Traditional Behavioral Therapy Research Articles

Stutterers’ experiences on classic psychedelics: A preliminary self-report study

Stuttering poses challenges to social, occupational, and educational aspects of life. Traditional behavioral therapies can be helpful but effects are often limited. Pharmaceutical treatments have been explored but there are no FDA-approved treatments for stuttering. Interest has grown in the potential use of classic psychedelics, including psilocybin and LSD, which have shown effectiveness in treating disorders with similar symptoms (e.g., anxiety, depression, PTSD). The potential effects of psychedelics on stuttering have not been explored. We conducted a preliminary investigation of self-identified stutterers who report their experiences taking classic psychedelics on the online messaging forum, Reddit. We qualitatively analyzed 114 publicly available posts, extracting meaningful units and assigning descriptor codes inductively. We then deductively organized responses into an established framework of psychedelics which includes behavioral, emotional, cognitive, belief-based, and social effects. These effects were subsequently grouped under organizing themes (positive, negative, neutral). Descriptive statistics revealed that the majority of users (74.0%) reported positive overall short-term effects particularly related to behavioral and emotional change (e.g., reduced stuttering and anxiety), but negative (9.6%), mixed (positive and negative; 4.8%), and neutral overall experiences (11.6%) were also reported. The results support the possibility that psychedelics may impact stuttering, but caution must be applied in their interpretation given the entirely uncontrolled research setting and potential adverse health effects of psychedelics as reported elsewhere. While these results do not encourage the use of psychedelics by stutterers, they suggest that future work could examine the impact of psychedelics on stuttering under supervised and in clinically controlled settings.

Vaccines to Treat Substance Use Disorders: Current Status and Future Directions.

Addiction, particularly in relation to psychostimulants and opioids, persists as a global health crisis with profound social and economic ramifications. Traditional interventions, including medications and behavioral therapies, often encounter limited success due to the chronic and relapsing nature of addictive disorders. Consequently, there is significant interest in the development of innovative therapeutics to counteract the effects of abused substances. In recent years, vaccines have emerged as a novel and promising strategy to tackle addiction. Anti-drug vaccines are designed to stimulate the immune system to produce antibodies that bind to addictive compounds, such as nicotine, cocaine, morphine, methamphetamine, and heroin. These antibodies effectively neutralize the target molecules, preventing them from reaching the brain and eliciting their rewarding effects. By obstructing the rewarding sensations associated with substance use, vaccines aim to reduce cravings and the motivation to engage in drug use. Although anti-drug vaccines hold significant potential, challenges remain in their development and implementation. The reversibility of vaccination and the potential for combining vaccines with other addiction treatments offer promise for improving addiction outcomes. This review provides an overview of anti-drug vaccines, their mechanisms of action, and their potential impact on treatment for substance use disorders. Furthermore, this review summarizes recent advancements in vaccine development for each specific drug, offering insights for the development of more effective and personalized treatments capable of addressing the distinct challenges posed by various abused substances.

Art education on students’ ADHD in the era of self-media

BackgroundStudents cannot concentrate too much in their adolescence. With the popularization of self-media, high school students’ attention is attracted by diverse information, leading to the symptoms of attention deficit hyperactivity disorder (ADHD) appearing or worsening among those students. Art education, as a multimodal discipline, has the potential to assist students in directing their attention and mitigating the symptoms associated with ADHD.Subjects and MethodsThe research encompassed 150 high school students diagnosed with ADHD, meticulously selected as participants. These students were subsequently allocated at random into three distinct groups: Experimental Groups A and B, as well as a Control Group, with each group consisting of 50 participants. The Control Group remained devoid of any specific interventions, while Experimental Group A underwent traditional behavioral therapy. In contrast, Experimental Group B received an augmented approach, involving an art-centric curriculum intertwined with behavioral therapy principles. The evaluation of the intervention’s efficacy was undertaken through established ADHD assessment scales and feedback garnered from teachers.ResultsAfter three months, all groups participating in the treatment showed improvement in ADHD symptoms. Moreover, experimental group B showed significant improvements in attention concentration, impulse control, and social behavior compared to the other two groups. In addition, the academic performance and artistic creativity of experimental group B have also been improved.ConclusionsIn the era of self-media, the role of high school art education takes on a pivotal significance, offering a potent instrument to aid in the concentration of ADHD-afflicted students and improve social skills. The amalgamation of traditional behavioral therapy and art education may provide a more comprehensive and effective treatment plan for this special group.

Psychological development on the positive psychology of autistic students

BackgroundAutism is a neurodevelopmental disorder characterized by social interaction and verbal communication deficits. Students with autism face various psychological difficulties in the college environment, such as social difficulties, emotional fluctuations, and limited cognitive function. This study aims to help autistic students develop their psychology and improve their quality of life.Subjects and MethodsThis study tried to carry out psychological extension training in college sports, and 50 students with autism were set as research objects. Half of the students received psychological extension training in the physical education course, and the other half received traditional behavioral intervention therapy in the physical education course. Both groups of students received one semester of therapeutic training. Results SPSS23.0 software was used for psychological data correlation statistics, P>0.5 indicated strong correlation and P<0.5 indicated medium weak correlation.Results The experimental results showed that after one semester of treatment training, the number of autistic students in the experimental group was reduced to 12. The overall mental state was good, and the cultivation of positive psychology was more effective. At the same time, the average test score was higher. However, the number of students with autism in the control group remained high at about 20, and the P-value was still greater than 0.5.ConclusionsThe psychological development training proposed in this study can provide theoretical and practical guidance for cultivating autistic students’ positive psychology to improve their overall mental health level.

Case Report: Zen meditation-integrated CBT normalized the impaired brain function of a chronic low back pain patient—from the findings of brain blood flow SPECT imaging

Background: Mindfulness meditation for chronic pain is popular globally, but evidence of its efficacy is limited. Moreover, there are no established methods on the objective evaluation of the effectiveness of interventions for chronic pain. In this study, a chronic low back pain patient was treated with traditional Japanese Buddhism meditation-integrated cognitive behavioral therapy and the pre- and post-intervention brain single-photon emission computed tomography (SPECT) images were compared. Case: A 45-year-old man was experiencing continuous back pain after a vehicular accident and experienced insufficient improvement after drug treatment. The patient underwent a 3-month outpatient mindfulness meditation-integrated cognitive behavioral therapy program executed by a multidisciplinary team: physician visits (once a week for 30 min), multidisciplinary medical and meditation education (Zen breath counting meditation and mantra), physiotherapy interventions (twice weekly), occupational therapy interventions (twice weekly), psychiatric occupational therapy interventions (twice weekly), and nutritional interventions (twice weekly). After treatment, the patient reported a decrease in subjective pain overall, based on whether or not a pain attack occurred. Brain SPECT imaging revealed an improvement in excess blood flow from the right temporoparietal junction to the inferior parietal lobe. Conclusions: These findings indicate that Zen meditation is an effective intervention method for chronic pain and SPECT is a useful tool for measuring its effectiveness.

New development trends of “metaverse + psychology” blending virtual and reality

<p align="justify">Metaverse is a hot topic recently, which has aroused widespread concern from all walks of life. The possible impact of the metaverse on the field of psychology includes creating a new field of panoramic learning process by creating an educational metaverse, creating a more scientific and novel teaching model by creating a MOOC metaverse, breaking the “magic circle” to alleviate interpersonal avoidance and promote individual social behavior, fostering individual self-identity by shaping the metaverse cyberpunk culture, improving the effectiveness of school mental health education by building a metaverse psychological experience center, creating a metaverse psychological intervention system based on traditional behavioral therapy to improve the effectiveness of psychological counseling, etc. However, the emerging technology represented by the metaverse is a double-edged sword. It is not only necessary to pay attention to this opportunity to create a perfect world or to create miracles, but also to guard against potential harm to the development of human society.<strong></strong></p>

New development trends of “metaverse + psychology” blending virtual and reality

<p align="justify">Metaverse is a hot topic recently, which has aroused widespread concern from all walks of life. The possible impact of the metaverse on the field of psychology includes creating a new field of panoramic learning process by creating an educational metaverse, creating a more scientific and novel teaching model by creating a MOOC metaverse, breaking the “magic circle” to alleviate interpersonal avoidance and promote individual social behavior, fostering individual self-identity by shaping the metaverse cyberpunk culture, improving the effectiveness of school mental health education by building a metaverse psychological experience center, creating a metaverse psychological intervention system based on traditional behavioral therapy to improve the effectiveness of psychological counseling, etc. However, the emerging technology represented by the metaverse is a double-edged sword. It is not only necessary to pay attention to this opportunity to create a perfect world or to create miracles, but also to guard against potential harm to the development of human society.<strong></strong></p>

Chapter 16 - Noninvasive brain stimulation to augment language therapy for primary progressive aphasia

Primary progressive aphasia (PPA) is a debilitating disorder characterized by the gradual loss of language functioning resulting from neurodegenerative diseases including frontotemporal lobar degeneration or Alzheimer's disease pathology. There is a dearth of research investigating language therapy in PPA. Unlike individuals with poststroke aphasia, language skills are expected to decline over time, so the goal of treatment is often to preserve existing language functioning. There has been an increasing interest in using non-invasive brain stimulation including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) to augment traditional behavioral therapy in PPA. Research is promising and suggests neuromodulation can lead to generalization and maintenance of treatment effects for a longer period compared to behavioral therapy alone. Emerging research is also beginning to identify predictors of treatment response. Yet there is still much to learn regarding how neuromodulation factors (e.g., type of stimulation, stimulation intensity), participant factors (e.g., demographics, extent and location of atrophy), and treatment factors (e.g., type of language therapy, and dosage) will interact to predict treatment response. We are moving toward a promising future where individuals with PPA will benefit from individualized therapy protocols pairing traditional language therapy with neuromodulation.

Effects of consultation for voiding behavior on nocturnal urination status of older adults living alone: A preliminary study.

Nocturia and its related arousal may impair the quality of life and increase the risk of falls in older adults. This study aimed to clarify the change in urination status during the main sleeping period within 1 year. We also aimed to examine the effects of a consultation for voiding behavior in addition to the traditional behavioral therapy on urination status during sleep in a group of independent community-dwelling older adults. A single-arm intervention study was conducted in 10 older adults, with a mean age of 80.1 years and nocturia frequency of 1-4 times/day. Natural changes in urination status were observed between 2016 and 2017. Participants received traditional behavioral therapy and a consultation related to voiding behavior four times from summer 2017 to spring 2018. Urination status was monitored using sensing devices placed in the participant's home. The average time staying in the toilet significantly increased after 1 year. Although this parameter significantly decreased after the first consultation in 2017, this change was not observed with the subsequent consultation. A combination of traditional behavioral therapy and consultation for voiding behavior may be effective in improving urination status during the main sleeping period.

Defining the Neurobiological Mechanisms of Action in Aphasia Therapies: Applying the Rehabilitation Treatment Specification System Framework to Research and Practice in Aphasia

The Rehabilitation Treatment Specification System (RTSS) was developed as a systematic way to describe rehabilitation treatments for the purpose of both research and practice. The RTSS groups treatments by type and describes them by 3 elements: the treatment (1) ingredients and (2) the mechanisms of action that yield changes in the (3) target behavior. Adopting the RTSS has the potential to improve consistency in research, allowing for better cross-study comparisons to strengthen the body of research supporting various treatments. Because it is still early in its development, the RTSS has not yet been widely implemented across different rehabilitation disciplines. In particular, aphasia recovery is one area of rehabilitation that could benefit from a unifying framework. Accordingly, this article is part of a series where we illustrate how the RTSS can be applied to aphasia treatment and research. This article more specifically focuses on examining the neurobiological mechanisms of action associated with experimental aphasia therapies, including brain stimulation and pharmacologic intervention, as well as more traditional behavioral therapy. Key elements of the RTSS are described, and 4 example studies are used to illustrate how the RTSS can be implemented. The benefits of a unifying framework for the future of aphasia treatment research and practice are discussed.

The effectiveness of physical activity interventions on communication and social functioning in autistic children and adolescents: A meta-analysis of controlled trials.

Difficulty with communication and social functioning are two outstanding core symptoms of autism spectrum disorder, while there is no efficacious pharmacologic treatment available to deal with them. Traditional behavioral therapies usually require specialist therapist and be conducted in specific settings, increasing burdens on families and individuals with autism. Physical activity has long been found to promote physical and mental well-beings, and it is more affordable and versatile than traditional therapies. There is preliminary support for the use of physical activity interventions to improve communication and social functioning in individuals with autism. In this study, we quantitatively aggregate data from existing controlled trials to provide an up-to-date inquiry into the effectiveness of physical activity interventions on communication and social functioning in autistic children and adolescents. We included 12 trials involving 350 participants (8 trials reported communication outcomes and 11 trials reported social functioning outcomes) and found small to moderate benefits on communication and social functioning. Further analyses showed that the benefit of physical activity interventions is greater in younger participants. Results of this study suggest that physical activity interventions are effective to improve communication and social functioning in autistic children and adolescents, and early participation in the interventions can be more beneficial. Given their affordability, versatility, and efficacy, physical activity interventions could be considered a cost-effective option for autism spectrum disorder management in the future.

Clinical Implementation of Transcranial Direct Current Stimulation in Aphasia: A Survey of Speech-Language Pathologists.

Purpose The objectives of this study are to (a) identify speech-language pathologists' (SLPs') familiarity with transcranial direct current stimulation (tDCS), (b) quantify what SLPs consider necessary tDCS-related improvement in aphasia severity (i.e., tDCS enhancement; desired improvement above and beyond traditional behavioral therapy) to implement this adjuvant therapy for the clinical management of aphasia, and (c) identify concerns that could potentially hinder the clinical adoption of tDCS. Method A brief (14-question) survey was disseminated via e-mail and social media outlets targeting SLPs working with individuals with aphasia. Results Two hundred twenty-one individuals responded, and 155 valid surveys were analyzed. Seventy-one percent of participants reported familiarity with tDCS prior to taking the survey. Clinicians reported a desired mean enhancement of 22.9% additional points on the Western Aphasia Battery-Revised Aphasia Quotient. Importantly, 94.2% of SLPs reported concerns regarding the implementation of tDCS in clinical settings (i.e., safety, cost, administrative approval, reimbursement and training). Conclusions This is the first study to identify SLPs' perspectives regarding the clinical adoption of tDCS. Results suggest the majority of queried SLPs were familiar with tDCS prior to taking the survey. Although SLPs report a desired improvement of approximately 23% additional points on the Western Aphasia Battery-Revised Aphasia Quotient to consider adopting tDCS into practice, many SLPs reported concerns regarding clinical adoption. Responses from the current survey offer important preliminary evidence to begin bridging the research-to-practice gap as it relates to the clinical implementation of tDCS. Relatedly, these results will inform future clinical trials.

The application of sacral neuromodulation in the treatment of female neurogenic lower urinary tract dysfunction

Trauma, iatrogenic injury, and neurological disorders can lead to neurogenic lower urinary tract dysfunction (NLUTD). However, there are some special causes in women, including radical hysterectomy, mid-urethral suspension, pelvic organ prolapse repair, Fowler syndrome, interstitial cystitis etc. Traditional behavioral therapy, drug treatment and surgeries may work less well in patients with NLUTD and may even lead to progression and deterioration of the diseases. A review of current literatures revealed that there is an increasing evidence on the application of sacral neuromodulation (SNM) in the treatment of NLUTD in female. This review will provide a summary of the known mechanisms of female NLUTD and the effectiveness of SNM. Key words: Electric stimulation therapy; Electrodes, implanted; Lumbosacral plexus; Lower urinary tract symptoms; Female urogenital diseases; Review

Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference.

Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants’ attention and gives users the illusion of “being there” in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high “presence” in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to practice mindfulness based on clinical expert feedback. VR is a technology with potential to increase computerized dissemination of DBT® skills training modules. Future research is warranted.

Les interventions basées sur la pleine conscience dans le trouble obsessionnel compulsif : mécanismes d’action et présentation d’une étude pilote

Obsessive-compulsive disorder (OCD) is a frequent and severe disease, potentially inducing a major impairment for the patient and burden for their family. Recent research in psychiatry and neuroscience have led to better comprehension of the disease's mechanisms and helped to improve its treatment. However, a large proportion of patients have refractory symptoms, including for traditional cognitive and behavioral therapy by exposure and response prevention (ERP), leading clinicians to look for new treatments. Mindfulness-based interventions (MBI) are a new type of approach, initially based on Buddhist meditation, which aims to provide better consciousness of the present moment. It has been successfully developed in some psychiatric diseases and other general medical conditions such as chronic pain. The two main programs using mindfulness meditation, Mindfulness-based stress reduction (MBSR) and Mindfulness-based cognitive therapy (MBCT), have shown effectiveness for the reduction of depressive and anxiety symptoms and relapses of depressive episodes in unipolar depression. It has no side effects and is well tolerated by patients. Its action relies on the specific correction of cognitive deficits in attention, emotion regulation and executive functions which are shared by OCD, GAD and depression. For OCD, we make the hypothesis that Mindfulness-Based Interventions could reduce the cognitive bias specifically existing in this pathology, such as dysfunctional beliefs, and therefore improve the symptoms. This article first reviews the existing literature on clinical trials involving Mindfulness-Based Interventions in OCD which comprises a small number of clinical studies based on very different types of protocols. At this time, and due to the lack of gold-standard studies with a large number of patients, no proof of the efficiency of mindfulness-based interventions in OCD has been shown. In a second section, following our hypothesis on the mechanisms of specific and non-specific action of this therapy in OCD, we propose a cognitive model of mindfulness-based therapy action in OCD involving the correction of OCD's cognitive bias. In this model, mindfulness-based therapy is supposed to treat specifically the cognitive aspects of the disease, while ERP is focused on its behavioral part. Then we present a clinical study aiming to prove the feasibility and the interest of the use of mindfulness in OCD, carried out in two different clinical centers. One of them used MBCT while the second used MBSR. Its results show the feasibility of mindfulness-based therapy in OCD patients and tend to prove that it could be more effective in young patients suffering from less severe forms of OCD. In parallel, attention tests and fMRI scans were done at the beginning and at the end of the therapy. Their results will be published separately. We also discuss the putative role of a specific form of MBCT adapted for OCD, specifically for its benefits in psychoeducation, which could reduce the dysfunctional beliefs present in OCD patients. Finally, we propose a therapeutic strategy in which the MBCT could complement the classical ERP therapy, as a “maintenance” treatment, aiming to extend the relapse of OCD symptoms. This article is a step further in the use of mindfulness-based therapy for OCD which could be added to the existing treatments reducing the patient's symptoms and improving their quality of life.

A randomized trial testing the efficacy of a novel approach to weight loss among men with overweight and obesity.

ObjectiveTo test the efficacy of a weight loss intervention designed to appeal to men.Design and methodsA randomized trial tested the efficacy of the REFIT (Rethinking Eating and FITness) weight loss program compared to a waitlist control. The six-month intervention was delivered via two face-to-face sessions followed by Internet contacts. REFIT encouraged participants to create calorie deficits by making six 100-calorie changes to their eating daily while increasing physical activity and the program encouraged customization through selection of specific diet strategies evaluated each week.ResultsParticipants (N=107, 44.2 years, 31.4 kg/m2, 76.6% white) were randomized into the study and 90.6% provided data at six months. REFIT participants lost -5.0 kg (95% CI: -6.1, -3.9) at three months, which was maintained through six months (-5.3 kg, 95% CI: -6.5, -4.2); this was greater than the control group (p<0.001; 6-month: -0.6, 95% CI: -1.8, 0.5). More REFIT participants (49%) achieved a 5% weight loss than control participants (19%; OR 9.4; 95% CI: 3.2, 27.4). An average of 11.2 (±2.7) of 13 of the online intervention contacts were completed.ConclusionsThe novel REFIT intervention produced clinically significant weight losses. This approach holds promise as an alternative to traditional behavioral therapy for men.

Book Review for Jon Frew and Michael D. Spiegler Contemporary Psychotherapies for a Diverse World (first Revised Edition)

In this hefty textbook, running to over 600 pages after its first revision, Frew and Spiegler have managed to produce an excellent resource for students and practitioners curious about contemporary psychotherapy and counselling as they are practised in the USA. Aimed at graduate students in North America, the text comprises elucidations of the histories, theories and practices of 11 new and renewed approaches within contemporary psychotherapy. The approaches are listed according to the chronology of their historical development, respectively: psychoanalytic therapy, Adlerian therapy, existential therapy, person-centered therapy, gestalt therapy, behaviourism (which gets two chapters: ‘Traditional Behaviour Therapy’ and ‘Cognitive-behavioural Therapy’), reality therapy, feminist therapy, family therapy, and narrative therapy. This approach to organising the material provides a clear sense of the evolutions and revolutions in therapy in North America across the twentieth and twenty-first centuries. But it is not without contention.

Riding the waves: A functional-cognitive perspective on the relations among behaviour therapy, cognitive behaviour therapy and acceptance and commitment therapy.

Different types of therapy explain psychopathology and the effects of psychotherapy differently. Different explanations are, however, not necessarily mutually exclusive. Based on the idea that functional and cognitive explanations are situated at different levels, we argue that functional therapies such as traditional Behaviour Therapy (BT) and Acceptance and Commitment Therapy (ACT) are not necessarily incompatible with Cognitive Behaviour Therapy (CBT). Whether a functional and a cognitive therapy actually align depends on whether they highlight the same type of environmental causes. This functional-cognitive perspective reveals various differences and communalities among BT, CBT and ACT.

Effects of an Organizational Linkage Intervention on Inter-Organizational Service Coordination Between Probation/Parole Agencies and Community Treatment Providers.

Weak coordination between community correctional agencies and community-based treatment providers is a major barrier to diffusion of medication-assisted treatment (MAT)--the inclusion of medications (e.g., methadone and buprenorphine) in combination with traditional counseling and behavioral therapies to treat substance use disorders. In a multisite cluster randomized trial, experimental sites (j = 10) received a 3-h MAT training plus a 12-month linkage intervention; control sites (j = 10) received the 3-h training alone. Hierarchical linear models showed that the intervention resulted in significant improvements in perceptions of interagency coordination among treatment providers, but not probation/parole agents. Implications for policy and practice are discussed.

Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review.

In 2011, the Centers for Medicare & Medicaid Services (CMS) approved intensive behavioral weight loss counseling for approximately 14 face-to-face, 10- to 15-minute sessions over 6 months for obese beneficiaries in primary care settings, when delivered by physicians and other CMS-defined primary care practitioners. To conduct a systematic review of behavioral counseling for overweight and obese patients recruited from primary care, as delivered by primary care practitioners working alone or with trained interventionists (eg, medical assistants, registered dietitians), or by trained interventionists working independently. We searched PubMed, CINAHL, and EMBASE for randomized controlled trials published between January 1980 and June 2014 that recruited overweight and obese patients from primary care; provided behavioral counseling (ie, diet, exercise, and behavioral therapy) for at least 3 months, with at least 6 months of postrandomization follow-up; included at least 15 participants per treatment group and objectively measured weights; and had a comparator, an intention-to-treat analysis, and attrition of less than 30% at 1 year or less than 40% at longer follow-up. Review of 3304 abstracts yielded 12 trials, involving 3893 participants, that met inclusion-exclusion criteria and prespecified quality ratings. No studies were found in which primary care practitioners delivered counseling that followed the CMS guidelines. Mean 6-month weight changes from baseline in the intervention groups ranged from a loss of 0.3 kg to 6.6 kg. In the control group, mean change ranged from a gain of 0.9 kg to a loss of 2.0 kg. Weight loss in both groups generally declined with longer follow-up (12-24 months). Interventions that prescribed both reduced energy intake (eg, ≥ 500 kcal/d) and increased physical activity (eg, ≥150 minutes a week of walking), with traditional behavioral therapy, generally produced larger weight loss than interventions without all 3 specific components. In the former trials, more treatment sessions, delivered in person or by telephone by trained interventionists, were associated with greater mean weight loss and likelihood of patients losing 5% or more of baseline weight. Intensive behavioral counseling can induce clinically meaningful weight loss, but there is little research on primary care practitioners providing such care. The present findings suggest that a range of trained interventionists, who deliver counseling in person or by telephone, could be considered for treating overweight or obesity in patients encountered in primary care settings.