Efficacy Of Psychosocial Interventions Research Articles

Psychosocial treatments for nightmares in adults and children: a systematic review

BackgroundAs nightmares may be a risk factor for, or symptom of, multiple psychological disorders, some researchers suggest that nightmares should be screened, diagnosed, and treated. Treatments for nightmares include trauma-focused Cognitive Behavioural Therapy and Image Rehearsal Therapy, and pharmacological interventions such as prazosin and nitrazepam. As recent research has put into question our current understanding of treatment efficacy, there is a need to systematically review findings related to the effectiveness of nightmare treatments to inform best practice. The current review assessed the efficacy of psychosocial treatments of nightmare in all cohorts.MethodsA systematic search of four databases for peer reviewed journal articles from 2000 onwards produced 69 (35 RCTs, 34 non-RCTs) eligible articles that underwent narrative synthesis.ResultsThe results provide strong evidence for exposure and image rehearsal treatments for the reduction of nightmare frequency, severity, and distress, in civilian, military, idiopathic, and posttraumatic stress disorder (PTSD) cohorts. There is emerging evidence that self-guided and brief treatment modalities offer efficient and effective treatment options. There is an urgent need for clinical trials of treatment effectiveness in children.ConclusionsThe results suggest that treatments for nightmares are most effective when they facilitate a sense of control or mastery by directly targeting the nightmare content and/or the client’s emotional responses to the nightmare content.Trial registrationA review protocol was registered with PROSPERO (CRD42020204861).

Psychosocial treatment for panic disorder: An umbrella review of systematic reviews and meta-analyses.

Panic disorder is a common and disabling psychiatric condition marked by sudden onset of physiological sensations that are appraised as dangerous. A number of studies and reviews have examined the efficacy of psychosocial treatments for PD; however, there is a lack of overarching reports that discuss the strength of evidence for the different psychosocial treatments for PD. This umbrella review provides an overview of systematic reviews and meta-analyses on psychosocial treatments for PD. A systematic search and review of the literature was conducted according to PRISMA guidelines. A total of 38 reviews (31 meta-analyses and 7 systematic reviews) were included in the umbrella review. Most of the 38 reviews were focused on the use of CBT, both in-person and internet-based, to treat PD among adults, generally finding it to be an efficacious treatment compared to control conditions. A limited number of the 38 reviews included other age ranges or examined other forms of psychosocial treatments. The methodological quality of most included reviews was rated as critically low according to the AMSTAR-2 rating system. Future reviews should focus on improving their methodological quality. Although the included reviews supported CBT as an efficacious treatment for reducing panic symptoms among adults, future research could focus on how CBT compares to other psychosocial treatments and the efficacy of CBT for PD among other populations (e.g., children and adolescents) and among diverse cultural groups.

Psychosocial treatment of nalbuphine addicts in war affected area: A retrospective study

Background: Psychosocial treatment for nalbuphine addiction is scarcely reported in the literature. Additionally, it is unclear that what is the efficacy of psychosocial treatment in nalbuphine addiction in vulnerable people, such as in war-affected people. Methods: We tried to find the efficacy of psychosocial treatment in nalbuphine addicts. In the current study, we evaluated retrospective data from war-torn areas of Pakistan. A total of 13 medical records of subjects who were suffering from nalbuphine addiction were included and analyzed. Results: One group post-test only research design was followed to check the impact of psychosocial treatment on various outcomes, including self-care, social interaction, and daily activates. Conclusion: All the sub-parameter included in the aforementioned outcomes were significantly high. The results of the study suggest that psychosocial intervention poses a huge potential as one of the interventions for the treatment of nalbuphine addiction.

Meta-Analysis of the Treatment of Posttraumatic Stress Disorder in Adults With Comorbid Severe Mental Illness.

Objective: To evaluate the efficacy of psychosocial treatments for posttraumatic stress disorder (PTSD) among individuals with a comorbid severe mental illness (SMI; ie, schizophrenia, bipolar disorder, major depressive disorder). Data Sources: PubMed, PsycINFO, CINAHL, and Cochrane Library were searched from January 1998 to March 2020 using keywords related to PTSD, treatment, and severe mental illness. Study Selection: All clinical trials for PTSD psychotherapy among individuals with SMI were included. From 38 potentially eligible studies, a total of 14 clinical trials across 684 individuals with comorbid SMI and PTSD were identified and included in the analysis. Data Extraction: Data on demographic, SMI diagnosis, symptom severity, sample attrition, and treatment protocol received were extracted. Effect size calculations and subsequent meta-analyses were conducted using the Meta-Analysis Package for R (metafor) version 2.1–0 in R (3.6.0). Results: PTSD treatments had a large effect on PTSD outcomes among individuals with SMI, with patients experiencing a standard deviation reduction in PTSD symptomatology pre- to post-treatment (g = −1.009, P < .001, k = 34). Prolonged exposure (g = −1.464; P < .001; SE = 0.276; k = 5), eye movement desensitization and reprocessing (g = −1.351; P < .001; SE = 0.276; k = 5), and brief treatment program (g = −1.009; P < .001; SE = 0.284; k = 5) had the largest effects on PTSD symptoms. Conclusions: Although underrepresented in the PTSD literature, PTSD psychotherapies are effective for individuals with SMI. Treatments with an exposure-based component may have greater efficacy in this clinical population.

Cognitive behavioural therapy for insomnia for patients with co-morbid generalized anxiety disorder: an open trial on clinical outcomes and putative mechanisms.

Very little is known concerning the efficacy of psychosocial treatments for patients with insomnia disorder co-morbid with generalized anxiety disorder (GAD). The aim was to examine the efficacy of cognitive behavioral therapy for insomnia (CBT-I) for patients with insomnia disorder co-morbid with GAD. Given the limited, previous research on therapies for patients with insomnia disorder co-morbid with GAD, an open trial design was used. Twenty-four patients with insomnia disorder and GAD were administered CBT-I across 10 weeks. Across the study period to 6 months follow-up, the participants completed measures indexing insomnia, anxiety, worry, depression, functional impairment, quality of life, treatment perception (credibility, expectancy and satisfaction), adverse events and putative mechanisms. Moderate to large effect sizes for CBT-I were observed for insomnia symptoms. In terms of insomnia severity, approximately 61% of the patients responded to CBT-I and 26-48% remitted. Moderate to large effect sizes were also demonstrated for GAD symptoms, depression, functional impairment and quality of life. Roughly one-third of the participants reported an adverse event during CBT-I. Five of the seven putative mechanisms were significantly reversed in the expected direction, i.e. all four cognitive process measures and time in bed. This open trial indicates that CBT-I is an efficacious intervention for patients with insomnia disorder co-morbid with GAD. The results highlight the need for further research using a randomized controlled trial design with analyses of mechanisms of change.

Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: a systematic review and meta-analysis

Summary Long-term benzodiazepine (BZD) use is not recommended in the treatment of chronic insomnia, and psychosocial interventions, particularly cognitive behavioral therapy for insomnia (CBT-I), are a potential treatment option for discontinuing BZDs. This systematic review and meta-analysis aimed to clarify whether psychosocial interventions are effective for discontinuing BZD hypnotics in patients with chronic insomnia. A literature search of major electronic databases was conducted up to July 2018. Two researchers independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Eight randomized-controlled trials, all of which evaluated CBT-I, were included in this review, and meta-analyses were performed. The results indicated that short-term (≤3 mo) CBT-I plus gradual tapering was more effective than gradual tapering alone for discontinuing BZDs hypnotics (risk ratio: 1.68, 95% confidence interval [CI]: 1.19–2.39, p = 0.003) and for improving insomnia symptoms (g: −0.69, 95% CI: −1.09 – −0.28, p = 0.0009). However, the long-term (12 mo) efficacy of CBT-I for discontinuing BZDs was not significant (risk ratio: 1.67, 95% CI: 0.91–3.07, p = 0.10). Thus, CBT-I is effective for discontinuing BZD hypnotics for ≤3 mo. Further studies are needed to clarify the long-term efficacy of psychosocial interventions for discontinuing BZD hypnotics.

Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Background: Recent evidence suggests that psychosocial treatments, particularly cognitive-behavioral therapy (CBT), are effective interventions for adult attention deficit hyperactivity disorder (ADHD). The objective of this review was to determine the long-term efficacy of psychosocial interventions in improving clinically relevant variables, including ADHD core symptoms, clinical global impression (CGI), and global functioning.Methods: In total, nine randomized controlled trials and three uncontrolled single-group pretest-posttest studies were included. The data from these studies were combined using the inverse variance method. Heterogeneity and risk of bias were assessed. Subgroup analyses and meta-regressions were performed, to determine the influence of different potential moderator variables (risk of bias, medication status, follow-up length, therapy type and setting, and control group type) on effect size (ES) estimates.Results: Up to 680 of a total of 1,073 participants assessed pre-treatment were retained at follow-up. Treatment groups showed greater improvement than control groups in self-reported total ADHD symptoms, inattention, and hyperactivity/impulsivity, in addition to CGI and global functioning. Blind assessors also reported a large ES in within-subject outcomes. Studies using dialectical behavioral therapy (DBT) in a group setting, with active control matching, and that were rated as having an unclear risk of bias, achieved significantly lower ES estimates for most outcomes. Treatment effectiveness, according to the CGI measure, and global functioning were significantly increased when the percentage of medicated participants was greater.Conclusions: Our results indicate that the post-treatment gains reported in previous reviews are sustained for at least 12 months. Nevertheless, these results must be interpreted with caution, because of a high level of heterogeneity among studies and the risk of bias observed in the majority of outcomes. Thus, these findings indicate that psychological interventions are a highly valuable and stable clinical tool for the treatment of core symptoms and global functioning in adults with ADHD.

Psychosocial Interventions for End‐of‐Life Care: An Invited Commentary

End‐of‐life care impacts on emotional, physical, spiritual, and social wellbeing for both the individual and their family. Despite remarkable medical advances in the field, the empirical evidence regarding the development and efficacy of psychosocial interventions at end‐of‐life care is lagging behind. A number of psychosocial interventions are promising and represent important progress in the field. Psychologists have a range of suitable skills and knowledge, however, the profession is underutilised in end‐of‐life care. This special issue on end‐of‐life care highlights the need for more research into this area and could act as a call to action to accelerate our understanding of the role of Psychology in end‐of‐life care.

Does Poverty Moderate Psychosocial Treatment Efficacy for ADHD? A Systematic Review

Objective: To determine the extent to which children in poverty show differential benefit versus non-impoverished peers when undergoing behavioral treatment for ADHD. Method: Multiple readers conducted a systematic review using four research databases, one national treatment database, and multiple recent reviews and meta-analyses to identify appropriate studies. Results: Of 1192 initial search results, only five studies met inclusion criteria and were fully abstracted. Conclusion: Results suggest mixed evidence that low-income children may benefit less, compared with peers from higher income families, from psychosocial treatment for ADHD. Findings point to the need for more consistent, more precise, and higher quality reporting of income information.

A Randomized Clinical Trial Comparing Family-Focused Treatment and Individual Supportive Therapy for Depression in Childhood and Early Adolescence

Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatment effects of family-focused treatment for childhood depression (FFT-CD) with those of individual supportive psychotherapy (IP) for children 7 to 14 years old with depressive disorders. Children were randomized to 15 sessions of FFT-CD (n= 67) or IP (n= 67) over 4 months. The primary treatment outcome was adequate clinical depression response, defined as at least a 50% decrease in score on the Children's Depression Rating Scale-Revised (CDRS-R). Additional outcomes included patient-centered outcomes (parent- and child-reported treatment satisfaction), remission (defined as CDRS-R score≤28), change in continuous CDRS-R score, and change in child and parent reports of depressive and non-depressive symptoms and social adjustment. Significant improvement was evident across groups for depressive and non-depressive symptoms, global response, and functioning and social adjustment. Compared with children randomized to IP, children randomized to FFT-CD showed higher rates of adequate clinical depression response (77.7% versus 59.9%; number needed to treat= 5.72; odds ratio 2.29; 95% CI 1.001-5.247; t= 1.97, p= .0498). Across treatments, families reported high satisfaction; compared with IP families, FFT-CD families reported greater knowledge and skills for managing depression. There were no significant differences between treatment arms on secondary outcomes. Results support the value of psychosocial intervention, emphasize the important role that families play, and highlight the potential for FFT-CD for supporting recovery in children with depression. Clinical trial registration information-Systems of Support Study for Childhood Depression; http://clinicaltrials.gov; NCT01159041.

Sustained effects of a psychoeducational group intervention following bariatric surgery: follow-up of the randomized controlled BaSE study

BackgroundEvidence regarding the efficacy of psychosocial interventions after bariatric surgery is rare and shows conflicting results. ObjectivesThe Bariatric Surgery and Education (BaSE) study aimed to assess the efficacy of a psychoeducational group intervention in patients after bariatric surgery. SettingThe BaSE study was a randomized, controlled, multicenter clinical trial involving 117 patients who underwent bariatric surgery. Patients received either conventional postsurgical visits or, in addition, a 1-year psychoeducational group program. The present study evaluated the sustained effects of the intervention program. Mean follow-up duration was 37.9 months (standard deviation [SD] 8.2 months) after surgery. MethodsOutcome measures were as follows: body mass index (BMI), weight loss, self-efficacy, depression severity, and health-related quality of life (HRQOL). Groups were compared using an intention-to-treat approach with a mixed model for repeated measurements. ResultsA total of 74 patients (63.2%) completed the follow-up (T5) assessment. Mean weight loss for all patients was 43 kg (SD 15.5 kg) at T5 (mean BMI 35.1 kg/m2). Mean excess weight loss was 60.4%. The effects of the surgery during the first postsurgical year were reflected, on average, by both decreasing weight and psychosocial burden. At the T5 time point, patients had slowly started to regain weight and to deteriorate regarding psychosocial aspects. However, at T5, patients who had participated in the intervention program (n = 39) showed significantly lower depression severity scores (p = .03) and significantly higher self-efficacy (p = .03) compared to the control group (n = 35). The 2 groups did not differ regarding weight loss and quality of life. ConclusionPsychoeducational intervention shows sustained effects on both depression severity scores and self-efficacy.

Exam 2: Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients With Chronic Liver Disease: A Systematic Review

Exam 2: Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients With Chronic Liver Disease: A Systematic Review

The Effects of Social Support on Health-Related Quality of Life of Patients with Metastatic Prostate Cancer.

Patients with metastatic prostate cancer (PC) live longer than patients with metastatic tumours of other sites. Consequently, their social network can influence their quality of life (QoL) during a remarkable life span. The aim of this article is to present the findings of a systematic review of the studies that focused on social network supporting the quality of life of these patients. A systematic review for studies meeting specific criteria was undertaken on three databases. Some level of unmet psychological needs was present in 54% of the patients. Depression and fatigue are highly prevalent, and the dyads, patient and partner, are at higher risk for distress symptoms. The efforts of individuals to cope with metastatic PC appear influenced by adaptative skills and specific types of family support. Psychological and relational problems predominate in the hormone-sensitive stage and are increasingly replaced by physical symptoms, social and spiritual needs in the later stages. In the early castration-resistant stage, patients will discuss with their doctors information about drugs, control of side effects and treatment strategies. In metastatic PC patients, needs change during the course of the disease. Social support plays a major role in maintaining or disrupting QoL and inthe efficacy of psychosocial treatments. The trajectory of disease and its effect on the reduced QoL over the entire life expectancy should be kept in mind by health system providers and social workers.

Efficacy of Psychosocial Interventions in Men Over 55

Whether psychosocial treatments work equally well for late middle-aged and older men and women is unknown. For this critical review, sixteen studies were identified that examined psychosocial treatments for psychopathology in men age 55 and older. The preponderance of evidence showed that treatments worked at least as well in men as in women. Six studies reported statistically significant treatment effects in exclusively male participants. Methodological problems include weak research designs, small sample size, and absence of indication of clinical significance. There continues to be a paucity of research addressing the efficacy of psychosocial interventions for late middle-aged and older men. Researchers are encouraged to include racially and ethnically diverse older men in carefully controlled studies that examine clinically significant change.

Compared with what? An analysis of control-group types in Cochrane and Campbell reviews of psychosocial treatment efficacy with substance use disorders.

Background and AimsA crucial, but under-appreciated, aspect in experimental research on psychosocial treatments of substance use disorders concerns what kinds of control groups are used. This paper examines how the distinction between different control-group designs have been handled by the Cochrane and the Campbell Collaborations in their systematic reviews of psychosocial treatments of substance abuse disorders.MethodsWe assessed Cochrane and Campbell reviews (n = 8) that were devoted to psychosocial treatments of substance use disorders. We noted what control groups were considered and analysed the extent to which the reviews provided a rationale for chosen comparison conditions. We also analysed whether type of control group in the primary studies influenced how the reviews framed the effects discussed and whether this was related to conclusions drawn.ResultsThe reviews covered studies involving widely different control conditions. Overall, little attention was paid to the use of different control groups (e.g. head-to-head comparisons versus untreated controls) and what this implies when interpreting effect sizes. Seven of eight reviews did not provide a rationale for the choice of comparison conditions.ConclusionsCochrane and Campbell reviews of the efficacy of psychosocial interventions with substance use disorders seem to underappreciate that the use of different control-group types yields different effect estimates. Most reviews have not distinguished between different control-group designs and therefore have provided a confused picture regarding absolute and relative treatment efficacy. A systematic approach to treating different control-group designs in research reviews is necessary for meaningful estimates of treatment efficacy.

The influence of premorbid functioning on the efficacy of psychosocial therapy in adolescents with schizophrenia spectrum disorders

To explore an effect of premorbid functioning level on the efficacy of psychosocial therapy in adolescents with schizophrenia spectrum disorders in order to determine a differential approach to its performance. A study included 53 adolescents with schizophrenia spectrum disorders at the early stage of remission achievement (PANSS scores <65). An impact of premorbid functioning was assessed with the DD-CGAS and the efficacy of psychosocial therapy with CGAS and PedsQL at baseline and after 3, 6 and 12 months. We described the most relevant differences in characteristics of treatment effect (dc) between three groups with different levels of premorbid functioning. To increase the efficacy of psychosocial interventions, we suggest a differential approach of psychosocial therapy in each group.

Efficacy of Psychosocial Interventions on Psychological and Physical Health Outcomes in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Background: Psychosocial intervention has been suggested as a potentially effective supplement to medical treatment in chronic obstructive pulmonary disease (COPD), but no reviews so far have quantified the existing research in terms of both psychological and physical health outcomes. We therefore conducted a systematic review and meta-analysis of controlled trials evaluating the effects of psychosocial interventions on psychological and physical health outcomes in COPD. Methods: Two independent raters screened 1,491 references for eligibility. Twenty independent studies investigating a total of 1,361 patients were included, assessed for their methodological quality, and subjected to meta-analytic evaluation. Results: After adjusting for potential publication bias, a statistically significant overall effect was found for psychological (Hedges' g = 0.38, 95% confidence interval, CI = 0.19-0.58; p < 0.001) outcomes. When analyzing individual intervention types, cognitive behavioral therapy appeared to be effective (g = 0.39, CI = 0.15-0.62; p = 0.001) for improving psychological outcomes. In contrast, for physical outcomes, only mind-body interventions (e.g. mindfulness-based therapy, yoga, and relaxation) revealed a statistically significant effect (g = 0.40; CI = 0.01-0.79; p = 0.042). Conclusions: Taken together, the results lend support to psychosocial intervention as a tool in the management of COPD. However, due to indications of possible publication bias towards positive findings, the results should be interpreted with some caution, and more high quality research is needed.

Changes in Sexual Behavior of HIV-Infected Older Adults Enrolled in a Clinical Trial of Standalone Group Psychotherapies Targeting Depression

By 2015, one-half of all HIV-positive persons in the U.S. will be 50-plus years of age, and as many as 30 % of older adults living with HIV/AIDS continue to engage in unprotected sexual intercourse. Contemporary positive prevention models often include mental health treatment as a key component of HIV prevention interventions. This secondary data analysis characterized longitudinal patterns of sexual behavior in HIV-positive older adults enrolled in a randomized controlled trial of group mental health interventions and assessed the efficacy of psychosocial treatments that targeted depression to reduce sexual risk behavior. Participants were 295 HIV-positive adults ≥50 years of age experiencing mild to severe depressive symptoms, randomized to one of three study conditions: a 12-session coping improvement group intervention, a 12-session interpersonal support group intervention, or individual therapy upon request. Approximately one-fifth of participants reported one or more occasions of unprotected anal or vaginal intercourse with HIV-negative sexual partners or persons of unknown HIV serostatus over the study period. Changes in sexual behavior did not vary by intervention condition, indicating that standalone treatments that target and reduce depression may be insufficient to reduce sexual risk behavior in depressed HIV-positive older adults.

A commentary on 'Effects of screening for psychological distress on patient outcomes in cancer: A systematic review'

Meijer et al. [1] set out to “evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identified as distressed; and (2) effects of screening for distress on distress outcomes [1].” While the overall objective is worthy, this seems like an unlikely pairing, as the title of the paper focuses on conducting a systematic review of screening for distress programs. Why then, is the first objective to evaluate interventions for treating distressed patients, independent of any screening program? What should be evaluated are screening programs that: 1) detect distress; 2) refer to treatment, 3) further evaluate the efficacy of treatment programs for those who attend, and 4) assess the efficacy of screening overall by comparing outcomes across the entire screened population. The authors explain this choice by referring to guidelines which recommend that in the absence of studies assessing full screening programs as described above, one should simply look at the efficacy of interventions for patients who likely would have been referred for treatment had screening existed. Hence, in this case that means looking at interventions which included only patients with high distress levels at the outset. While this rationale makes sense once explained, what is lacking in this approach is the linking back to and comparison with the overall population-based statistics of everyone from the distress screening program. It is not an intuitive pairing, especially since there is such a large and independent volume of work evaluating the efficacy of psychosocial interventions in cancer care. The result of this is two very separate reviews, one of treatment studies (which may have nothing to do with screening for distress) and one of screening studies (which may have nothing to do with intervention efficacy). Hence, we will address each part separately as well.

Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder.

Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and posttreatment symptom levels accounted for by demographic, clinical, and treatment variables as moderators and predictors of outcome. Data were aggregated from 11 randomized, controlled trials of psychosocial treatments for BED conducted at treatment sites across the United States. Participants were N = 1,073 individuals meeting criteria for BED including n = 946 Caucasian, n = 79 African American, and n = 48 Hispanic/Latino participants. Approximately 86% had some higher education; 85% were female. Multilevel regression analyses examined moderators and predictors of treatment retention, Eating Disorder Examination (EDE) global score, frequency of objective bulimic episodes (OBEs), and OBE remission. Moderator analyses of race/ethnicity and education were nonsignificant. Predictor analyses revealed African Americans were more likely to drop out of treatment than Caucasians, and lower level of education predicted greater posttreatment OBEs. African Americans showed a small but significantly greater reduction in EDE global score relative to Caucasians. Self-help treatment administered in a group showed negative outcomes relative to other treatment types, and longer treatment was associated with better outcome. Observed lower treatment retention among African Americans and lesser treatment effects for individuals with lower levels of educational attainment are serious issues requiring attention. Reduced benefit was observed for shorter treatment length and self-help administered in groups.