Psychotherapy Program Research Articles

A Turkish-Speaking Community Program in A Primary Care Psychotherapy Setting: How to Support and Engage A Complex Patient Population

ABSTRACT This paper presents a description of a multigroup-based psychotherapy program for Turkish-speaking individuals provided by an innovative primary care mental health service in London. As of 2021, the project offers two types of therapy: a year-long horticultural group, which is a blend between talking therapy and gardening, and a 20-week psychotherapy group. Both were designed to engage the particularly complex Turkish-speaking patient population in the London Borough of Hackney. The project is grounded in group psychotherapy and borrows elements from different theoretical orientations and therapeutic modalities including community psychology, group analytic therapy, horticultural therapy, attachment theory, and dynamic therapies. Here, we present how the program was created and developed and the specifics of the groups, together with the main themes and dynamics that emerged in the therapeutic process. The program evaluation and outcomes are illustrated by several clinical case vignettes throughout the paper.

Change in Interpersonal and Metacognitive Skills During Treatment With Cognitive Behavioral Analysis System of Psychotherapy and Metacognitive Therapy: Results From an Observational Study.

Background: Interpersonal skills deficits and dysfunctional metacognitive beliefs have been implicated in the etiology and maintenance of depression. This study aimed to investigate the association between changes in these skills deficits and change in depressive symptoms over the course of treatment with Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Metacognitive Therapy (MCT).Methods: In this prospective, parallel group observational study, data was collected at baseline and after 8 weeks of an intensive day clinic psychotherapy program. Based on a shared decision between patients and clinicians, patients received either CBASP or MCT. Ninety patients were included in the analyses (CBASP: age M = 38.7, 40.5% female, MCT: age M = 44.7, 43.3% female). Interpersonal deficits were assessed with the short-form of the Luebeck Questionnaire for Recording Preoperational Thinking (LQPT-SF) and the Impact Message Inventory (IMI-R). Metacognitive beliefs were assessed with the Metacognition Questionnaire-30 (MCQ-30). The Quick Inventory of Depressive Symptomatology (QIDS-SR16) was utilized to assess depressive symptoms. A regression analysis was conducted to assess variables associated with outcome. ANCOVAs were utilized to investigate whether improvement in skills deficits is dependent on type of treatment received.Results: Improvements in preoperational thinking and increases in friendly-dominant behavior were associated with change in depressive symptoms. There was no association between reductions in dysfunctional metacognitive beliefs and a decrease in depressive symptoms. While both treatment groups showed significant improvements in interpersonal and metacognitive skills, there was no significant between-group difference in the change scores for either of these skills.Conclusion: Our findings suggest that changes in interpersonal skills seem to be of particular relevance in the treatment of depression. These results have to be replicated in a randomized-controlled design before firm conclusions can be drawn.

Ecological momentary assessment of emotional processing: An exploratory analysis comparing daily life and a psychotherapy analogue session

AbstractBackgroundEmotional processing has been studied in psychotherapy as a state‐dependent, sequential process of change. So far, no studies have applied this conceptualisation of emotional processing to the assessments of emotion in daily life. This is particularly important in the light of the pertinence of day‐by‐day fluctuations of emotions for understanding mental health and for monitoring the impact of prevention and psychotherapy programmes. This study examined the internal and ecological validity of a state‐dependent conceptualisation of emotional processing in daily life, in comparison with an experiential‐psychodynamic psychotherapy analogue session.MethodsIn total, N = 42 university students participated in an experiential‐psychodynamic session, completed symptom measures and responded to a one‐week period of ecological momentary assessment (EMA) using a smartphone. Emotional processing in the session was assessed using the valid observer‐rated measure Classification of Affective Meaning States (CAMS), and emotional responses in daily life were assessed using newly developed theory‐consistent items self‐rated via an interactive smartphone program.ResultsInternal validity was generally satisfactory across the subscales used in EMA. Correspondence between EMA and in‐session emotional processing was generally low, but specific relationships were found between self‐rated fear, rejecting anger, hurt/grief or loneliness and the observer‐rated productive emotions in the psychotherapy analogue session. Relationships between maladaptive emotional processing and intensity in symptoms were found.ConclusionsThis is the first study to have examined the validity of a state‐dependent conception of emotional processing in daily life, in direct comparison with a psychological session. We recommend using this assessment schedule to develop or complement integrative prevention or intervention programmes.

Developing and Implementing a Web-Based Psychotherapy Program to Address Mental Health Challenges Among Patients Receiving Oncologic and Palliative Care: Protocol for an Open-Label Randomized Controlled Trial

BackgroundThe demand for mental health care, particularly for depression and anxiety, is 3-fold greater among patients receiving oncologic and palliative care than for the general population. This population faces unique barriers, making them more susceptible to mental health challenges. Various forms of psychotherapy have been deemed effective in addressing mental health challenges in this population, including supportive psychotherapy, cognitive behavioral therapy, problem-based therapy, and mindfulness; however, their access to traditional face-to-face psychotherapy resources is limited owing to their immunocompromised status, making frequent hospital visits dangerous. Additionally, patients can face hospital fatigue from numerous appointments and investigations or may live in remote areas, which makes commutes both physically and financially challenging. Web-based psychotherapy is a promising solution to address these accessibility barriers. Moreover, web-based psychotherapy has been proven effective in addressing depression and anxiety in other populations and may be implementable among patients receiving oncologic and palliative care.ObjectiveThe study will investigate the feasibility and effectiveness of web-based psychotherapy among patients receiving oncologic and palliative care, who have comorbid depression or anxiety. We hypothesized that this program will be a viable and efficacious treatment modality compared to current treatment modalities in addressing depression and anxiety symptoms in this population.MethodsParticipants (n=60) with depression or anxiety will be recruited from oncology and palliative care settings in Kingston (Ontario, Canada). Participants will be randomly allocated to receive either 8 weeks of web-based psychotherapy plus treatment as usual (treatment arm) or treatment as usual exclusively (control arm). The web-based psychotherapy program will incorporate cognitive behavioral therapy, mindfulness, and problem-solving skills, and homework assignments with personalized feedback from a therapist. All web-based programs will be delivered through a secure platform specifically designed for web-based psychotherapy delivery. To evaluate treatment efficacy, all participants will complete standardized symptomology questionnaires at baseline, midpoint (week 4), and posttreatment.ResultsThe study received ethics approval in February 2021 and began recruiting participants in April 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 11 participants (treatment, n=5; control, n=4; dropout, n=2) have been recruited. Data collection and analysis are expected to conclude by December 2021 and January 2022, respectively. Linear regression (for continuous outcomes) will be conducted with interpretive qualitative methods.ConclusionsOur findings can be incorporated into clinical policy and help develop more accessible mental health treatment options for patients receiving oncologic and palliative care. Asynchronous and web-based psychotherapy delivery is a more accessible, scalable, and financially feasible treatment that could have major implications on the health care system.Trial RegistrationClinicalTrials.gov NCT04664270; https://clinicaltrials.gov/ct2/show/NCT04664270International Registered Report Identifier (IRRID)DERR1-10.2196/30735

Changes in reflexivity during existential supervision

ABSTRACT The goal of the current study was to uncover and describe the phenomenon of changes in reflexivity during existential supervision. We analyzed interviews with four female existential psychotherapy trainees utilizing Interpretative Phenomenological Analysis. The data yielded three themes: (1) The supervisory relationship: a basis for changes in reflexivity, (2) The influence of the nature of the supervisor’s presence and interventions used for expression of reflexivity, and (3) Changes in reflexivity: a subjective experience of internal transformations. Findings suggest supervision educators should be cognizant of the nature of the supervisory relationship and the supervisor’s presence and specific interventions used in supervision to enhance supervisee reflexivity. These findings add to an in-depth understanding of the supervision process and inform psychotherapy and supervision training programs aimed at improving trainee reflexivity.

Determining prognostic variables of treatment outcome in obsessive\u2013compulsive disorder: effectiveness and its predictors in routine clinical care

The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive–compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive–behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD–symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed.

Análise de processos de formação de quadros psíquicos de surdos congênitos em psicoterapia / Analysis of processes of formation of psychic pictures of congenital deaf people in psychotherapy

Speech is one of the main tools of psychotherapy. This represent an obstacle to the treatment of congenital deaf patients who do not use the oral language. Here we aim to analyze processes of psychic construction in deaf patients who use sign language, its relationship with the linguistic modality and indicate possible considerations for psychotherapy whit this population. We carried out a mutiple case study through a psychotherapy program, planned to attend three congenital deaf subjects fron the deal community of Sao Jose do Rio Preto –SP, selected by lot, from a private clinical record. The program was structured in 26 sessions, developed by a psychoanalyst versed in the Brazilian Sign Language. The sessions tool place an individual and systematic basis, aiming to observe the patterns in the development of mental processes, held once a week, lasting 50 minutes. For data analysis we used Spink’s Association Maps and Trees (2010). The results indicate that differences in the semiotic system of language in congenital deaf people determine adaptations in the psychic development of these patients due the psychotherapeutic treatment for deaf people must take place in their own semiotic system, symbolic organization and culture.

An Arts-based research on group sandplay therapy for children in local children's centers who are overly dependent on internet and smartphones experiencing the COVID-19 pandemic era

The purpose of this study is to find a clue of psychological intervention in group sandplay therapy for children in local children's centers who are overly dependent on internet and smartphones experiencing the COVID-19 pandemic era. Art is a process of expressing imagination, and it is in line with the fact that play is a symbolic and creative activity. Therefore, it can be said that children's imaginary play scenes and imaginary stories appearing in sandplay therapy are a form of art. Sandplay enables non-verbal expression, and the unconscious contents expressed by children are useful in understanding children's emotions. In this process, the researcher understands the client through imagination which is the intersubjective method and experiences an accepting relationship where healing and change occur. However, previous studies have limitations in that they approached children's dependence on the Internet and smartphones based on language. Therefore, these researchers conducted an arts-based study from an analytical psychology perspective to understand the experiences of children in local children's centers who are overly dependent on the Internet and smartphones through the group sandplay therapy process. To this end, co-researchers attending the doctoral program in child counseling and psychotherapy have categorized and discussed four themes: ‘wanting to be loved’, ‘suffering from anxiety’, ‘tolerating being alone/not communicating’, ‘trying to protect oneself’. Finally, it was intended to alleviate the psychological difficulties of children in local children's centers who are overly dependent on internet and smartphones, and to provide an open method for resolving the Internet and smartphone dependence phenomenon.

HEALTH RELATED QUALITY OF LIFE OF THE PATIENT WITH IMMUNOGLOBULIN G4-RELATED CRANIAL HYPERTROPHIC PACHYMENINGITIS (IGG-HP) CAUSING DISTURBANCES OF COGNITIVE CONTROL TREATED WITH NEUROFEEDBACK

Health related quality of life (HRQoL) is the most desired patient centered outcome of medical care (Leplége et al. 1997). In patients with long term illness, such as Hypertrophic Pachymeningitis (HP) still under diagnosis, therefore no possible to properly cure, it might be the only outcome achievable (Netuveli et al. 2005; Trystuła 2017). The problem becomes even more serious when occurs in young person: starting a family and caring for children becomes hard or even impossible, because of his/her physical and psychical conditions. Most clinicians are aware of the importance for quality of life of this functional limitation, but there are no articles describing this problem in the literature. We aimed to fill this gap in knowledge. 29 year old patient, a car mechanic, married, with 4-year-old son, with the long his- tory of the illnes, and especially persistent, diffuse, non-specific headaches, frequent seizures and cognitive deterioration which have been particularly troublesome recently. He was finalny diagnosed with Hypertrophic Pachymeningitis (HP) associated with Immunoglobulin G4-related (IgG4) with the use of specific diagnostic criteria for HP associated with IgG4-RD (IgG4-HP), which rely on histopathologic analysis (Lindstrom et al. 2010; Lu et al 2014). Computed tomography (CT) of the head showed massive calcifications visible along the cerebellar tentorium on the right side, along the cerebral falx, as well as on dura mater on the cranial vault of both cerebral hemispheres. The patient was diagnosed with common variable immunodeficiency (D 83), thrombocytopenia, chronic EBV hepatitis and epilepsy. IgG4-HP was confirmed by CT, MRI and biopsy (IGg4-RHP antibody was detected). The treatment with steroids, and immunosuppressive therapy (RTX) was introduced (as it was suggested by Levraut et al. (2019). It should be stressed that he had a significantly reduced health-related quality of life (HRQoL), mainly because of long-lasting illness, diverse symptoms, often hospitalization, complex differential diagnosis, and especially biopsy which requires neurosurgical intervention, which affect his physical and mental well-being, especially cognitive control, and not possibility to take care of his family. To help the patient we introduce HBI methodology (Kropotov 2016), that is an evaluation of working brain in milliseconds. Quantitative electroencephalography (qEEG), event-related potentials (ERPs) and low-resolution sLORETA tomography were performed. We did not found any paroxysm of 3 Hz rhythm in Eyes Closed (EO) and in Eyes Open (EO) conditions, however the ERPs deviations from the reference indicate deficit of cognitive control (decrease of P3 NOGO wave in comparison to 100 persons from the normative data base from the Human Brain Index in Chur, Switzerland). Therefore, the patient was offered Transcranial Direct Current Stimulation (atDCS) combined with goal-oriented psychotherapy program. It was found that after 40 days of therapy, cognitive control returned, which was translated into a better quality of life related to the patient's health, measure in the 36-Item Short Form Survey (SF-36). The patient returned to his previous job as a head of car mechanic service. Final diagnosis of IgG4-HP and subsequently, proper farmacotherapy, and introduction of HBI methodology allowing for the selection of an adequate method of neurotherapy, for our patient the transcranial direct current stimulation (atDCS) combined with goal- oriented psychotherapy, was helpful in the improvement of his quality of life.

High-frequency monitoring of personalized psychological variables during outpatient psychotherapy in people with seizures: An uncontrolled feasibility study

BackgroundThis feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients’ compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful. MethodsA naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system’s model at the outset of therapy. Daily time-stamped self-assessments were collected during outpatient psychotherapy. This process-monitoring was technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). The reflection of person-specific time series informed by patients’ replies to their personalized process questionnaire was integrated in the therapy process. Compliance rates were assessed during a period of six months (i.e., 180 days) after the first entry of the questionnaire [compliance rate = (number of completed questionnaires/180) × 100]. User-friendliness and usefulness of this process monitoring were evaluated quantitatively. ResultsTwenty patients [15 women/5 men, median age 48 years (range 23–73 years)] were recruited. Compliance rates were high (median: 93%, range 31–100%) among the participants. Participants reported a high overall satisfaction with the application and user-friendliness of SNS. ConclusionThe results support the feasibility of high-frequency monitoring of personalized psychological processes during outpatient psychotherapy. Repeated daily assessments of a personalized questionnaire yield highly resolved, equidistant time series data, which gives insight into individual psychological processes during outpatient psychotherapy.

Determining the Efficacy of Electronic Cognitive Behavioral Therapy for Generalized Anxiety Disorder Compared to Pharmaceutical Interventions: Protocol for a Quasi-Experimental Study.

BackgroundGeneralized anxiety disorder (GAD) is an extremely prevalent and debilitating mental health disorder. Currently, the gold standard treatment for GAD is cognitive behavioral therapy (CBT) and/or pharmacotherapy. The most common medications used to treat GAD are selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. While CBT is the gold standard treatment for GAD, it is costly, time-consuming, and often inaccessible. Fortunately, the electronic delivery of CBT (e-CBT) has emerged as a promising solution to address these barriers. e-CBT has shown to offer comparable results to in-person CBT while improving accessibility for patients and time efficiency for clinicians.ObjectiveThis study aims to investigate the treatment efficacy of e-CBT compared to and in conjunction with pharmacotherapy for GAD.MethodsThis study will use a quasi-experimental design to allow patients the freedom to choose which treatment modality they would like to receive. Participants with a diagnosis of GAD will be enrolled in 1 of 3 possible treatment arms: (1) e-CBT, (2) medication, or (3) a combination of e-CBT and medication. The e-CBT program will include a 12-week psychotherapy program delivered through the Online Psychotherapy Tool—a secure, cloud-based, digital mental health platform. The treatment efficacy of e-CBT will be compared with that of medication alone and medication in combination with e-CBT.ResultsThe study received ethics approval in April 2019 and participant recruitment began in June 2019. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 146 participants (e-CBT: n=53; medication: n=49; combination: n=44) have been recruited. Data collection is expected to conclude by June 2021, and data analysis is expected to be completed by October 2021. Linear regression (for continuous outcomes) and binomial regression (for categorical outcomes) analysis will be conducted using interpretive qualitative methods.ConclusionsIf either the efficacy of e-CBT is shown to be comparable to that of medication or the effects of both treatments are augmented when used in tandem, these findings could have major implications on the mental health care system. e-CBT is a more accessible and affordable treatment that could increase mental health care capacity 4-fold if proven viable.Trial RegistrationClinicalTrials.gov NCT04478526; https://clinicaltrials.gov/ct2/show/NCT04478526International Registered Report Identifier (IRRID)DERR1-10.2196/27772

Оцінки рівня дистресу, депресії, тривоги та соматизації у ветеранів з ПТСР та легкою черепно-мозковою травмою після 8-тижневого комплексного втручання

Background. Understanding the complex relationships between combat injuries, physical health, and mental health symptoms is critical to meeting the healthcare needs of veterans. The relationship between head injuries, posttraumatic stress disorder (PTSD), and depression among combat-injured service members is unique to modern conflicts but understudied. Research suggests a relationship between PTSD and somatic complaints in veterans, suggesting that PTSD influences somatic complaints through underlying symptoms of depression and anxiety sensitivity. Aims. To investigate the dynamics of distress, depression, anxiety, and somatization in veterans with PTSD and mTBI after an 8-week comprehensive intervention (combining a psychotherapy program with transcranial direct current electrical stimulation (tDCS)). Methods. The data of the initial and repeated examination of 329 veterans from three clinical groups were analyzed: individuals with PTSD (n=109), with mild TBI (n = 112), and with PTSD+TBI comorbid condition (n=108). All patients received standard therapy as well as psychotherapeutic intervention and transcranial direct current electrical stimulation (tDCS). The Four-Dimensional Symptom Questionnaire (4DSQ) was used to assess distress, depression, anxiety, and somatization. The rank correlation between the primary and repeated examination data for each clinical group was also determined. Results. Patients suffering from PTSD or PTSD with mTBI had significantly more symptoms of depression, anxiety, and somatization than patients with mTBI without PTSD. After the therapy, patients from the PTSD and PTSD+mTBI groups experienced a subjective increase in the feeling of distress, which was associated with a reduction of mainly depressive and somatoform symptoms in the respondents of the PTSD+mTBI group, and in patients with PTSD with a decrease of mainly depressive and anxiety symptoms. In contrast, in the patients with TBI, there was no increase in the subjective feeling of distress, and the improvement of the mental state was accompanied by a decrease in the entire investigated spectrum of symptoms - depressive, somatoform, and anxiety. In patients with TBI, a higher level of distress at the primary examination led to a lower level of depression and distress at the repeated examination, and a high somatization score was correlated with its significant reduction under the influence of therapy. In the patients of the PTSD+mTBI group, a high index of somatization at the primary examination was correlated with a subjective increase in distress, but a decrease in somatization itself at the end of therapy. Conclusions. The presence and level of expressiveness of symptoms of distress, depression, anxiety, and somatization in persons with PTSD, TBI, and a combination of these painful conditions are closely related to the effectiveness of the complex intervention, which provides the possibility of differentiated targeted therapy of individual clinical groups of patients.

FASTER and SCOTT&EVA trainings for adults with high-functioning autism spectrum disorder (ASD): study protocol for a randomized controlled trial

BackgroundAutism spectrum disorder (ASD) is a chronic neurodevelopmental condition with a prevalence rate above 1%, characterized by deficits in social communication and interaction; restrictive, repetitive patterns of behavior, interests, or activities; and a preference for sameness and routines. The majority of adult ASD patients suffer from comorbid conditions such as depression and anxiety. Therapy options for adult ASD patients are lacking, with presently no available evidence-based interventions in Germany. Recently, two interventions to improve social responsiveness have been published. FASTER (“Freiburger Asperger-Spezifische Therapie für ERwachsene” = Freiburg Asperger-specific therapy for adults) is a manualized group psychotherapy program including three modules on psychoeducation, stress regulation management, and non-verbal and verbal social communication training with videotaped tasks. SCOTT&EVA (“Social Cognition Training Tool”, and its enhancement “Emotionen Verstehen und Ausdruecken” = understanding and expressing emotions) is a computer-based training program to enhance social cognition including video and audio material of emotional expressions and complex real-life social situations. Initial studies for both programs have shown good feasibility and efficacy.MethodsThree hundred sixty adult participants with an autism spectrum disorder (ASD) will take part in a randomized controlled three-armed multi-center trial to prove the efficacy of manualized group psychotherapy and a manualized computer-based training program. Both interventions will be compared with a treatment as usual (TAU) group, aiming to establish evidence-based psychotherapy approaches for adult individuals with ASD. The primary outcome is evaluated by parents, spouses, or others who have sufficient insight into the respective participant’s social communication and interaction, and will be measured with the Social Responsiveness Scale. First, each of both interventions will be compared to TAU. If at least one of the differences is significant, both interventions will be compared against each other. The primary outcome will be measured at baseline (T0) and 4 months after baseline (T1).DiscussionThe trial is the first to validate psychiatric therapeutic and training interventions for adult ASD patients in Germany. A trial is needed because the prevalence of ASD in adulthood without intellectual disability is high, and no evidence-based intervention can be offered in Germany.Trial registrationGerman Clinical Trial Register DRKS00017817. Registered on 20 April 2020.

Відновлення функціонування ветеранів з ПТСР та легкою черепно-мозковою травмою після 8-тижневого комплексного втручання Смашна О.Є.

Background. Significant numbers of veterans with mild traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD), usually co-morbid, have functional impairments in various areas of life, which significantly complicate the process of their readaptation and resocialization. They experience significant persistent limitations in daily life, including problems with occupational, family, social activities, and self-care due to a combination of emotional, cognitive, and behavioral impairments that should be targets of intervention, including transcranial stimulation and psychotherapy. Aims. To investigate the effectiveness of a complex intervention, namely the combination of a psychotherapy program with transcranial direct current electrical stimulation (tDCS) in the treatment of patients with PTSD and mTBI by assessing their level of functioning. Methods. Examination data of 329 veterans from three clinical groups were analyzed: individuals with PTSD (n=109), mild TBI (n = 112), and with comorbid PTSD+TBI (n=108). All patients received standard therapy as well as psychotherapeutic intervention (a combination of psychoeducation with elements of motivational interviewing and acceptance and commitment therapy for PTSD (ACT) and transcranial direct current electrical stimulation (tDCS). According to the WHODAS 2.0 scale, the level of functioning was determined in six domains: cognition (CW); mobility (MW); self-care ( SW); relationships (RW); daytime activity (LW); social activity (PW); general level of functioning (WHO). A rank correlation was also determined between individual criteria of the CAPS-5 scale and domains of the WHODAS 2.0 test. Results. In patients of all clinical groups, the most pronounced disorders were in the cognitive sphere (CW), the sphere of relationships (RW), social (PW), and daytime activity (LW). The combination of PTSD and TBI was associated with more significant and persistent cognitive impairment, as well as reduced daytime activity. In the majority of respondents, the indicators of all scales of the WHODAS 2.0 methodology at the second examination were significantly lower than at first, which indicated the effectiveness of the therapy. The state of the cognitive sphere turned out to be essential for the effective psychotherapeutic effect on patients both within the PTSD group and with CCM. The connection of separate domains of WHODAS 2.0 with pathological symptoms of PTSD determines the recommendations to increase the duration of the therapeutic program specifically for the group of PTSD. Conclusions. Impairment of functioning in persons with PTSD, TBI, and the combination of these painful conditions is closely related to the presence and expressiveness of PTSD symptoms, which provides the possibility of differentiated targeted therapy for certain clinical groups of patients.

STEPPS for Borderline Personality Disorder: A Pragmatic Trial and Naturalistic Comparison With Noncompleters.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group psychotherapy approach that is effective for patients with borderline personality disorder (BPD) in a public health care setting. The sample in this study comprised 118 outpatients with BPD who were asked to participate in a Spanish-adapted version of STEPPS for 18 months, a psychotherapy program that could be added to their usual psychiatric intervention. They were divided into an experimental group who participated in STEPPS, and a control group, who received treatment as usual. Several variables were collected and the Borderline Evaluation of Severity Over Time (BEST) scale was administered at pretest, Months 3 and 6, posttest (Month 18), and 2-year follow-up (Month 42), after which a post hoc data analysis was carried out. The STEPPS program improved the as-usual treatment provided previously, and the results were cost-effective. A higher educational level and good patient collaboration predicted better outcome.

A Pilot Feasibility Study of Interpersonal Psychotherapy for the Prevention of Excess Weight Gain Among Adolescent Military-dependent Girls.

Adolescent military-dependents face unique psychosocial stressors due to their parents' careers, suggesting they may be particularly vulnerable to excess weight gain and symptoms of depression and anxiety. Despite these risk factors, there is a lack of tested preventative interventions for these youths. Given the transient nature of military family deployments, research may be hindered due to difficulty in collecting long-term prospective outcome data, particularly measured height and weight. The primary aim of this study was to examine the feasibility and acceptability of collecting body mass index (BMI, kg/m2) outcome data up to 2 years following a randomized controlled pilot trial of an adapted interpersonal psychotherapy (IPT) program aimed at preventing excess weight gain and improving psychological functioning for adolescent military-dependents. In exploratory analyses, patterns in body composition over time were examined. Twenty-seven adolescent military-dependent girls (baseline: Mage: 14.4 ± 1.6 years; MBMI: 30.7 ± 4.9 kg/m2; MBMI-z: 1.9 ± 0.4) participated in this study. After a baseline assessment, utilizing a computerized program to create a randomization string, girls were assigned to either an IPT or a health education (HE) program. Participants completed three follow-up visits (posttreatment, 1-year follow-up, and 2-year follow-up). Girls completed a Treatment Acceptability Questionnaire at posttreatment; at all time points, height and fasting weight were collected. For the primary aim, Fisher's exact tests examined the rate of obtained follow-up data and lost to follow-up status between the two groups, Mann-Whitney U tests examined the session attendance between groups, and treatment acceptability ratings were compared between the two groups at posttreatment using an independent samples t-test. For the exploratory aim, one-way analyses of covariance (ANCOVAs) examined the group differences in BMI at each time point, adjusting for baseline values, and paired samples t-tests examined the within-group differences at each time point relative to baseline. Using imputed data in the full intent-to-treat sample, mixed model ANCOVAs were conducted to examine the group differences over time. Across both groups, girls attended an average of 72.0% of sessions. At least partial data were collected at posttreatment, 1-year follow-up, and 2-year follow-up for 96.3%, 85.2%, and 74.1% of the participants, respectively. There were no significant group differences in follow-up data collection rates, follow-up status, number of sessions attended, or treatment acceptability. BMI-z stabilized across groups, and there were no group differences in BMI-z. In adjusted ANCOVA models with imputed data, no significant group-by-time effects emerged. For this randomized controlled prevention trial, long-term outcome data collection of measured BMI was possible in adolescent military-dependents and IPT was an acceptable and feasible intervention. An adequately powered trial is required to assess the efficacy of this intervention among military-dependents for obesity prevention and improvements in BMI.

Public Funding of Evidence-Based Psychotherapy for Common Mental Disorders: Increasing Calls for Action in Canadian Provinces.

Canada's provinces are without a publicly funded psychotherapy program for common mental disorders despite evidence that psychological services help reduce the length and number of depressive episodes, symptoms of post-traumatic stress and associated negative outcomes (hospitalizations and suicide attempts). Studies also show that including psychological services as part of the service package offered under the public health plan for those without access pays for itself. We posit that a publicly funded psychotherapy program in Canada, including digitized self-guided psychotherapy platforms for common mental disorders, will lead to improved population health useful in the COVID-19 context and beyond.

A Case Study on Using Online Integrated Arts Psychotherapy Program for Stress Reduction in Adolescents: Based on ARC Model

A Case Study on Using Online Integrated Arts Psychotherapy Program for Stress Reduction in Adolescents: Based on ARC Model

Predictors of family violence through the COVID-19 pandemic: Structural equation modeling.

There has been much talk, globally and locally, about family violence during the COVID‐19 pandemic. Family violence has received increasing interest from the researchers in many different fields, while family violence during the COVID‐19 pandemic outbreak still needs researchers' attention to investigate its predictors and detect the prevalence among family members through this health crisis. This study aimed to investigate the spread of family violence and detect the predictors of it with the applied advanced statistical procedure, structural equation modeling (SEM). The researchers prepared the family violence scale that consisted of 21 items, and applied it in a random sample that consisted of (312) individual. The finding indicated that there are high levels of family violence, violence between spouses, violence from parents to children, and sibling violence. As well as, the findings found that the years of marriage are statistically significant of violence between spouses, violence from parents to children, and sibling violence, and the total score of the family violence. As well as, sex is a statistically significant predictor of violence between spouses. While the educational level, age, and income level did not predict violence (total score or dimensions). Based on the results of the current study, counseling programs to reduce family violence and psychotherapy programs to reduce the negative effects of family violence on parents and children must be planned. Therefore, the role of traditional and online family counseling and psychotherapy must be activated in light of the outbreak of the COVID‐19 pandemic.

Challenges to mental health services for refugees: a global perspective.

Challenges to mental health services for refugees: a global perspective.