behavioral Intervention for Gynecologic Cancer Survivors Undergoing Pelvic Exams

Regular pelvic exams after completing cancer treatment are critical for detecting endometrial and cervical cancer recurrence. Patients report high levels of distress and pain during exams. We conducted in-depth individual interviews with patients (N = 13) and providers (N = 10) to explore patients’ pelvic exam experiences and intervention preferences. Findings suggested that most patients experience exam-related distress and pain, and a telemedicine cognitive behavioral intervention targeting anxiety and pain would be acceptable and feasible for most patients. Findings informed PEACE (Pelvic Examination and Anxiety Coping skills for Empowerment) intervention development. Formative work is described, including a conceptual model, qualitative data collection and analysis, and session content.

Stimulants : Current insights into the principles, diagnostics and treatment

Consumption of stimulant drugs, aheterogeneous group of addictive substances, has significantly increased in recent years with rising numbers of stimulant-associated intoxication and deaths. To provide an overview of recent scientific evidence of the diagnosis and treatment of stimulant use disorders. Aliterature review of the neuropathology, clinical presentation, diagnostic criteria and evidence-based treatment for stimulant use disorders. The chronic use of stimulant drugs is associated with significant physical (e.g., hypertension, tachycardia and dyspnoea) and psychological harm (e.g., dependence, psychotic disorders and affective disorders). Despite major advances in the research of the neuropathology of stimulant use disorder and the refinement of diagnostic criteria, the disorder still presents achallenge, not least because of the lack of effective treatments. There are currently no approved pharmacotherapeutic interventions for stimulant use disorder and meta-analyses show that the efficacy of behavioural interventions is low to moderate, similar to cognitive behavioural treatment. Despite growing insights into the neuropathology associated with stimulant use disorder, treatment remains achallenge. The lack of effective interventions makes it difficult to give clear recommendations for the clinical practice. Further scientific research is thus warranted.

50 Years of Research on the Psychology of Sport Injury: A Consensus Statement

Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete’s cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.

A Network Analysis of the Fear Avoidance Model of Genital Pain

ABSTRACT Using a novel data-driven network approach, this study aimed to examine the interconnection between the key elements of the Fear-Avoidance Model of female genital pain – sexual arousal, fear-avoidant cognitions, and motivational coping – and its associated factors to predict the intensity and frequency of genital pain across women over time. Network modeling allowed for a comprehensive evaluation of the Fear-Avoidance model while capturing the dynamic features of genital pain. We estimated a cross-sectional and a temporal, contemporaneous, and between-persons network model on convenience-based data of 543 female students (mean age = 23.7 years, SD = 3.6) collected at three time points. Results showed that lubrication, pain catastrophizing, pain avoidance, fear-avoidance beliefs, sexual satisfaction, anxiety, and frequency of coital and non-coital sex predicted pain, with lubrication being the most consistent predictor across estimations. The network of women with recurrent genital pain showed a similar pattern as the network of the total sample, except that pain avoidance and fear-avoidance beliefs rather than pain catastrophizing predicted pain directly, and frequency of coital and non-coital sexual activities played a more prominent role. These results suggest that the main problem of genital pain centers around women not being sufficiently aroused during intercourse and inadequate ways of pain coping, which are critical targets of cognitive-behavioral therapy treatment and should be developed further.

Factors Associated with Prospective Acceptability and Preferences for Unified Transdiagnostic Cognitive-Behavioral Treatments and Group Therapy in the Portuguese General Population

Group transdiagnostic cognitive-behavioral therapy (CBT) offers a promising solution for limited mental health access in Portugal. Understanding barriers to patient adherence is crucial for successful implementation. This study aimed to characterize the prospective acceptability and preferences for unified transdiagnostic CBT and group therapy in the Portuguese general population and explore their correlates. A sample of 243 participants (18–88 years old), recruited online, completed an online survey collecting information on sociodemographic and clinical characteristics, acceptability of transdiagnostic CBT treatments, specifically of Unified Protocol (UP), acceptability of group therapy, therapeutic format preferences, beliefs about group therapy and help-seeking attitudes. Most participants were receptive to and perceived as useful both unified transdiagnostic CBT and group therapy. Overall, participants presented significantly more favorable attitudes than unfavorable attitudes toward unified transdiagnostic CBT and group therapy (p < .001). Multivariate analyses revealed that (1) favorable attitudes toward transdiagnostic treatments were negatively associated with being employed and positively associated with living in an urban area, and higher efficacy scores; (2) unfavorable attitudes toward transdiagnostic treatments were positively associated with being married/cohabitating and negatively associated with vulnerability scores; (3) being female, living in an urban area, and higher efficacy and myth scores emerged as positive predictors of favorable attitudes toward group therapy; and (4) efficacy and vulnerability scores and help-seeking propensity emerged as negative predictors of unfavorable attitudes toward group therapy. These findings highlight the importance of delineating strategies to increase knowledge and acceptance of unified transdiagnostic CBT and group therapy in the Portuguese population, addressing specific individual characteristics.

Cognitive Behavioral Interventions for Separation Anxiety in Youth

Cognitive Behavioral Interventions for Separation Anxiety in Youth

Collaborative Care for Chronic Pain After Traumatic Brain Injury

Chronic pain after traumatic brain injury (TBI) is prevalent and associated with poor outcomes. By providing multidisciplinary care through expert consultation, a collaborative care (CC) treatment approach may reduce pain interference. To compare CC with usual care (UC) in decreasing pain interference. This randomized clinical trial was conducted from July 2018 through April 2021 at 2 hospital-based academic rehabilitation medicine clinics in Seattle, Washington. Participants included adults with mild-to-severe TBI (at least 6 months before enrollment) and chronic pain. Data analysis was performed from March 30, 2022, to August 30, 2023. The CC intervention (called TBI Care) included up to 12 in-person or telephone visits over 16 weeks with a care manager (CM) who provided person-centered cognitive behavioral treatment. The CM met weekly with members of the expert team to review participants and discuss recommendations to optimize treatment. The primary outcome was pain interference on the Brief Pain Inventory at treatment conclusion (4 months after randomization). Secondary outcomes included pain interference at 8 months; pain severity; symptoms of depression, anxiety, and sleep disturbance; pain-related emergency department visits; community participation; and participant satisfaction. Linear mixed-effects regression was used for analysis. A total of 1379 individuals were screened for eligibility, and 158 were randomized (79 to CC and 79 to UC). The participants were mostly women (92 participants [58%]) with a mean (SD) age of 46.8 (13.2) years and a mean (SD) of 15.3 (3.0) years of education. TBI occurred a mean (SD) of 4.0 (5.9) years (median [IQR], 1.9 [0.8-4.5] years) before enrollment. All TBI severities were included, and of 149 participants for whom TBI severity was known, the majority (97 participants [65%]) had mild TBI. In the CC group, 71 participants (90%) completed at least 11 sessions, and, at 4 months, this group had significantly lower pain interference scores compared with the UC group (mean [SD], 3.46 [2.17] vs 5.03 [2.28]). This difference was maintained at 8 months after randomization, with mean (SD) TBI care pain interference scores of 3.61 (2.22) for CC vs 4.68 (2.51) for UC. At 4 months, there was significantly lower pain severity in the CC group vs UC group (mean [SD] score, 3.63 [1.95] vs 4.90 [1.96]), as well as symptoms of depression (mean [SD] score, 8.07 [5.34] vs 11.31 [6.37]) and anxiety (mean [SD], 6.20 [5.17] vs 9.58 [6.00]). Satisfaction with pain treatment (mean [SD] score, 2.99 [1.23] vs 2.52 [1.25]), clinical care (mean [SD] score, 3.28 [1.00] vs 2.84 [1.26]), and overall health care (mean [SD] score, 3.25 [0.88] vs 2.82 [1.00]) were significantly higher in the CC group vs the UC group; global impression of change was significantly lower in the CC group vs the UC group (mean [SD] score, 2.74 [1.02] vs 3.47 [1.26]) (lower scores denote a better impression of change). In this randomized clinical trial of CC compared with UC for patients with TBI, CC was effective at reducing pain interference and was sustained at 8-month follow-up. Further research is needed to examine the implementation and cost-effectiveness of CC for TBI in other health care settings. ClinicalTrials.gov Identifier: NCT03523923.

Integrating Real-Time Biomechanical Feedback with Cognitive-Behavioral Interventions to Enhance the Efficacy of Strength Training

This study investigates the efficacy of integrating real-time biomechanical feedback with cognitive-behavioral interventions in enhancing the outcomes of strength training programs. A mixed-methods experimental design was utilized, involving 90 participants randomly assigned to three groups: a control group receiving traditional strength training, a biomechanical feedback group, and a combined intervention group receiving both biomechanical feedback and cognitive-behavioral strategies. The interventions lasted for 12 weeks, with assessments conducted pre- and post-intervention. Key performance indicators included improvements in one-repetition maximum (1RM) strength tests and psychological well-being metrics. Results indicated that the combined intervention group demonstrated significantly greater improvements in 1RM strength, technique efficiency, and psychological resilience compared to the other two groups. The integration of biomechanical and cognitive-behavioral strategies not only improved physical performance but also enhanced mental focus and training adherence, showcasing a holistic approach to strength training. The findings suggest that a synergistic approach, encompassing both biomechanical feedback and cognitive strategies, can substantially elevate the effectiveness of strength training regimes. These outcomes have implications for coaches, athletes, and sports medicine professionals looking to optimize performance and rehabilitation protocols. The study highlights the potential for a more personalized and psychologically supportive training environment, promising for future research and practical applications in sports science and physical training.

Cultural Adaptation and Development of an Educational Intervention 'Meri Sehat, Mere Rules' Relating to Cardiovascular Disease Associated with Rheumatoid Arthritis for South Asian People.

The cardiovascular disease (CVD) risk is elevated by 1.5 times among South Asians with rheumatological conditions like rheumatoid arthritis (RA) in the UK. However, there is a dearth of culturally sensitive educational interventions tailored to this population. We have culturally adapted an existing cognitive behavioural patient education intervention, originally designed for predominantly White populations, to address this gap. The adaptation process followed the Ecological Validity Model, comprising four phases: stage-setting and expert consultations, preliminary content adaptation, iterative content adaptation with patient partners, and finalisation with patient partners and feedback. The Theoretical Domains Framework (TDF) was employed to evaluate the relevance, acceptability, and cultural adaptation of the existing intervention. Seven South Asian Patient Experts with RA were interviewed, and their input aided in developing new content for the culturally sensitive intervention. The intervention was successfully adapted to suit South Asians. Cultural adaptation involved reviewing elements of the existing intervention, including language tone, content, and metaphors. Moreover, by incorporating behaviour change techniques, the content was designed to enhance understanding of RA, CVD risk associated with RA, and promote a healthy lifestyle. The newly developed educational intervention addressed topics such as community resistance, perspectives on health and culture, societal pressure, and opportunities for change. Key messages were visually illustrated through pictorial diagrams in a twenty-five-minute online resource. The first culturally adapted CVD intervention targeting South Asian individuals with RA, particularly those who are non-English-speaking, is now accessible free of charge at www.nras.org.uk/apnijung nationally and internationally.

Adapting Cognitive Behavioral Therapy for Depression After Traumatic Brain Injury: A Case Study

This case study describes a cognitive-behavioral treatment for depression adapted for individuals with traumatic brain injury (CBT-TBI) and provides a case description of a patient who experienced meaningful symptom reduction. CBT-TBI includes several adaptations to traditional CBT for depression structure, content and process aimed at meeting the unique needs of individuals with TBI sequelae. The patient, a single, White, college-educated, cisgender female in her late 30s who sustained a complicated mild TBI and endorsed symptoms of depression, anxiety, and persistent post-concussive symptoms, completed 12 individual, in-person sessions of CBT-TBI in the context of a randomized, waitlist-controlled trial. Clinician and self-rated measures, as well as neuropsychological assessments, were completed at baseline and posttreatment, and depressive symptoms were assessed weekly by self-report (Beck Depression Inventory-II). Symptom improvement was analyzed using the Reliable Change Index (RCI) and demonstrated a clinically significant reduction in depression and anxiety symptoms, as well as improvement in coping abilities and adaptive thinking. In addition to the adapted content of the intervention, this case example highlights the importance of therapist flexibility, continual assessment, collaboration, and elicitation of feedback in the delivery of CBT for depression for individuals with TBI.

Preventing Postpartum Anxiety and Obsessive-Compulsive Disorder Over the Internet: An Open-Trial Pilot Study

Anxiety disorders are the most common postpartum psychiatric conditions, yet limited research exists on the prevention of postpartum anxiety and obsessive-compulsive disorder (OCD). Postpartum anxiety leads to significant problems in both mother and child, such as maternal depression, difficulty breastfeeding, interference with parent-infant bonding, and childhood anxiety. In the current study, we tested the feasibility, acceptability, and initial efficacy of an Internet-delivered postpartum anxiety and OCD prevention program, “Preventing Postpartum Onset Distress” (P-POD), in a sample of 15 pregnant women in their third trimester. Geared toward at-risk pregnant people, P-POD includes seven 30-minute educational, interactive modules that teach skills derived from cognitive-behavioral treatment for anxiety and OCD. P-POD also includes three additional modules for partners, with strategies for supporting their partners. Findings suggest that P-POD is acceptable and feasible. Participants experienced reductions in postpartum anxiety risk factors. However, this was a small, open-trial pilot study with a relatively homogeneous sample. Future research should compare P-POD to an active control condition, use more diverse samples, include qualitative interviews, and assess symptoms postpartum.

Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial.

Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86).There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=-0.12, 95% CI -0.17 to -0.06) and TAU (B=-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=-0.030, 95% CI -0.05 to -0.01; P=.005). To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573. RR2-10.1186/s13063-016-1511-1.

Defeatist Beliefs and Schizotypy in Adolescents and Emerging Adults

Defeatist beliefs involved overgeneralized negative beliefs regarding the ability to successfully perform tasks and accomplish goals. These cognitive errors have been shown to affect one’s ability to accurately assess and react in social situations and serve as hallmarks of many mood disorders. These negative beliefs also exist at high rates in adults with schizophrenia spectrum diagnoses. There is evidence for these beliefs existing during prodromal periods in young adults at-risk for psychosis, especially if they exhibit motivational or interpersonal difficulties (negative symptoms). However, there is little known about when these beliefs first emerge and whether they predate clinical disorder during earlier life stages where only subclinical presentations of risk (schizotypy) may be present. To address this research gap and help to inform cognitive-behavioral interventions targeting defeatist belief structures, we investigated the relations between defeatist beliefs and schizotypy in a sample of adolescents and emerging adults. Participants were 86 high school students (ages 14-17) and 270 college students (ages 18-22). Participants completed a 30-minute, self-report survey on defeatist beliefs and schizotypy. Our analyses found little difference in mean or standard deviation in defeatist beliefs or schizotypy between our two samples, with a robust positive association (r=0.46) when the samples where aggregated. These findings suggests that defeatist beliefs correspond with subclinical risk more-or-less on a continuum during this wider period of life potentially helping to understand variability in symptom severity. Future research is needed to clarify the nature of this relationship and to inform future interventions. Our finding suggests that cognitive behavioral approaches, which are well suited to target and modify defeatist beliefs, could serve a preventative role in the risk for future psychosis in at-risk adolescents and emerging adults.

An internet-based cognitive behavioural intervention for adults with depression in Arabic-speaking countries: A randomized controlled trial.

Internet-based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet-based cognitive behavioural writing intervention for Arabic-speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M=25.58, SD=6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG=128) or a waitlist control group (WG; nWG=131). The TG received an internet-based intervention over a 6-week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T-tests with change scores from pre- to post-treatment were used for data analyses. Intention-to-treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257=-4.89, p<0.001, d=0.70) and QoL (T257=3.39, p<0.001, d=0.47). Significant differences regarding anxiety symptoms (T257=3.25, p<0.05, d=0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet-based cognitive behavioural writing intervention in adults from Arabic-speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment.

Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential

BackgroundAnxiety is highly prevalent, but undertreated, in primary care. Brief, non-pharmacological interventions are needed. Modular Anxiety Skills Training (MAST), a cognitive-behavioral anxiety intervention, was developed for primary care and tailored for a Veteran sample (MAST-V). The purpose of this mixed methods pilot study was to evaluate MAST-V's feasibility, acceptability, and implementation potential, and preliminarily examine its effectiveness compared to Primary Care Behavioral Health (PCBH) usual care. MethodsThis hybrid I randomized controlled trial (conducted 2019–2021) assigned 35 primary care patients (Mage = 47, 17 % female, 27 % racial/ethnic minority) with clinically significant anxiety symptoms to receive MAST-V or PCBH usual care. Participants completed validated measures of anxiety symptoms and functional impairment at 0, 4, 8, 12, and 16 weeks. ResultsParticipants attended more sessions in MAST-V than usual care. After necessary adjustments to reduce session duration, MAST-V will likely fit within PCBH practice parameters. Participants in both conditions valued treatment, but treatment satisfaction, credibility, and therapeutic alliance were higher for MAST-V. Study therapists achieved high treatment fidelity and rated MAST-V as highly feasible, acceptable, and appropriate for PCBH. They identified ways to address potential barriers to implementation. MAST-V was more effective than usual care in reducing anxiety symptoms and impairment. LimitationsThis was a small pilot study at a single site using study therapists. Results should be considered preliminary until replicated in a full-scale clinical trial. ConclusionsThis brief modular anxiety intervention, which was designed with implementation in mind, may help to address the anxiety treatment gap in primary care.

Exploring the Complexities of Temporomandibular Joint Function and Dysfunction: A Contemporary Review

This contemporary review delves into the intricate realm of temporomandibular joint (TMJ) function and dysfunction, shedding light on its multifaceted nature and offering insights into diagnostic and therapeutic strategies. The TMJ, a vital component of the craniofacial complex, plays a pivotal role in everyday activities such as chewing, speaking, and yawning. Understanding its anatomy and physiology is paramount in the treatment and management of TMJ dysfunction. The biomechanics of TMJ function, from the articular disc to the surrounding ligaments and muscles, have been explored comprehensively. A critical aspect of this review revolves around the diverse etiological factors contributing to TMJ dysfunction. Genetic predispositions, parafunctions, occlusal irregularities, and psychological stress are dissected to illuminate the roles of these factors in the development of TMJ disorders. These complexities prompted the need for a robust classification system elucidating the clinical manifestations and diagnostic criteria for various TMJ disorders. Modern diagnostic modalities, including clinical assessment, imaging techniques, and joint aspiration, are scrutinized for their indispensable roles in accurate diagnosis. The comprehensive overview included management strategies, from conservative measures to surgical interventions. In recognizing the pivotal influence of psychosocial factors, this review underscores the importance of patient-centered care and cognitive-behavioral interventions. Furthermore, regenerative therapies, minimally invasive techniques, and personalized medicine are emerging trends in TMJ research. This review provides a contemporary roadmap for comprehending, diagnosing, and managing TMJ-related conditions.

Examining facilitator experiences delivering an intervention to system-involved women with mental illnesses

Gender differences have been found in the experiences and needs of individuals involved in the criminal legal system, underscoring the importance of interventions tailored to address the needs of system-involved women. Despite this recognition, there remains a gap in understanding how to effectively implement interventions for women with mental illnesses—a population that is increasingly prevalent within correctional facilities. This qualitative study examined facilitator experiences delivering a cognitive behavioral intervention to incarcerated women with mental illnesses. Qualitative open coding techniques were used to analyze facilitator notes from each session to learn more about the challenges facilitators experienced and the strategies they used to address them. Teaching interpersonal conflict skills was identified as the primary challenge facilitators faced throughout intervention delivery. Two aspects of teaching interpersonal conflict skills were found to be particularly difficult: how facilitators worked with participants to identify interpersonal conflicts, and how facilitators fostered discussions of conflict during intervention sessions. This study provides initial insights into the complexities inherent in delivering interventions to system-involved women with mental illnesses. Our results highlight the need for future research and interventions that address dynamics at the intersection of interpersonal conflict, gender, and mental illness.

Pain and temporality: a merleau-pontyian approach

Chronic pain is a common disorder with enormous sociomedical importance. A major part of primary and secondary costs of illness is caused by the various pain syndromes. Nociception – the sensory perception of a painful stimulus – is a complex process relying on an intricate system of anatomical, neurophysiological and biochemical networks. This applies even more so to pain – the state of experiencing a nociceptive event, of interpreting it in terms of meaning for the affected individual and of suffering a range of emotions it elicits. This intricacy renders it obvious, that the empirical medical sciences alone cannot explain all aspects of pain. Hence, it has also become a focus of phenomenological research. One aspect of these investigations is the interaction of pain and the perception of the lived body’s spatiality. The focus of this article will build on these concepts to develop a construct of the alteration of temporality caused by chronic pain and the effects this spells out for the affected subject. To this end, I will primarily draw on Merleau-Ponty’s ideas of the lived body as well as on theories of enactivism and embodiment. I will also point out parallels to neuroscientific data, thereby demonstrating the proximity of phenomenology and neuroscience. A possible partial solution to the pain dilemma may be derived from psychology: techniques relying on cognitive behavioural intervention, awareness training, and existential analysis may provide alleviation to patients suffering from chronic pain.