Reduction In Physical Symptoms Research Articles

Addressing Symptom Burden and Palliative Care Needs in Cystic Fibrosis: A Narrative Review of the Literature.

Among people with cystic fibrosis (CF), illness burden is multifaceted, and symptoms may fluctuate in intensity across a lifespan. Caregivers of people with CF may also experience distressing symptoms. Recent developments in CF care, including the availability of highly effective modulator therapies (HEMTs) and new palliative care guidelines promoting palliative care screening may help alleviate symptoms. The objective of this review was to present a narrative view of the recent literature on symptom burden in CF, new screening approaches informed by the Cystic Fibrosis Foundation (CFF) palliative care guidelines, and early data from studies examining the impact of HEMTs on CF symptom burden. A review of the relevant literature was conducted using Google Scholar and PubMed. Included articles covered approaches to burden assessment in CF and other chronic illnesses, epidemiology of CF symptom burden, the impact of HEMTs on symptom burden, and the CFF palliative care guidelines. A primary palliative care model implementing the CFF guidelines was also described. Results of this review show that while recent developments in CF care have led to a reduction in physical symptoms, mental health symptoms remain prevalent. Ongoing screening and triage can ensure that physical symptoms, psychological symptoms, social needs, practical problems, and communication concerns are addressed by care teams.

Reduced loneliness mediates the effects of multiple group identifications on well-being.

Membership of multiple groups and identification with those groups have been found to be positively related to individuals' health and well-being. The present research sought to replicate this finding in two large, representative samples. Moreover, we sought to extend previous work by shedding light on the mechanisms mediating the effects of multiple group membership on positive health outcomes. Specifically, we proposed that the links between multiple group membership and positive health outcomes are mediated by reduced feelings of loneliness. In Study 1, a two-wave survey of a German population, participants (N = 989) were asked about their identification with family, friends, neighbourhood, their country and humanity and 4 weeks later about feelings of loneliness, physical health and stress. As hypothesized, multiple identifications predicted lower stress. They were also associated with a marginal reduction in physical symptoms of poor health. Both relationships were mediated by the absence of loneliness. In Study 2, we conducted a cross-sectional survey of German participants (N = 1635), which also included a sixth target of identification (Europe). Results replicated findings from Study 1 and also found similar relations associated with smaller (family, friends and neighbourhood) versus larger (country, Europe and Humanity) foci of identification.

A scalable 12-week exercise and education programme reduces symptoms and improves function and wellbeing in people with hip and knee osteoarthritis.

Osteoarthritis is a chronic musculoskeletal condition that impacts more than 300 million people worldwide, with 43 million people experiencing moderate to severe disability due to the disease. This service evaluation provides the results from a tailored blended model of care on joint health, physical function, and personal wellbeing. 1,593 adult participants with osteoarthritis completed the Nuffield Health Joint Pain Programme between February 2019 and May 2022. The 12-week programme included two 40-min exercise sessions per week. All exercise sessions were conducted face-to-face and were followed by 20 min of education to provide information and advice on managing osteoarthritis. The 12-week joint pain programme significantly improved Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global scores (Week 0: 37.5 [17.2]; Week 12: 24.0 [16.6]; p < 0.001), as well as subscales for pain (Week 0: 7.6 [3.7]; Week 12: 4.9 [3.7]; p < 0.001), function (Week 0: 26.0 [13.0]; Week 12: 16.3 [12.4]; p < 0.001), and stiffness (Week 0: 3.9 [1.6]; Week 12: 2.8 [1.7]; p < 0.001). Significant improvements in health-related outcomes including systolic and diastolic blood pressure (Week 0: 139 [18] mmHg; Week 12: 134 [17] mmHg, and Week 0: 82 [11] mmHg; Week 12: 79 [19] mmHg; both p < 0.001), body mass index (Week 0: 29.0 [4.5] kg/m2; Week 12: 28.6 [4.4] kg/m2; p < 0.001), waist to hip ratio (Week 0: 0.92 [0.23]; Week 12: 0.90 [0.11], p < 0.01) and timed up and go (Week 0: 10.8 s [2.9]; Week 12: 8.1 s [2.0]; p < 0.001) were also observed. On completion of the joint pain programme, participants also reported significant improvements in all assessed aspects of self-reported wellbeing (all p < 0.001). With reductions in physical symptoms of osteoarthritis and improvements in personal wellbeing, the joint pain programme delivered by personal trainers in a gym-setting offers a nationally scalable, non-pharmacological treatment pathway for osteoarthritis.

Changes after multicomponent group-based treatment in patients with medically unexplained physical symptoms

ABSTRACT Psychological treatments for patients with medically unexplained physical symptoms (MUPS) reduce somatic symptom severity only moderately. However, patients may profit from changes other than that of symptom reduction. The aim of the present study was to capture the changes that patients with MUPS experience after a multicomponent group-based treatment. Semistructured interviews with 30 patients with MUPS were undertaken after the treatment. Thematic analysis was used to identify the changes the patients reported. The changes included developing a different view of their somatic symptoms, learning how to fulfill their needs, modifying their lifestyle, and becoming open to painful experiences. The patients also noted changes in their somatic symptoms and their quality of life. Multicomponent treatment helps patients with MUPS achieve a variety of changes that reach beyond physical symptoms reduction. Patients’ symptoms often worsen after a return to normal life, which calls for continual care.

“It didn't bring back the old me but helped me on the path to the new me”: exploring posttraumatic growth in British veterans with PTSD

Purpose This study explores the role of scuba diving therapy in growth experiences of ex-servicemen. Previous research has focused on difficulties arising from re-entering civilian life after deployment. Known mental health challenges occurring after severe combat related trauma exposure include depression, anxiety, and posttraumatic stress disorder (PTSD). However, less is known about the potential positive transformation which can occur when individuals navigate these challenges. Known facilitators of this positive transformation, often referred to as posttraumatic growth (PTG), are still sparse in this participant pool. Methods This study utilized an in-depth qualitative approach of interpretative phenomenological analysis utilizing semi-structured interviews. A homogeneous sample of five male British ex-service personnel with a diagnosis of PTSD who identified with PTG was recruited. Results All participants reported positive mental health benefits from diving with four themes emerging: human connection; meaningful leisure; embodiment; and the calm. Conclusions Scuba diving appeared to afford instant access to lasting relief of anxiety, stress, and symptoms of PTSD and reduction of physical symptoms of their trauma connected to underwater weightlessness. The reduction of PTSD symptoms carved space for PTG, facilitated through a meaningful leisure environment with opportunities for human connection with individuals who had gone through similar experiences. Implications for rehabilitation Veterans with posttraumatic stress disorder (PTSD) respond less well to conventional treatments for PTSD than civilian populations. Scuba diving has the potential to benefit veterans by giving access to relief from anxiety and symptoms of PTSD, such as hypervigilance and invasive thoughts. Scuba diving not only reduces symptoms of physical and psychological ill health but can facilitate wellbeing and growth. Scuba diving, as a meaningful leisure activity, could potentially enhance medical and psychological therapy.

Efficacy of expressive helping in adult hematologic cancer patients undergoing stem cell transplant: protocol for the Writing for Insight, Strength, and Ease (WISE) study\u2019s two-arm randomized controlled trial

BackgroundDuring, shortly after, and sometimes for years after hematopoietic stem cell transplant, a large proportion of hematological cancer patients undergoing transplant report significant physical and psychological symptoms and reduced health-related quality of life. To address these survivorship problems, we developed a low-burden, brief psychological intervention called expressive helping that includes two theory- and evidence-based components designed to work together synergistically: emotionally expressive writing and peer support writing. Building on evidence from a prior randomized control trial showing reductions in physical symptoms and distress in long-term transplant survivors with persistent survivorship problems, the Writing for Insight, Strength, and Ease (WISE) trial will evaluate the efficacy of expressive helping when used during transplant and in the early post-transplant period, when symptoms peak, and when intervention could prevent development of persistent symptoms.MethodsWISE is a multi-site, two-arm randomized controlled efficacy trial. Adult hematological cancer patients scheduled for a hematopoietic stem cell transplant will complete baseline measures and then, after hospitalization but prior to transplant, they will be randomized to complete either expressive helping or a time and attention “neutral writing” task. Both expressive helping and neutral writing involve four brief writing sessions, beginning immediately after randomization and ending approximately 4 weeks after hospital discharge. Measures of symptom burden (primary outcome), distress, health-related quality of life, and fatigue (secondary outcomes) will be administered in seven assessments coinciding with medically relevant time points from baseline and to a year post-intervention.DiscussionThe steady and continuing increase in use of stem cell transplantation has created growing need for efficacious, accessible interventions to reduce the short- and long-term negative physical and psychosocial effects of this challenging but potentially life-saving treatment. Expressive helping is a psychological intervention that was designed to fill this gap. It has been shown to be efficacious in long-term transplant survivors but could have even greater impact if it is capable of reducing symptoms during and soon after transplant. The WISE study will evaluate these benefits in a rigorous randomized controlled trial.Trial registrationClinicaltrial.govNCT03800758. Registered January 11, 2019

Feasibility and acceptability of hypnosis-derived communication administered by trained nurses to improve patient well-being during outpatient chemotherapy: a pilot-controlled trial

PurposeThis pilot-controlled trial aimed to examine the feasibility and acceptability of hypnosis-derived communication (HC) administered by trained nurses during outpatient chemotherapy to optimize symptom management and emotional support — two important aspects of patient well-being in oncology.MethodsThe trial was conducted in two outpatient oncology units: (1) intervention site (usual care with HC), and (2) control site (usual care). Nurses at the intervention site were invited to take part in an 8-h training in HC. Participants’ self-ratings of symptoms and emotional support were gathered at predetermined time points during three consecutive outpatient visits using the Edmonton Symptom Assessment Scale and the Emotional Support Scale.ResultsForty-nine patients (24 in the intervention group, 25 in the control group) with different cancer types/stages were recruited over a period of 3 weeks and completed the study. All nurses (N = 10) at the intervention site volunteered to complete the training and were able to include HC into their chemotherapy protocols (about ± 5 min/intervention). Compared to usual care, patients exposed to HC showed a significant reduction in physical symptoms during chemotherapy. In contrast, perception of emotional support did not show any significant effect of the intervention. Participants exposed to HC report that the intervention helped them relax and connect on a more personal level with the nurse during chemotherapy infusion.ConclusionsOur results suggest that HC is feasible, acceptable, and beneficial for symptom management during outpatient chemotherapy. While future studies are needed, hypnosis techniques could facilitate meaningful contacts between cancer patients and clinicians in oncology.Trial registrationClinical Trial Identifier: NCT04173195, first posted on November 19, 2019

Relevant Patient Benefit of Sublingual Immunotherapy with Birch Pollen Allergen Extract in Allergic Rhinitis: An Open, Prospective, Non-Interventional Study.

IntroductionSublingual immunotherapy (SLIT) with birch pollen extract has been shown to be an efficacious treatment of allergic rhinitis (AR). An as-yet unanswered question is whether and how clinical benefit translates into patient benefit, i.e. what benefit patients derive from this treatment.MethodsThis 1-year, open, prospective, multicenter, non-interventional study conducted in 75 German centers measured patient-relevant benefit of birch pollen SLIT (Staloral® Birch) using the questionnaire “Patient Benefit Index for Allergic Rhinitis (PBI-AR)”. At treatment onset, patients rated the importance of 25 treatment needs; after the first birch pollen season on treatment, goal achievement was evaluated. A preference-weighted benefit index was calculated and its association with gender, asthma, allergy status, and severity of AR symptoms was determined.ResultsMean age of the 291 adult patients was 38.8 years; 58.4% were female. The most important treatment goals were to “be able to stay outdoors without symptoms” (87.3% quite or very important), “no longer have a runny or stuffed-up nose” (86.9%), and “be able to breathe through your nose more freely” (86.9%). The treatment goals with the highest benefit ratings (referring to those patients to whom the respective goal applied) were to “have confidence in the therapy” (60.5% has helped “quite” or “very much”), “have an easily applicable treatment” (55.6%), and “be able to breathe through my nose more freely” (51.7%). The average PBI-AR global score was 2.19 (SD 1.04) (0–4; with 4 indicating maximum benefit). No significant differences in PBI-AR global score or subscales were found between men and women, poly- and monoallergic patients, or patients with severe versus mild rhinoconjunctivitis. Patients with asthma reported relevant but lower benefit than patients without asthma.ConclusionAfter 1 year of birch pollen SLIT treatment, patients reported considerable benefit, mainly due to a reduction of physical symptoms and treatment burden.

Persistent physical symptoms reduction intervention: a system change and evaluation in secondary care (PRINCE secondary) \u2013 a CBT-based transdiagnostic approach: study protocol for a randomised controlled trial

BackgroundPersistent physical symptoms (PPS), also known as medically unexplained symptoms (MUS), affect approximately 50% of patients in secondary care and are often associated with disability, psychological distress and increased health care costs. Cognitive behavioural therapy (CBT) has demonstrated both short- and long-term efficacy with small to medium effect sizes for PPS, with larger treatment effects for specific PPS syndromes, including non-cardiac chest pain, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS). Research indicates that PPS conditions share similar cognitive and behavioural responses to symptoms, such as avoidance and unhelpful beliefs. This suggests that a transdiagnostic approach may be beneficial for patients with PPS.MethodsA randomised controlled trial (RCT) will be conducted to evaluate the efficacy and cost-effectiveness of a transdiagnostic CBT-based intervention for PPS. 322 participants with PPS will be recruited from secondary care clinics. Participants stratified by clinic and disability level will be randomised to CBT plus standard medical care (SMC) versus SMC alone. The intervention consists of 8 CBT sessions delivered by a qualified therapist over a period of 20 weeks. Outcomes will be assessed at 9, 20, 40- and 52-weeks post randomisation. Efficacy will be assessed by examining the difference between arms in the primary outcome Work and Social Adjustment Scale (WSAS) at 52 weeks after randomisation. Secondary outcomes will include mood, symptom severity and clinical global impression at 9, 20, 40 and 52 weeks. Cost-effectiveness will be evaluated by combining measures of health service use, informal care, loss of working hours and financial benefits at 52 weeks.DiscussionThis trial will provide a powered evaluation of the efficacy and cost-effectiveness of a transdiagnostic CBT approach versus SMC for patients with PPS. It will also provide valuable information about potential healthcare pathways for patients with PPS within the National Health Service (NHS).Trial registrationClinicalTrials.gov NCT02426788. Registered 27 April 2015. Overall trial status: Ongoing; Recruitment status: No longer recruiting.

Persistent physical symptoms reduction intervention: a system change and evaluation (PRINCE)—integrated GP care for persistent physical symptoms: protocol for a feasibility and cluster randomised waiting list, controlled trial

IntroductionPersistent physical symptoms (PPS), also known as medically unexplained symptoms are associated with profound physical disability, psychological distress and high healthcare costs. England’s annual National Health Service costs of attempting...

Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical trial.

The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

Associations of treatment effects between follow-up times and between outcome domains in interventions for somatoform disorders: Review of three Cochrane reviews

BackgroundInterventions for somatoform disorders typically address a range of outcomes. We aimed to examine treatment effects across outcome domains and specifically assess the association, at study level, between short and long term treatment effects and between treatment effects in different outcome domains. MethodsWe used data from recent systematic reviews of interventions for somatoform disorders to address three questions: We described outcome domains and measures by compiling forest plots of standardised mean difference. We examined the association of changes in outcome between short and long-term and between different outcome domains by non-parametric correlation. ResultsWe analysed data from 47 studies across four outcome domains: physical symptoms, health-related quality of life, depression and anxiety. Short-term and long-term treatment effects within each outcome domain were broadly similar and were correlated Reported reduction in physical symptoms was correlated with reductions in depression (rho=0.73, p=0.002) and anxiety (0.70, p<0.001) and increase in quality of life (0.54, p=0.03). ConclusionShort term changes in outcome measures are correlated with longer term changes; outcome changes are correlated across domains independently of the type of treatment.

Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment.

This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms. Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

Efficacy of Attribution Retraining on Mental Health of Epileptic Children.

Background:Epilepsy affects children’s quality of life and leads to social and mental problems. Promoting the mental health of children, especially epileptic ones, and preventing problems affecting them constitute major concerns for every country. Mental health promotion requires intervention programs.Objectives:We sought to assess the efficacy of attribution retraining on the mental health of epileptic children.Patients and Methods:The present study is a semi-experimental investigation with a pretest and posttest design and includes a control group. Thirty children, comprising 17 boys and 13 girls, were selected randomly from the Iranian epilepsy association in Tehran and assigned to experimental and control groups. They answered to the general health questionnaire (Goldberg and Hiller, 1979). The experimental group participated in 11 training sessions (twice a week; 45 minutes for each session) and received attribution retraining. The data were analyzed using the multiple analysis of covariance.Results:The findings showed that the experimental group, in comparison with the control group, experienced a reduction in physical symptoms, anxiety and insomnia, social dysfunction, and depression and an increase in mental health significantly (P < 0.01) after the training sessions. There were no significant differences, however, between the two groups at 6 weeks’ follow-up.Conclusions:Attribution retraining improved mental health in the epileptic children in our study. It, therefore, seems to be an appropriate intervention for promoting the mental health of children.

Randomized controlled trial on the relaxation effects of back massages for puerperants on the first post-partum day.

The purpose of this study was to investigate relaxation effects of back massage for puerperants on the first post-partum day using physiological and subjective indicators. This randomized controlled trial included both primiparous and multiparous groups, each of which was divided into intervention and control groups. The intervention group was given a back massage for 20 min, while the control group maintained a sitting position for 20 min. Physiological measurements included heart rate variability, parasympathetic nerve activity (high frequency, HF), sympathetic nerve activity (low frequency, LF/HF), and blood pressure. The subjective indicator was an assessment of the feeling of relaxation. The intervention group included 27 primiparous and 26 multiparous women, and the control group included 23 primiparous and 25 multiparous women. In both primiparous and multiparous women, there were significant differences in heart rate variability and sense of relaxation between the intervention and control groups, and a partial reduction of physical symptoms was found in the intervention groups. In the multiparous women, a significant difference in HF was also observed, and beneficial effects were found in the intervention group. A back massage is considered to be one of the effective nursing care methods with which psychological relaxation can be given to puerperants in the early part of the puerperium. The multiparous group demonstrated the relaxation effects because a significant effect was observed in heart rate, HF, and diastolic blood pressure. However, no significant difference was seen in LF/HF; therefore, further investigation of this relaxation effect using physiological indicators is warranted.

Comparison of the effects of Matricaria chamomila (Chamomile) extract and mefenamic acid on the intensity of premenstrual syndrome

The study aimed to compare the effects of Chamomile Extract and Mefenamic acid (MA) on the intensity of Premenstrual syndrome (PMS) symptoms.This study was a clinical randomized double blind trial, carried out with 90 students living in the dorms of Iran. The participants filled the daily forms about the intensity of PMS for two consecutive months. Once the definitive diagnosis of PMS was made, the participants were divided into two groups, each receiving either Chamomile capsule 100 mg or MA 250 mg three times a day. Intensity reduction of emotional symptoms was significantly higher among Chamomile Extract-users (30.1 ± 26.6 and 33.4 ± 25.3 percent) than that among MA-users (11.6 ± 25.7 and 10.7 ± 26.8 percent) after two cycles intervention (p < 0.001). Intensity reduction of physical symptoms was not significantly different (p > 0.05) among groups. Consumption of Chamomile seems to be more effective than MA in relieving the intensity of PMS associated symptomatic psychological pains.

Prospective outcome study of 106 cases of vertical mastopexy, augmentation/mastopexy, and breast reduction

Patient-reported data, including effects on patient satisfaction and quality of life, have not been rigorously studied in women treated with mastopexy and augmentation/mastopexy. This prospective outcome study evaluates and compares mastopexy (n=36), augmentation/mastopexy (n=47), and reduction (n=20) from the patient's perspective. Over a 5-year period, 125 consecutive women underwent vertical mammaplasties incorporating a medial pedicle. In-person interviews were conducted among 106 women at least 1 month after surgery (response rate, 84.8%). Questions were asked in six categories: patient data, indications, recovery, results, complications, and psychological effects. A follow-up study examined the incidence of subjective nipple numbness. The mean pain rating was 4.5 on a 1-10 scale. Both mastopexy (resection weight<300 g per breast) and reduction patients reported a significant reduction in physical symptoms after surgery (p<0.001). The mean result rating was 9.0 n a scale of 1-10. Expectations were met or exceeded in 91.5% of augmentation/mastopexy patients. The reported complication rate was 15.1%. The incidence of persistent nipple numbness was 10.6%. All procedures reduced breast self-consciousness (p<0.001). A correlation was found between the result rating and a lack of complications (p=0.01). All three breast procedures provide a high level of patient satisfaction (94.3%), improved self-esteem (89.3%), and improved quality of life (69.5%). Mastopexy patients report a symptomatic benefit in addition to correction of ptosis. Vertical augmentation/mastopexy provides a high level of patient satisfaction.

Treating Comorbid Anxiety in Adolescents With ADHD Using a Cognitive Behavior Therapy Program Approach

Objective: To evaluate an 8-week cognitive behavior therapy (CBT) treatment specifically designed for adolescents with ADHD and comorbid anxiety. Method: Using a multiple baseline design, nine adolescents (13 years to 16 years 9 months) received a weekly CBT, which focused on four identified anxiety-arousing times. Participants self-recorded their levels of anxiety for each of the four times during baseline, intervention, and a maintenance phase. Anxiety was also assessed using the Multidimensional Anxiety Scale for Children (MASC). Results: Paired samples t tests supported the success of the intervention. Interrupted time-series data for each participant revealed varying rates of success across the four times, however. The MASC data revealed significant reductions in Physical Symptoms of Anxiety, Social Anxiety, Separation Anxiety, Harm Avoidance, and Total Anxiety. Conclusion: The data demonstrate the efficacy of a CBT program for the treatment of comorbid anxiety in adolescents with ADHD.

Should I Stay or Should I Go? Time as a Variable in Open‐ended Psychoanalytic Psychotherapy

ABSTRACTVarious factors could play a role in a patient's decision to leave treatment. This study asks whether patients who leave treatment before one year are different from those who stay beyond a year in open‐ended psychoanalytic psychotherapy, using a variety of experiential measures. Our data indicate that the personality trait of “openness” assessed at intake, correlates with staying in therapy, and that relationship factors as assessed by the patients during therapy correlate with staying in therapy at the beginning, at the average point of dropping out (before one year – average 31 weeks), and at the end of the study. These results indicate that the failure to engage in the therapeutic relationship is a salient factor in the phenomena of leaving before one year. Significant reductions in physical symptoms and other positive trends toward improvement do not emerge until such therapeutic engagement has occurred. We conclude that the personality trait of “openness,” and the quality of the therapeutic relationship significantly influence who will stay in open‐ended psychoanalytic psychotherapy and who will go. Those who stay in psychoanalytic psychotherapy beyond one year benefit more from the experience than those who leave. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Effects of written emotional expression: The role of positive expectancies.

Writing in an emotional way about stressful or traumatic experiences has beneficial effects on emotional well-being and physical health. Yet the mechanisms that underlie these effects still need to be explored. Integrating research on the effects of positive expectancies, the authors suggest that positive effects of written emotional expression may, in part, depend on expectancies induced by writing about emotional experiences. Two studies were conducted to test this hypothesis. In both studies, participants wrote about either an upsetting event or trivial issues. After the writing period, participants rated their expectancies that the writing intervention would improve (or impair) their emotional well-being over time. Study 1 assessed the emotional impact of an upsetting event, whereas Study 2 assessed subjective reports of physical symptoms. In both studies, outcome variables were collected both before and 6 weeks after the writing intervention. The results showed that (a) writing about upsetting experiences induced higher positive expectancies than writing about trivial issues and (b) expectancies associated with written emotional expression were related to a reduction in the emotional impact of an upsetting event (Study 1) and to a reduction in physical symptoms (Study 2). There may be 2 alternative ways to render written emotional expression effective in reducing negative emotions: (a) by rendering an emotional experience more meaningful and (b) by inducing positive affect regulation expectancies.