Conventional Psychological Treatments Research Articles

Clinical effectiveness of treatments for the management of anxiety in community dwelling people living with dementia: a systematic review and meta‐analysis

AbstractBackgroundPeople living with dementia commonly experience distress or behavioural and psychological symptoms, such as anxiety, which are associated with worse outcomes in this population. Symptoms of anxiety can be challenging to manage, as there is limited evidence supporting the prescription of psychotropic medications and it is unclear if conventional psychological treatments, such as cognitive behavioural therapy, are effective. The aim of this systematic review and meta‐analysis was therefore to investigate the effectiveness of pharmacological and non‐pharmacological treatments for the management of anxiety in community dwelling people living with dementia.MethodA systematic review and meta‐analysis was conducted of randomised controlled trials until January 2022, searching EMBASE, CINAHL, MEDLINE and PsycInfo. This is currently being updated to Jan 2023. Standardised mean differences were estimated at follow‐up between treatments and pooled across studies using random‐effects models. The Cochrane risk‐of‐bias tool for randomized trials assessed risk of bias and meta‐analysis was performed if three or more studies of a treatment group were available.ResultTwenty‐seven studies (comprising 2517 participants) were included. We categorised these as pharmacological interventions (n = 8), non‐pharmacological group interventions (n = 8) and non‐pharmacological individual interventions (n = 11). Pharmacological interventions with evidence of potential effectiveness included olanzapine, loxapine, citalopram, buspirone and risperidone; and those with no evidence of effectiveness were thioridazine and haloperidol. Meta‐analyses was not performed due to study heterogeneity.Some non‐pharmacological treatments were found to be effective in reducing anxiety in people living with dementia, compared to usual care or active controls. For interventions aimed at individuals the pooled standardised mean difference was ‐0.41 (CI: ‐0.71, ‐0.11) and for those aimed at groups it was ‐0.44 (CI: ‐0.79, ‐0.09). When examining different type of intervention, results suggest music therapy and muscular approaches (e,g, relaxing massage) were effective in reducing anxiety symptoms, while cognitive approaches and sensory stimulation were not. We will present additional findings from updated searches.ConclusionResults suggest non‐pharmacological interventions can be effective in reducing anxiety in community‐dwelling people living with dementia. This supports the development and use of more group‐based non‐pharmacological interventions to help reduce anxiety among people living with dementia in the community and their carers.

Treatment of social anxiety disorder by integrating digital news communication with psychological identification

BackgroundSocial anxiety disorder is a mental illness characterized by anxiety or fear in public or social activities. It often occurs in adolescence or early adulthood and can cause further decline in the patient’s social function. The treatment method for social anxiety disorder mainly focuses on psychological treatment based on the clinical symptoms of patients, supplemented by medication treatment.Subjects and Methods42 patients with social anxiety disorder were divided into a control group and an experimental group, with 21 patients in each group. The control group received duloxetine 60mg/d and conventional psychological treatment. The experimental group received digital news communication and psychological identification treatment on the basis of the control group. After 8 weeks of treatment, the treatment effectiveness of patients were evaluated using the Social Avoidance and Distress (SAD) scale.ResultsThere was no significant difference in the evaluation of the SAD scale between the two groups of patients before treatment (P>0.05); After 8 weeks of treatment, the SAD scale evaluation showed significant differences (P˂0.05), the SAD scale scores of both groups of patients decreased, and the scores of the experimental group were significantly lower than those of the control group (P<0.01).ConclusionsThe combination of drug therapy and psychotherapy has a certain therapeutic effect on patients with social anxiety disorder. On this basis, digital news dissemination and psychological identity therapy can enhance the effectiveness of clinical treatment.

Psychological influence of emerging niche clothing culture on youth with OCPD

Background Subculture is a unique cultural group formed outside the mainstream culture, and emerging niche clothing culture usually refers to some non-traditional, independent brand or style clothing culture. Compulsive personality disorder is a psychological disorder in which patients tend to overly focus on details, order, and perfectionism. For young people with obsessive-compulsive personality disorder, participating in emerging niche clothing culture may have some psychological effects.Subjects and MethodsSelect 100 patients with obsessive-compulsive personality disorder and randomly divide them into two groups: the experimental group and the control group. The experimental group of patients adopted emerging niche clothing culture and conventional psychological treatment methods, while the control group adopted conventional psychological treatment methods. The experimental period is 3 months, and the treatment effects of patients after 3 months are compared and statistically analyzed using Excel and SPSS23.0.ResultsThe research results indicate that the combination of emerging niche clothing culture and conventional psychotherapy methods is more likely to obtain a different way of relaxation and decompression compared to conventional psychotherapy methods. This novel rather than traditional clothing style can become a way for them to alleviate the pressure of compulsive thinking and behavior, providing physical and mental comfort.ConclusionsThe emerging niche clothing culture can provide a unique way for young people with obsessive-compulsive personality disorders to express their individuality and uniqueness. By choosing clothing and styles that are different from mainstream clothing styles, they can express their independent thinking and aesthetic preferences.Acknowledgement2021 National Social Science Foundation Art Program (No.21BG103).

Study protocol for a randomized controlled trial of in-home decluttering augmentation of group cognitive-behavioral therapy for hoarding disorder: the Joining Forces Trial

BackgroundCognitive behavioral therapy (CBT) is a moderately efficacious treatment for hoarding disorder (HD), with most individuals remaining symptomatic after treatment. The Joining Forces Trial will evaluate whether 10 weeks of in-home decluttering can significantly augment the outcomes of group CBT.MethodsA randomized controlled trial of in-home decluttering augmentation of group CBT for HD. Adult participants with HD (N = 90) will receive 12 weeks of protocol-based group CBT for HD. After group CBT, participants will be randomized to either 10 weeks of in-home decluttering led by a social services team or a waitlist. The primary endpoint is 10 weeks post-randomization. The primary outcome measures are the self-reported Saving Inventory-Revised and the blind assessor-rated Clutter Image Rating. Participants on the waitlist will cross over to receive the in-home decluttering intervention after the primary endpoint. Data will be analyzed according to intention-to-treat principles. We will also evaluate the cost-effectiveness of this intervention from both healthcare and societal perspectives.DiscussionHD is challenging to treat with conventional psychological treatments. We hypothesize that in-home decluttering sessions carried out by personnel in social services will be an efficacious and cost-effective augmentation strategy of group CBT for HD. Recruitment started in January 2021, and the final participant is expected to reach the primary endpoint in December 2024.Trail registrationClinicalTrials.gov NCT04712474. Registered on 15 January 2021

Efficacy of combined naikan and morita therapies on psychological distress and posttraumatic growth in Chinese patients with advanced cancer: A randomized controlled trial.

Background:Advanced cancer (AC) patients experience serious physical and psychological problems with the disease progression. When approaching the end of life, these patients have to cope with not only the bodily illness, but also the spiritual crisis. Conventional psychological treatments reduce distress to a certain extent, but for patients with AC, especially when they face progressive illness and are approaching death, their psychological problems are complex, and no simple solutions are in sight. Therefore, we designed this study to evaluate the efficacy of the combined Naikan therapy (NT) and Morita therapy (MT) on psychological distress and posttraumatic growth in patients with AC.Method:One hundred thirty patients newly diagnosed with AC were allocated randomly into treatment (n = 65) and control (n = 65) groups. Patients in the treatment group received combined NT and MT for 7 consecutive weeks, while the control group received normal medical treatments without NT and MT. Patients were assessed before and after the therapies. The primary outcome measures include distress thermometer (DT) and posttraumatic growth, and the secondary outcome measure contains the list of distress problems.Results:At the post-treatment stage, the treatment group displayed a decreased score of psychological distress as compared to that in the control group, which accompanied by a higher post-traumatic growth total score and subscale scores in relationship to others, new possibilities, personal strength, spiritual changes, and appreciation of life. A significant decrease in fear, sleeping difficulty/insomnia, nervousness/anxiety, and loss of appetite was also observed in the treatment group.Conclusion:The results proved that the combined Naikan and Morita therapies decreased the psychological distress and improved the posttraumatic growth of the patients with AC.Trial Registration:ChiCTR1900026691.

Evidence-Based Brief Psychological Treatment for Emotional Disorders in Primary and Specialized Care: Study Protocol of a Randomized Controlled Trial.

Emotional Disorders (EDs) are very prevalent in Primary Care (PC). However, general practitioners (GPs) have difficulties to make the diagnosis and the treatment of this disorders that are usually treated with drugs. Brief psychological therapies may be a new option to treat EDs in a PC context. This article aims to present a study protocol to evaluate the effectiveness and the efficiency of an adaptation to brief format of the “Unified Protocol (UP) for the transdiagnostic treatment of EDs.” This is a single-blinded RCT among 165 patients with EDs. Patients will be randomly assigned to receive brief psychological treatment based on UP, conventional psychological treatment, conventional psychological treatment plus pharmacological treatment, minimum intervention based on basic psychoeducational information, or pharmacological treatment only. Outcome measure will be the following: GAD-7, STAI, PHQ-9, BDI-II, PHQ-15, PHQ-PD, and BSI-18. Assessments will be carried out by blinded raters at baseline, after the treatment and 6-month follow-up. The findings of this RCT may encourage the implementation of brief therapies in the PC context, what would lead to the decongestion of the public health system, the treatment of a greater number of people with EDs in a shorter time, the reduction of the side effects of pharmacological treatment and a possible economic savings for public purse.Clinical Trial Registration: ClinicalTrial.gov, identifier NCT03286881. Registered September 19, 2017.

Acceptance and commitment therapy for adults with advanced cancer (CanACT): study protocol for a feasibility randomised controlled trial.

BackgroundOne-third of people with cancer experience psychological distress and may suppress distressing thoughts, emotions, and concerns, leading to further problems. Conventional psychological treatments reduce distress by problem solving, but in advanced cancer, when ill health is progressive and death may be approaching, physical and psychological difficulties are complex and have no simple solutions. Acceptance and Commitment Therapy encourages acknowledgement and acceptance of mental experiences, increasing people’s ability to work with problems that cannot be solved. Previous pilot work in advanced cancer confirms that distress can be associated with an avoidance of experiencing uncomfortable thoughts and emotions.Methods/DesignThis feasibility randomised controlled trial of Acceptance Commitment Therapy aims to establish parameters for a larger trial. Fifty-four participants with advanced cancer will be randomly allocated to up to eight sessions (each 1 hour) of Acceptance Commitment Therapy or a talking control. Participants will be recruited from those attending outpatient services and hospice day care at three specialist palliative care units in North and East London, United Kingdom. The primary outcome is a measure of functioning in four areas of life (physical, social/family, emotional, and general activity) using the Functional Assessment of Cancer Therapies - General questionnaire at 3 months after randomisation. Secondary outcomes are (i) acceptance using the Acceptance and Action Questionnaire; (ii) psychological distress using the Kessler Psychological Distress Scale; (iii) physical functioning using a timed walk and sit-to-stand test; and (iv) quality of life measures including the Euroqol-5 Dimensions and ICECAP Supportive Care measures. Qualitative data will be collected at 3 months to explore the participants’ experiences of the trial and therapy. Data will be collected on the costs of care.DiscussionData generated on the recruitment, retention, and experience of the interventions and the usefulness of the outcome measures will inform the adaptations required and whether changes in function are consistent with existing data when planning for a sufficiently powered randomised controlled trial.Trial registrationISRCTN13841211 (registered 22 July 2015).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1169-8) contains supplementary material, which is available to authorized users.

PSYCHOLOGICAL INTERVENTION INCLUDING EMOTIONAL FREEDOM TECHNIQUES FOR AN ADULT WITH MOTOR VEHICLE ACCIDENT RELATED POSTTRAUMATIC STRESS DISORDER: A CASE STUDY

Posttraumatic Stress Disorder (PTSD) is a significant public health concern and can have long-term emotional, social and financial consequences for individuals and society. Lifetime prevalence in the general population is estimated at 8% and rates of exposure to Post-Traumatic Events (PTE) indicate approximately 50 to 65% have been exposed to at least one PTE in their lives. This indicates that approximately 15 to 25% of people exposed may also have a diagnosis of PTSD at some time in their life. It is therefore paramount that sufferers receive effective treatment. A case of successful treatment using Emotional Freedom Technique (EFT) combined with more conventional psychological treatment for a woman, DS, suffering from acute PTSD with travel anxiety post a motor vehicle accident is presented. The client’s progress was evaluated at baseline and post treatment. After six sessions, over an eight week period, improvements were noted on all identified goals and on all assessment tools such that at post treatment DS no longer met the criteria for PTSD. The case highlights the utility of single case designs to evaluate the clinical decisions made in selection of treatment of PTSD. Theoretical implications of this study are discussed and an evaluation of using EFT in this case is provided.

IS TREATMENT OF DEPRESSION COST-EFFECTIVE IN PEOPLE WITH DIABETES? A SYSTEMATIC REVIEW OF THE ECONOMIC EVIDENCE

Depression is common in diabetes and linked to a wide range of adverse outcomes. UK policy indicates that depression should be treated using conventional psychological treatments in a stepped care framework. This review aimed to identify current economic evidence of psychological treatments for depression among people with diabetes. Electronic search strategies (conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, NHS EED) combined clinical and economic search terms to identify full economic evaluations of the relevant interventions. Prespecified screening and inclusion criteria were used. Standardized data extraction and critical appraisal were conducted and the results summarized qualitatively. Excluding duplicates, 1,516 studies for co-morbid depression and diabetes were screened. Four economic evaluations were identified. The studies found that the interventions improved health status, reduced depression and were cost-effective compared with usual care. The studies were all U.S.-based and evaluated collaborative care programs that included psychological therapies. Critical appraisal indicated limitations with the study designs, analysis and results for all studies. The review highlighted the paucity of evidence in this area. The four studies indicated the potential of interventions to reduce depression and be cost-effective compared with usual care. Two studies reported costs per QALY gained of USD 267 to USD 4,317, whilst two studies reported the intervention dominated usual care, with net savings of USD 440 to USD 612 and net gains in patient free days or QALYs.

Stalking: Patterns, motives, and intervention strategies

Stalking is generally defined as an intentional pattern of repeated intrusive and intimidating behaviors toward a specific person that causes the target to feel harassed, threatened, and fearful, or that a reasonable person would regard as being so. Motivations for stalking include a delusional belief in romantic destiny, a desire to reclaim a prior relationship, a sadistic urge to torment the victim, or a psychotic overidentification with the victim and the desire to replace him or her. Stalkers may carry a variety of diagnostic labels, including psychotic disorders, delusional disorders, or cluster-B personality disorders, and are generally refractive to conventional psychological treatments. Risk factors for violence in a stalking scenario include a prior intimate relationship, the stalker's feeling of being rejected or humiliated, and generic risk factors for violence such as low educational level and substance abuse. Cyberstalking can be as distressing, if not more so, to victims as physical stalking due to the concealment and anonymity afforded by electronic communication. Victims may adopt varying strategies for dealing with stalkers, such as avoiding, confronting, seeking third party assistance, and accessing the legal system. Threat management specialists have offered certain recommendations that can make it easier for a victim to deter and discourage a stalker.

Internet-Delivered Exposure-Based Treatment vs. Stress Management for Irritable Bowel Syndrome: A Randomized Trial

Our research group has developed an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS). We compared ICBT with internet-delivered stress management (ISM) for IBS to assess whether the effects of ICBT are specific. This was a randomized controlled trial, including 195 self-referred participants diagnosed with IBS. The treatment interventions lasted for 10 weeks and included an online therapist contact. The ICBT emphasized acceptance of symptoms through exposure to IBS symptoms and related negative feelings. The ICBT also included mindfulness training. The ISM emphasized symptom control through relaxation techniques, dietary adjustments, and problem-solving skills. Severity of IBS symptoms was measured with the gastrointestinal symptom rating scale-IBS version (GSRS-IBS). Credibility of the treatments and expectancy of improvement were assessed with the treatment credibility scale. The participants' perceived therapeutic alliance with their online therapist was measured with the working alliance inventory. At post-treatment and 6-month follow-up, 192 (99%) and 169 (87%) participants returned data, respectively. At post-treatment and 6-month follow-up, we found significant differences on the GSRS-IBS, favoring ICBT. The difference on GSRS-IBS scores was 4.8 (95% confidence interval (CI): 1.2-8.4) at post-treatment and 5.9 (95% CI: 1.9-9.9) at 6-month follow-up. There were no significant differences on the treatment credibility scale or the working alliance inventory between the groups. Internet-delivered CBT has specific effects that cannot be attributed only to treatment credibility, expectancy of improvement, therapeutic alliance, or attention. Furthermore, a treatment based on exposure exercises specifically tailored for IBS may be a better treatment option than general stress and symptom management for IBS patients. ICBT is a promising treatment modality for IBS as it can be offered to IBS patients in much larger scale than conventional psychological treatments.

Psychologists entering primary care: Manhattan cannot be bought for $24 worth of beads.

Speer and Schneider's review (2003; this issue) illustrates a number of problems in psychologists’ understanding of elderly primary care (PC) patients and their providers, as well as the context of PC. Claims that elderly patients overutilize health services and do so primarily because of mental health problems are not well founded. Older PC patients also face practical and preference barriers to accepting conventional psychological treatment The evidence that psychological services provide cost offset is questionable, and cost offset is not the best way of evaluating the value of psychological services. Rather than as frontline providers, psychologists’ best prospects for an expanded role in PC is in the design, supervision, and evaluation of augmented services in this setting.

Media-based behavioural treatments for behavioural disorders in children.

Prevalence studies show that behaviour problems in children are quite common (10-15% in preschoolers). These problems may manifest as, for example anxiety, sadness, over-activity and tantrums. Some studies have shown that these problems can be persistent, and that they lead to a range of problems in adolescence and adulthood. Many approaches are used to address behavioural problems such as medication, or more usually, psychological treatments either directly with the child and/or his/her family. Behavioural interventions have been shown to be highly effective but access to these treatments is limited due to factors such as time and expense. Presenting the information parents need in order to manage these behaviour problems in booklet or other media-based format would reduce the cost and thus increase access to these interventions. In the adult population it seems that media-based interventions such as these can be moderately effective. Given that the cost of media-based treatment is so low it is useful to know how effective they are when given to parents. It was hypothesised that media-based treatments would be less effective than conventional psychological treatments and that efficacy would improve with increasing amounts of therapist intervention. To review the effects of media-based behavioural therapies (definitions below), for any young person with a behavioural disorder (however diagnosed) compared to standard care and no treatment controls. A range of electronic databases were systematically searched using a specified search strategy. Individual journals of interest were hand-searched where necessary, references in all selected trials were checked for other trials and, where it was thought to be of possible use, individual authors were contacted for additional information. Randomised controlled trials of behavioural media-based treatments for behaviour problems in children. Abstracts and titles of studies identified from searches of electronic databases were read to determine whether they met the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by the reviewer and queries were resolved by discussion with an independent rater. Data were analysed using Revman. In general, media-based therapies for behavioural disorders in children had a moderate effect when compared with both no-treatment controls and with standard care. Significant improvements were often made with the addition of up to 2 hours of therapist time. These formats of delivering behavioural interventions for carers of children are possibly worth considering in clinical practice. For straightforward cases media-based interventions may be enough to make clinically significant changes in a child's behaviour, and reduce the amount of time primary care workers have to devote to each case. Consequently this would increase the number of families who could possibly benefit from this type of intervention. Media-based therapies would therefore appear to have both clinical and economic implications as regards the treatment of children with behavioural problems.