Reliable Change Index Scores Research Articles

Spontaneous speech: a robust measurement before, during and after awake brain surgery in patients with glioma

Background Patients with glioma often report language complaints with devastating effect on daily life. Analysing spontaneous speech can help to understand underlying language problems. Spontaneous speech monitoring is also of importance during awake brain surgery: it can guide tumour resection and contributes to maintaining language function. We aimed to investigate the spontaneous speech of patients with glioma in the perioperative period and the additional value of spontaneous speech analyses compared to standardised language testing. Methods We elicited and transcribed spontaneous speech of eight patients with glioma elected for awake brain surgery preoperatively, intraoperatively and 2.0–3.5 months postoperatively. Linguistic errors were coded. Type Token Ratio, Mean Length of Utterance of words, minimal utterances, and errors were extracted from the transcriptions. Patients were categorised based on total error patterns: stable, decrease or increase during surgery. Reliable Change Index scores were calculated for all spontaneous speech variables to objectify changes between time points. Language performance on language tests was compared to spontaneous speech variables. Results Most errors occurred in lexico-syntax, followed by phonology/articulation, syntax, and semantics. The predominant errors were Repetitions, Self-corrections, and Incomplete sentences. Most patients remained stable over time in almost all spontaneous speech variables, except in Incomplete sentences, which deteriorated in most patients postoperatively compared to intraoperatively. Some spontaneous speech variables (total errors, MLUw, TTR) gave more information on language change than a standard language test. Conclusions While the course of spontaneous speech over time remained relatively stable in most patients, Incomplete sentences seems to be a robust marker of language difficulties patients with glioma. These errors can be prioritised in spontaneous speech analysis to save time, especially to determine intra- to postoperative deterioration. Importantly, spontaneous speech analyses can give more information on language change than standardised language testing and should therefore be used in addition to standardised language tests.

Effectiveness of psychological workplace counseling for South Korean employees: A longitudinal study

Purpose: This study aimed to determine the effectiveness of psychological workplace counseling for South Korean employees.Methods: Psychological counseling sessions were conducted for 93 employees from 11 companies that signed a contract for psychological counseling services with the Workplace Mental Health Institute, Kangbuk Samsung Hospital. Each 50-minute session was tailored to the individual needs of the clients. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) counseling effectiveness assessment scale was administered before and after the counseling. A paired t-test was used to compare the mean scores before and after the sessions, and an analysis of variance (ANOVA) was performed, followed by a Scheffe post hoc analysis.Results: In the overall sample, the mean CORE-OM scores before and after counseling showed a significant decrease from 1.343 to 0.883, with improvements observed in all four sub-domains. ANOVA showed that the group with more than 11 sessions showed greater change in scores than the group with four sessions or fewer. The reliable change index scores showed that 38% of the employees demonstrated a reliable change, and the groups with eight or more sessions exhibited greater change than the group with fewer than eight sessions.Conclusion: Among South Korean employees who received workplace counseling services, both the mean total score of the CORE-OM and the mean scores of the four sub-domains decreased after counseling. In addition, the effectiveness of counseling significantly increased as the total number of sessions increased.

A - 24 Treatment Response to Internet-Delivered Cognitive Behavioral Therapy for Depression in Multiple Sclerosis

Abstract Objective A recent randomized-controlled (phase III) clinical trial examined the efficacy of an internet-delivered cognitive behavioral therapy (iCBT) intervention designed to treat depressive symptoms in persons with multiple sclerosis (PwMS). Significant mean reductions in depressive symptoms were found in the stand-alone iCBT and guided-iCBT conditions compared to the control group. The purpose of the current study was to identify the proportion of PwMS who responded to iCBT (stand-alone and guided) for depression compared to a waitlist control group. Method 224 PwMS completed the Beck Depression Inventory-II (BDI-II) to measure depression severity at baseline and post-intervention. Reliable change index (RCI) scores for depressive symptoms were calculated for each participant. Clinical significance was determined using the 95th percentile cutoff (RCI = ± 1.96). Results Combining the stand-alone and guided-iCBT (n = 147) groups, 89 PwMS (61%) demonstrated a reliable decrease in BDI-II scores, whereas 58 PwMS (39%) did not show a reliable decrease. For waitlist controls (n = 77), 19 PwMS (25%) showed a reliable decrease in BDI-II scores, χ2(2, N = 224) = 33.82, p < 0.001, φ = 0.39. Conclusions We found that the iCBT treatment was highly effective, with 61% of PwMS showing a reliable decline in depressive symptoms compared with only 25% of waitlist controls. Still, generally consistent with previous research, almost 40% of PwMS did not respond to iCBT for depression. Future work will investigate baseline cognitive, psychosocial, and disease-related predictors of response to iCBT to better understand treatment outcomes and possible targets to optimize interventions for depression in MS.

Taking ACTion for anxiety and depression: A pilot study of a brief virtual Acceptance and commitment therapy group in primary care

Brief Acceptance and Commitment Therapy (ACT) interventions are well-suited to facilitate timely access to effective treatment for patients experiencing common mental health concerns. This study piloted a 4-session virtual ACT group for primary care patients experiencing symptoms of depression and anxiety (n = 21). Changes in symptoms of depression and anxiety, psychological flexibility, and quality of life (QoL) were examined at post-treatment and at 1- and 3-month follow-up. At a group level, there were significant reductions in symptoms of depression for all time points and symptoms of anxiety were significantly reduced at 1- and 3-month follow-up. Measures of psychological flexibility and QoL were significantly improved at 1- and 3-month follow-up. Reliable change index scores revealed high proportions of individual improvement for depression and anxiety symptoms (56–83% across time points). Proportions of reliable change ranged from 25 to 50% for measures of psychological flexibility and QoL at 1- and 3-month follow-up. Overall, these results are comparable with previously reported rates of improvement for empirically supported treatments and provide preliminary evidence for the effectiveness of this brief ACT intervention delivered in a community setting.

Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) in Chile

Objective To examine the psychometric properties of the Spanish version of the 34-item Clinical Outcomes in Routine Evaluation—Outcome Measure questionnaire (CORE-OM). Method Psychometric exploration was conducted in two samples: non-clinical (n = 706) and clinical (n = 420) participants. The non-clinical sample comprised a subgroup of community members (n = 308) and students (n = 398). The clinical sample consisted of self-reported patients (n = 209) and outpatients (n = 211). The analysis included both internal and test-retest reliability, convergent validity, and principal component analysis. A reliable change index and clinical cut-off scores were established for assessing clinically significant change. Results The Spanish CORE-OM demonstrated good internal consistency and test-retest reliability, along with satisfactory convergent validity against the 45-item Outcome Questionnaire (OQ-45.2). There were strong differentiations between the clinical and non-clinical samples and the four sample subsets. The outpatient group reported the highest scores, while the community group exhibited the lowest scores. There were no marked gender effects. All observed patterns aligned closely with the established Spanish referential data. Conclusion Our findings provide support for the utilization of the Spanish CORE-OM as a measure for tracking psychotherapeutic progress in the context of Chile.

Sensitivity to change in well-being and health-related quality of life in adults with eating disorder symptoms: ICECAP-A versus EQ-5D-5L.

Economic evaluations of treatments help to inform decisions on allocating health care resources. These evaluations involve comparing costs and effectiveness in terms of quality of life. To calculate quality-adjusted life years, generic health related quality of life is often used, but is criticized for not being sensitive to change in mental health populations. Another approach, using experienced well-being measured through capabilities with the ICECAP-A, has been proposed as an alternative. The aim of this study was to investigate whether changes in individuals with eating disorder (ED) symptoms can be better captured using health related quality of life (EQ-5D-5L) or well-being (ICECAP-A). Measurements at two time points with an interval of 1 year were used from a sample of 233 participants with self-reported ED symptoms. An analysis of variance was used to test whether the EQ-5D-5L and ICECAP-A differed in sensitivity to change over time. In order to compare the two questionnaires in terms of clinically significant outcome, the reliable change index and clinical cut-off score were calculated. The two questionnaires did not differ in sensitivity to change. More individuals had recovered but also more had deteriorated according to the EQ-5D-5L compared to the ICECAP. The present study revealed no differences in sensitivity to change in health-related quality of life or well-being in individuals with ED symptoms in the context of mild clinical change. Results corroborated the pervasiveness of low quality of life in this population, even after alleviation of ED symptoms. Measuring treatment benefits in terms of improvements in quality of life is an integral part of economic evaluations in health care. It was expected that these treatment benefits would be better captured as changes in well-being (measured with the ICECAP-A) than as changes in health-related quality of life (measured with the EQ-5D-5L) for individuals with ED symptoms. Based on the results of this study, no preference for one of the two approaches was found.

Functional and structural brain MRI changes associated with cognitive worsening in multiple sclerosis: a 3-year longitudinal study.

Heterogeneous processes may contribute to cognitive impairment in multiple sclerosis (MS). To apply a longitudinal multiparametric MRI approach to identify mechanisms associated with cognitive worsening in MS patients. 3T brain functional and structural MRI scans were acquired at baseline and after a median follow-up of 3.4years in 35 MS patients and 22 healthy controls (HC). Associations between cognitive worsening (reliable change index score < -1.25 at the Rao's battery) and longitudinal changes in regional T2-hyperintense white matter (WM) lesions, diffusion tensor microstructural WM damage, gray matter (GM) atrophy and resting state (RS) functional connectivity (FC) were explored. At follow-up, HC showed no clusters of significant microstructural WM damage progression, GM atrophy or changes in RS FC. At follow-up, 10 MS patients (29%) showed cognitive worsening. Compared to cognitively stable, cognitively worsened MS patients showed more severe GM atrophy of the right anterior cingulate cortex and bilateral supplementary motor area (p < 0.001). Cognitively worsened vs cognitively stable MS patients showed also decreased RS FC in the right hippocampus of the right working memory network and in the right insula of the default mode network. Increased RS FC in the left insula of the executive control network was found in the opposite comparison (p < 0.001). No significant regional accumulation of focal WM lesions nor microstructural WM abnormalities occurred in both patients' groups. GM atrophy progression in cognitively relevant brain regions combined with functional impoverishment in networks involved in cognitive functions may represent the substrates underlying cognitive worsening in MS.

Exploring the linkage between changes in detainees’ perceptions of procedural justice and changes in misconduct

ABSTRACT A growing body of research has studied the role of procedural justice for securing compliant behavior in the correctional context. The purpose of this paper is to advance current knowledge by examining (a) whether detainees change their perceptions of prison staff procedural justice over time, and (b) the extent to which individual changes in procedural justice relate to changes in misconduct. We used longitudinal data on 712 adults who entered Dutch pre-trial detention centers. Reliable change index scores were used to identify changes in procedural justice experienced in contacts with prison staff. Logistic regression models were employed to estimate the effects of changes in procedural justice on changes in misconduct. The results show that detainees’ perceptions of fairness are malleable, and that most detainees (52.2%) experience a decrease in procedural justice during imprisonment. Detainees reporting an increase in procedural justice are less likely to show increases in misconduct. Furthermore, those with high procedural justice perceptions at both times are more likely to abstain from misconduct at both times. More research is needed to improve our knowledge on individual changes in procedural justice and changes in actual behavior.

Tai Wātea/Waves of freedom: An evaluation of a surf therapy programme for improving psychosocial functioning in young men at high risk of adverse life outcomes

ABSTRACT Surf therapy programs have been successfully utilised with vulnerable populations worldwide. This study is the first to examine the effects of a surf therapy program on the psychosocial functioning of young men at high risk of adverse life outcomes in Aotearoa New Zealand. A single-group pre-test post-test research design, with repeated measures and replication was used. The Youth Outcome Questionnaire Self-Report’s Reliable Change Index and clinical cut-off scores were employed to assess outcomes pertaining to each individual. Effect size measures were used to estimate an overall treatment effect. Modified Brinley plots revealed that 25 out of 27 participants demonstrated reliable improvement in psychosocial functioning, 20 of whom also demonstrated clinically significant improvement. The effect size measures also confirmed a large overall treatment effect. Findings suggest that the Tai Wātea surf therapy program may be a highly effective intervention for reaching, retaining and improving the psychosocial functioning of high-risk young men.

The development of a reliable change index and cutoff score for the SCORE-15.

The Systemic Clinical Outcome and Routine Evaluation version 15 (SCORE-15) is a measure used to assess family-level change in family therapy. The SCORE-15 has been demonstrated to be a reliable and valid measure, with high clinical utility; however, the SCORE-15 lacks the ability to determine whether the change in family functioning during the course of therapy is clinically significant. This study aimed to establish a reliable change index (RCI) and clinical cutoff score so that researchers and clinicians can determine clinically significant change in family therapy. USsamples of 71 clinical participants and 244 community participants completed the SCORE-15. Results indicated a cutoff score of 40.37 and an RCI of 9.52. Consequently, family members who improve their SCORE-15 score during the course of therapy by at least 9 points and who cross the threshold of 40 during the course of therapy are considered to have experienced clinically significant change.

Superior Verbal Memory Outcome After Stereotactic Laser Amygdalohippocampotomy.

Objective: To evaluate declarative memory outcomes in medically refractory epilepsy patients who underwent either a highly selective laser ablation of the amygdalohippocampal complex or a conventional open temporal lobe resection.Methods: Post-operative change scores were examined for verbal memory outcome in epilepsy patients who underwent stereotactic laser amygdalohippocampotomy (SLAH: n = 40) or open resection procedures (n = 40) using both reliable change index (RCI) scores and a 1-SD change metric.Results: Using RCI scores, patients undergoing open resection (12/40, 30.0%) were more likely to decline on verbal memory than those undergoing SLAH (2/40 [5.0%], p = 0.0064, Fisher's exact test). Patients with language dominant procedures were much more likely to experience a significant verbal memory decline following open resection (9/19 [47.4%]) compared to laser ablation (2/19 [10.5%], p = 0.0293, Fisher's exact test). 1 SD verbal memory decline frequently occurred in the open resection sample of language dominant temporal lobe patients with mesial temporal sclerosis (8/10 [80.0%]), although it rarely occurred in such patients after SLAH (2/14, 14.3%) (p = 0.0027, Fisher's exact test). Memory improvement occurred significantly more frequently following SLAH than after open resection.Interpretation: These findings suggest that while verbal memory function can decline after laser ablation of the amygdalohippocampal complex, it is better preserved when compared to open temporal lobe resection. Our findings also highlight that the dominant hippocampus is not uniquely responsible for verbal memory. While this is at odds with our simple and common heuristic of the hippocampus in memory, it supports the findings of non-human primate studies showing that memory depends on broader medial and lateral TL regions.

Memory changes in patients with hippocampal sclerosis submitted to surgery to treat mesial temporal lobe epilepsy

PurposeThis study was performed with the purpose of analysing the relationship between epileptological and surgical variables and post-operative memory performance, following surgery for refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). MethodsLogical memory (LM) and visual memory (VM) scores for immediate and late follow-up of 201 patients operated for MTLE/HS were reviewed. Scores were standardized with a control group of 54 healthy individuals matched for age and education. The Reliable Change Index (RCI) was calculated to verify individual memory changes for late LM and VM scores. A multiple linear regression analysis was carried out with the RCI, using LM and VM scores as well as the clinical variables. ResultsA total of 112 (56%) patients had right HS. The RCI of the right HS group demonstrated that 6 (7%) patients showed improvement while 5 (6%) patients showed decreased scores in late LM; for late VM, 7 (8%) patients presented improvement, and 2 (3%) patients showed poorer scores. RCI of the left HS group showed that 3 (3%) individuals showed improved scores, while scores of 5 (4%) patients worsened for late LM; for late VM, 3 (3%) patients presented higher scores and 6 (5%) showed lower scores. Left HS and advanced age at onset of the first epileptic seizure were predictors of late LM loss (p<.05). ConclusionLeft MTLE/HS and seizure onset at advanced ages were predictive factors for the worsening of late LM. We observed poorer baseline LM function in the left HS group and improvement of LM in some patients who had resection of the right MTL. Patients in the right HS group showed a higher percentage of reliable post-operative improvement for both VM and LM scores.

Immediate Post-Concussion and Cognitive Testing (ImPACT): Effects of Data Integration Strategies on Classification Accuracy.

The current study aimed to evaluate varying data integration procedures and their effects on the classification accuracy of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Data were collected from an independent secondary school that included students in grades 9 to 12. The study examined 300 consecutive ImPACT score reports generated by secondary school students between 2010 and 2015. To appraise ImPACT's utility as a serialized measure, standardized regression-based equations were formulated to compute reliable change index scores. Discriminant function analyses (DFAs) consisting of varying combinations of ImPACT composite scores were conducted and their accuracy was compared to that produced by the standard interpretive procedure. Varying combinations of scores produced on Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Speed, and the Postconcussion Symptom Scale were included in analyses. DFAs yielded sensitivities ranging from 31% to 49%, specificities from 88% to 95%, positive predictive values (PPVs) from 61% to 83%, and negative predictive values (NPVs) from 67% to 75%. Conversely, the standard interpretive procedure yielded a sensitivity of 73%, specificity of 43%, PPV of 45%, and NPV of 72%. The standard interpretive procedure produced a higher sensitivity than the DFAs; however, its PPV did not exceed chance levels. Conversely, DFA equations produced superior PPVs; however, their sensitivity hovered around 50%, leaving a substantial proportion of individuals with concussion undetected. Cognitive composite scores did not appear to offer significant incremental utility in relation to symptom self-report. Base rate conditions and psychometric factors appeared to contribute to ImPACT's limited classification accuracy.

Nostalgic conversations: The co-production of an intervention package for people living with dementia and their spouse.

ObjectivesNostalgic memories are more social than other forms of autobiographical recall, often refer to atypical events, express more positive affect and reflect life as meaningful. Recalling a nostalgic (compared to ordinary) memory increases self-esteem, self-growth, meaning in life and social connectedness for people living with dementia. We set two objectives: to work with people living with dementia to develop an intervention based on nostalgia, and to assess whether couples could engage in nostalgic conversations.MethodOur research fell into three phases. Initially, we consulted with people living with dementia and with carers to identify the parameters for a nostalgic intervention. From this, we drafted a workbook that contained triggers for nostalgic conversations, which we then took back to the public contributors for refinement. Finally, we trialled the workbook over 5 weeks with six couples, each of which included a person living with dementia. We assessed pre- and post-intervention self-esteem, self-growth, meaning in life and social connectedness for participants with dementia and social connectedness for carers. We then calculated Reliable Change Index scores and established levels of clinically significant change. We also interviewed couples at the end of the intervention to explore its implementation and acceptability.ResultsAll six couples could identify nostalgic memories, with five couples successfully integrating the nostalgic conversations into their day-to-day lives. A sixth couple found it difficult to engage fully with the intervention, but still considered it useful. All six couples manifested a reliable change in at least one outcome, with one couple showing reliable change across three outcomes.ConclusionThe psychological benefits of nostalgia have been robustly demonstrated in laboratory-based studies. This co-production of an intervention that sets nostalgic recall into the context of a conversation has clinical potential but requires further investigation through a larger study.

Randomized controlled trial of Regulation Focused Psychotherapy for children: A manualized psychodynamic treatment for externalizing behaviors

ABSTRACT Objective This article examines outcomes of the first randomized controlled trial of Regulation Focused Psychotherapy for Children (RFP-C), a manualized, short-term, psychodynamic intervention for decreasing symptoms of the oppositional defiant disorder (ODD) in school-aged children. Method Participants (n = 43) were school-aged children who were randomly assigned to RFP-C or a waitlist control group. Symptoms of ODD and explicit emotion regulation capacities were assessed at baseline, end of waitlist, and end of treatment. Multilevel modeling was used to account for patient and therapist factors in outcomes. Results At the end of treatment, parents reported significant reductions in children’s ODD symptoms on the primary outcome measure. There were no observed changes in explicit emotion regulation. Reliable change index scores indicated that 79.4% of children were recovered or improved after 10 weeks of treatment. There were no identifiable patient or therapist effects. Treatment adherence and completion was high. Conclusion This study is the first randomized controlled trial of a manualized psychodynamic intervention for children with ODD. Participants demonstrated significant reductions in symptoms of ODD after 10 weeks of treatment. Further investigation is needed to compare RFP-C relative to active treatment, assess changes in implicit emotion, and to determine long-term maintenance of symptom improvement. Clinical trial registration information: Evaluation of Regulation Focused Psychotherapy for Children (RFP-C); https://clinicaltrials.gov/ct2/show/NCT03594253

Methodological considerations of assessing meaningful/reliable change in computerized neurocognitive testing following sport-related concussion

Objective Traditional reliable change index (RCI) methods may be psychometrically limited due to their inability to account for particularly high or low baseline performance and regression to the mean following serial testing. The current study sought to examine differences between RCI and standardized regression-based (RBz) methods in a cohort of adolescent athletes engaged in sport-related concussion recovery. Methods Consultation records and results of computerized testing data via the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery were retrospectively reviewed among 240 adolescent athletes involved in return-to-play protocols following a sport-related concussion. Results High concordance rates were found between RCI and RBz metrics across ImPACT composites, consistent with previous literature. However, especially for those with lower baseline performance, RBz scores tended to suggest cognitive performance not meeting or exceeding baseline scores despite RCI metrics being appropriate across speed-based ImPACT composites. In contrast, results revealed high rates of RCI scores suggesting continued cognitive difficulties despite RBz metrics being within normal limits, especially for adolescents with higher baseline performance. Conclusions Results suggest value in interpreting RBz values in addition to RCI values as these allow for clinical interpretation more sensitive to statistical confounds, including baseline performance and regression to the mean.

The international trauma questionnaire (ITQ) measures reliable and clinically significant treatment-related change in PTSD and complex PTSD

ABSTRACT Background: The International Trauma Questionnaire (ITQ) is a validated measure that assesses ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). An important task is to determine whether the ITQ is an appropriate evaluative measure for clinical trials. Objective: To assess the psychometric properties of the ITQ in the context of treatment and determine if the ITQ measures reliable and clinically significant change over the course of a psychosocial intervention. Method: Analyses were based on data from an online skills training programme delivered to 254 U.S. Veterans. Reliability and validity of the ITQ scores were assessed at baseline. Changes in symptom scores and probable diagnostic rates were compared at pre-, mid- and post-treatment. A reliable change index (RCI) score was computed to classify participants as improved, unchanged, or worsened. The PCL-5 was used as a comparison measure. Results: Baseline concurrent and factorial validity was similar to previous studies. Internal consistency at each assessment was excellent and comparable to the PCL-5. Decline in symptoms from pre-to-post-treatment was significant for PTSD and CPTSD symptom profiles. Rate of probable disorder (PTSD or CPTSD) declined significantly from pre-treatment to post-treatment. Pre-to-post treatment declines exceeded the critical RCI values for the ITQ. Clinically significant changes were observed where most participants improved, some stayed the same, and few worsened. The performance of the ITQ was consistent with the PCL-5 regarding sensitivity to change. Conclusion: This study provides the first demonstration that the ITQ measures reliable and clinically significant treatment-related change of ICD-11 PTSD and CPTSD symptoms.

The relationship between depressive symptoms, general psychopathology, and well-being in patients with major depressive disorder.

ObjectiveIn mental health care, treatment effects are commonly monitored by symptom severity measures. This study aimed to investigate the relationship between symptom severity and well‐being in the treatment of patients with major depressive disorder (MDD).MethodsAdult MDD outpatients (n = 77) were administered the Quick Inventory of Depressive Symptomatology—Self‐Report (QIDS‐SR), the Outcome Questionnaire (OQ‐45), and the Mental Health Continuum‐Short Form (MHC‐SF) before treatment and 6 months later.ResultsSymptom severity correlated moderately with well‐being at baseline and strongly at follow‐up. Reliable change index scores showed improvement on the QIDS‐SR, OQ‐45, and MHC‐SF in 65%, 59%, and 40%, respectively. A quarter of patients improved in symptom severity but not well‐being (Inventory of Depressive Symptomatology—Self‐Report [IDS‐SR]: 25%; OQ‐45: 24%).ConclusionFindings suggest that symptom severity and subjective well‐being are related, but distinct concepts. Several reasons for the stronger improvements in symptoms than in well‐being are discussed.

A Randomized Clinical Trial of a Modified Mindfulness-Based Cognitive Therapy for Children Hospitalized with Cancer

Many youth diagnosed with cancer also suffer from anxiety, depression, posttraumatic distress, and attention problems, which can negatively affect their quality of life. Mindfulness-based Cognitive Therapy for Children (MBCT-C) aims to enhance self-management of attention, improve emotional self-regulation, and bolster social-emotional resiliency. A modified MBCT-C intervention was conducted with hospitalized pediatric cancer patients to evaluate its efficacy for reducing internalizing and attention problems. Forty children (ages 11 to 13) diagnosed with cancer were randomly assigned to either a modified MBCT-C group (n = 20) or treatment as usual (TAU) control group (n = 20). To meet the needs of hospitalized participants, the manualized MBCT-C protocol was adapted to consist of 20 sessions, each lasting 45 min. Sessions were conducted 5 times weekly for 4 weeks. Primary outcome measures were the Child Behavior Checklist, Parent Report and its companion instrument, and the Youth Self-Report (YSR). Data were collected at pre-intervention, post-intervention, and at 2 months following the intervention. Repeated measures ANOVAs showed that, as compared with TAU controls, the MBCT-C group achieved significant reductions in internalizing and attention problems, and those gains were maintained at the 2-month follow-up. Reliable Change Index scores showed that the gains made by the MBCT-C group were both clinically significant and stable. By reducing internalizing and attention problems, mindfulness-based interventions may improve the quality of life for children hospitalized with cancer. These promising results warrant further investigation into the efficacy of mindfulness-based interventions to remediate internalizing and attentional problems in youth diagnosed with serious medical illnesses.

A preliminary comparison of the efficacy of online Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) stress management interventions for social and healthcare workers.

Social and healthcare workers have been shown to experience greater levels of illness, depression and burnout as a result of chronic workplace stress. The purpose of this study was to examine whether brief online ACT and CBT interventions could reduce the experience of stress and burnout in employees, while also improving mental health and psychological flexibility. A total of 42 individuals working within the social and healthcare professions were randomly assigned to either a 2-week online ACT or CBT intervention. Recruitment was undertaken internationally, although the majority of participants were based in Ireland at the time of their participation (79%). Participants' perceived stress, burnout, mental health and work-related psychological flexibility were assessed at baseline and post-treatment. Intent-to-treat analyses were conducted on all data. Outcomes indicated that both interventions resulted in significant improvements in stress, burnout and mental health scores from baseline to post-treatment. No significant differences were observed between ACT and CBT conditions, or in psychological flexibility scores from baseline to post-treatment. Reliable Change Index (RCI) scores indicated that clinically significant improvements in stress and mental health were seen in 42% and 19% of programme-completers, respectively. These results provide preliminary evidence for the usefulness of brief internet-delivered ACT and CBT interventions for the treatment of occupational stress and its comorbid symptoms. Online programmes with a longer duration and additional therapist support should be evaluated, as these may improve the outcomes of future interventions.