Behavioral Treatment Research Articles

Grocery intervention and DNA-based assessment to improve diet quality in pediatric obesity: a pilot randomized controlled study.

We assessed the impact of a food-provisioning intervention on diet quality in children with obesity. Participants (n = 33, aged 6-11 years) were randomly assigned to either usual care (intensive health behavior and lifestyle treatment) or intervention (usual care + food provisioning; high-fiber, low-dairy diet) for 4 weeks. The primary outcome was a change in child diet quality at Week 4. Secondary outcomes were changes in weight, food insecurity, gut microbiome composition (16S ribosomal RNA), and dietary intake, measured via an objective DNA-based biomarker (i.e., FoodSeq). Genomic dietary data were analyzed against a larger pediatric adolescent obesity cohort (n = 195, aged 10-18 years) from similar households. Intervention demonstrated changes across all assessed diet components and was more effective than usual care in increasing whole grain (β = 0.20, 95% CI: 0.05 to 0.34; p = 0.013) and fiber (β = 2.52, 95% CI: 1.28 to 3.76; p < 0.001) and decreasing dairy (β = -1.31, 95% CI: -2.02 to -0.60; p = 0.001). FoodSeq results, highly concordant with grocery orders (adjusted R2 = 0.65; p < 0.001), indicated a dietary shift toward low-energy-density plant taxa in the intervention relative to a prior survey of diet in a related cohort (β = 8.64, 95% CI: 5.18 to 12.14; p < 0.001). No significant changes were observed in microbiome, weight, or food insecurity. Our study supports the potential of dietitian-guided food provisioning for improving diet quality in children with obesity and demonstrates an objective genomic approach for evaluating dietary shifts.

Metformin attenuated depressive-like behaviors by suppressing TRPV1/NLRP3 mediated neuroinflammation in the hypothalamus of allergic rhinitis mice.

In addition to nasal symptoms, allergic rhinitis (AR) has increasingly been reported to be associated with depression-like behaviors. Recent evidence suggests that neuroinflammation in the hypothalamus may cause these depressive symptoms in AR. However, the precise mechanisms and effective treatments remain to be elucidated. This study investigated the ameliorative effects of metformin on neuroinflammation in the hypothalamus, depressive-like behavior and the underlying molecular mechanisms of AR mice. Mice were administered ovalbumin (OVA) intranasally to induce allergic rhinitis and subsequently subjected to behavioral experiments to detect depressive-like behavior. The roles of the TRPV1/NLRP3 pathway in depression-like behaviors in AR were examined in vivo. Additionally, the mechanism of TRPV1/NLRP3-mediated neuroinflammation was investigated in vitro. Finally, metformin was utilized to explore its possible mechanisms and efficacy in treating depressive-like behavior in AR. AR mice exhibited significant depressive-like behavior, which was attenuated by metformin. The number of Iba-1+ microglia significantly increased in the hypothalamus of AR mice. The expression of NLRP3 was significantly upregulated in the hypothalamus, activating microglia. Metformin ameliorated the neuropsychiatric symptoms by reducing NLRP3 expression in the hypothalamus. Moreover, metformin inhibited LPS-induced upregulation of the TRPV1/NLRP3 signaling pathway in microglial cell line, an effect that can be reversed by the TRPV1-specific agonist capsaicin. Increased TRPV1 expression activates the NLRP3 inflammasome in hypothalamic microglia, promoting the pathological process of depressive-like behavior in AR mice. Metformin could effectively treat neuroinflammation by regulating microglia via TRPV1 downregulation, indicating its potential as a treatment for depressive-like behaviors in AR.

Australian Naturopaths Approach to the Clinical Management of Patients Presenting with Sleep Disorders.

Objective: Naturopathic practitioners consult an estimated 6.2% of Australian adults, equating to 1,550,000 people receiving their care each year. Sleep is now recognized as a key pillar of health; however, nearly half of all Australian adults report inadequate sleep. Evidence suggests that many Australians consult naturopaths (NPs) for sleep-related problems and use complementary medicines (CMs) to manage these. However, NPs' clinical approach to caring for people living with sleep disorders has not been reported. Therefore, the aim of this study was to describe and understand the clinical assessment and treatment approaches used by NPs in their care of people living with sleep disorders. Materials and Methods: A cross-sectional online survey with a purposively sought sample. NPs were recruited via the practitioner research-based network. The participants received an email invitation containing a link to the survey along with a Participant Information Sheet. The online survey (Research Electronic Data Capture-see Supplementary Data S1) comprised multiple-choice, binary (yes/no) questions, or 5-point Likert scale-type questions structured across four sections related to: clinical assessment of patients, treatments used, interprofessional communication with conventional doctors, and demographics. Results: Sixty-seven complete data sets were analyzed. Most survey participants treated-one to three patients with sleep disorders weekly, being consulted primarily for insomnia (82%) and its treatment (98.5%). Comprehensive sleep health histories were commonly assessed. Additionally, 69% of participants reported that patients sought their services to complement conventional care. The most frequently used complementary medicine (CM) approaches included sleep hygiene counseling (75%) and meditation (64.7%). Vitamins, minerals, herbal medicines, and nutritional supplements were the most recommended CM medicines (92.6%). Referrals to conventional medicine professionals were minimal. Conclusion: Australian NPs are frequently consulted by people living with sleep disorders who are also using conventional medicines. Our study highlights the need for integrated models of health care tailored to patient needs that maximize potential benefits and reduce any harms associated with drug-CMs interactions. The provision of training to the Australian health care workforce of NPs that focuses on evidence-based behavioral treatments can improve access to these treatments for patients.

Preliminary feasibility and efficacy of a brief behavioural treatment for insomnia after acquired brain injury: A case series.

Insomnia after acquired brain injury (ABI) is common and can negatively impact an individual's rehabilitation, recovery, and quality of life. The present study investigated the feasibility and preliminary efficacy of a Brief Behavioural Treatment for Insomnia (BBTI) in a community sample following ABI. Ten participants were recruited. Seven participants attended four weekly sessions of BBTI and kept a daily sleep diary. Participants completed a semi-structured sleep interview at baseline and self-report measures of sleep, anxiety, and depression pre- and post-treatment as well as a treatment acceptability questionnaire post-treatment. Follow-up data were collected at 1-, 2-, and 3-months post-treatment. Visual analyses of the data were performed on a case-by-case basis. Five of the seven participants (71%) no longer met the criteria for insomnia disorder on the Sleep Condition Indicator (SCI) post-treatment. Treatment effects on sleep outcomes were either maintained or augmented at follow-ups. BBTI was found to be well tolerated, as evidenced by the high overall retention rates (70%) and positive feedback on the treatment acceptability questionnaire. These results provide preliminary evidence of BBTI being both feasible to use and potentially efficacious in individuals with post-brain-injury insomnia. Larger-scale randomised controlled trials are needed to establish the effectiveness of BBTI following ABI.

Assessing Theoretical Considerations of Effects Within a Behavioural Obesity Treatment in Women: Implications for Medical Professional Referral.

Obesity is an increasing medical issue not responding well to behavioural treatments beyond their initial weeks/months. Before suggesting surgical or pharmacological interventions, medical professionals might consider referrals to cost-effective, community-based behavioural treatments if stronger theoretical/empirical bases were demonstrated. Thus, evaluation of such is warranted. Women with obesity were randomly assigned to 6-month treatments emphasizing either behavioural theory-based methods focused on exercise-associated psychological changes generalizing to dietary changes (n = 101), or typical instruction in weight-control methods (n = 53). Theory-driven psychosocial, behavioural and weight changes were assessed over 12 months. Improvements in all measured variables were significantly greater in the behavioural theory group. In the evaluation of hypothesized theory-based relationships-which have overarching bases in social cognitive theory-(1) self-efficacy theory was supported by self-regulation-associated increases in self-efficacy predicting later positive changes in exercise and the diet; (2) coaction theory was reinforced by the identified transfer of changes in self-regulation of exercise to self-regulation of eating; (3) the mood-behaviour model was sustained by improved mood predicting exercise and dietary improvements through (mediated by) self-regulation changes; (4) self-regulation theory was bolstered through early improvements in self-regulation supporting its longer-term increase, especially under conditions of self-regulatory skills practice and (5) operant conditioning theory was supported through results indicating a reinforcing effect from exercise-associated mood improvement to reduced emotional eating. Across the theories, relationships among tested variables were generally stronger in the behavioural theory group. Improvements in exercise and dietary behaviours were significant independent predictors of reduced weight. Findings support the addressed behavioural theories within a community-based obesity treatment model that emphasized exercise for its psychosocial impacts on dietary behaviours and sustained weight loss. Based on the present empirical supports, medical professionals should consider referral to such approaches before (or in combination with) surgical or pharmacological methods.

The Longitudinal-Experimental Design and the Development and Prevention of Criminal Offending Over the Life-Course: Advances in Science and Policy From the Cambridge-Somerville Youth Study.

David Farrington (1944-2024) wrote extensively about the methodological rigour and utility of the longitudinal-experimental research design to advance knowledge about the development, explanation, prevention and treatment of antisocial behaviour and criminal offending over the life-course. Founded in 1935, the Cambridge-Somerville Youth Study (CSYS) is recognised as the first randomised controlled trial in criminology and the first longitudinal-experimental study in criminology. To report on key scientific and policy contributions made by the CSYS in investigating the development and prevention of delinquency and criminal offending over the life-course. Uses previously analysed observational and experimental data from follow-ups of study participants conducted in middle age (N=494; mean=47years) and old age (N=488; 84-92years). Identified several parental socialisation practices and interactions during childhood (but not father absence) as strongly associated with serious criminal offending in middle age. Support for peer deviancy as a causal mechanism for iatrogenic effects among treatment groups, compared to pair-matched controls, during middle age drew policy attention to group-based prevention interventions. The longitudinal-experimental design is a highly important yet under-utilised methodological approach in criminology. Future research should include revisiting the original plan for the design, addressing a key potential concern of the design and carrying out longer follow-ups at key stages of the life-course.

Pain Catastrophizing and Substance Misuse: A Scoping Review of the Literature

Abstract Background Pain catastrophizing, or the interpretation of pain as unbearable or intolerable, can increase pain-related anxiety and severity. High levels of pain catastrophizing have also been linked to substance use, particularly for substances with analgesic properties. Importantly, behavioral treatments can reduce pain catastrophizing, making them promising interventions for mitigating pain-related substance use. The aim of this scoping review is to summarize literature investigating the relationship between pain catastrophizing and substance use in adults. Methods We performed a scoping review of peer-reviewed literature. Included articles had both a measurement of pain catastrophizing and substance use, and reported analyses characterizing the relationship between the two. Results Of the 341 abstracts identified, 47 articles met eligibility criteria. Most studies focused on people with chronic pain. Some studies also considered samples with substance use disorders (with and without chronic pain) or acute pain, and general population samples. There was generally a positive association between pain catastrophizing and substance misuse; this association was consistent across multiple samples and substances. Most studies were cross-sectional, although associations were also detected in longitudinal studies. The magnitude of associations tended to be stronger for higher severity substance use and more proximal tests of association. More longitudinal and experimental studies are needed, however, to better delineate these effects. Discussion Findings indicate a consistent positive association between pain catastrophizing and substance use, highlighting the potential for interventions targeting pain catastrophizing to reduce negative substance-related consequences.

The Relationship between the Therapeutic Alliance and Social Anxiety Symptoms Along the Course of Internet-delivered Cognitive Behavior Treatment

The Relationship between the Therapeutic Alliance and Social Anxiety Symptoms Along the Course of Internet-delivered Cognitive Behavior Treatment

The Effectiveness of an Imagery-Based Behavioral Activation Intervention for Depressive Symptoms

Background: Behavioral activation treatment (BAT) is an evidence-based treatment for depression. However, depressive symptoms can make it difficult to engage in activities crucial for the success of behavioral activation. Mental imagery may assist with activity engagement. This study examined the effectiveness of imagery-based BAT (BAT-I) compared to standard BAT in reducing depressive symptoms and improving behavioral activation, activity anticipation, activity motivation, and activity completion rates.Methods: Thirty adults with moderate to severe depressive symptoms were randomly assigned to either the BAT-I or BAT groups. The participants received eight sessions of twice-weekly BAT intervention, with an additional four-eight mental imagery sessions provided for the BAT-I group.Results: Repeated measures analysis of variance indicated that participants in both groups showed reductions in depressive symptoms and improvements in behavioral activation, activity anticipation, and activity motivation. However, the BAT-I group demonstrated significantly higher activity motivation (6.1＞ 5.1) and activity completion rates (93.17%＞66.18%) than the BAT group.Conclusions: While use of imagery appears to support activity engagement, further research is needed to explore how imagery can be utilized to enhance the BAT effectiveness.

IMPACT OF COMMUNITY TYPE ON SLEEP HEALTH DISPARITIES IN GRANDPARENTS RAISING GRANDCHILDREN

Abstract Grandparents raising grandchildren (GRG) report greater sleep problems than non-caregiving peers. Individuals living in low-income urban areas also report difficulty sleeping due to increased noise, light, and unsafe neighborhoods. However, no studies have examined urbanity’s impact on sleep among GRG and this study fills that gap. Grandparents living in rural (N=50, Mage=56.80), urban (N=59, Mage=53.07), and suburban areas (N=74, Mage=56.03) caring for their grandchild (&amp;gt;17 years old) completed the Pittsburg Sleep Quality Index (PSQI-sleep latency, sleep duration, sleep efficiency, sleep medication, sleep disturbances, and global sleep scales) and indicated their community type (rural, urban, suburban). Two-way ANOVAs evaluated interactions (sleep x community) and main effects. Pairwise comparisons clarified significant differences. Interactions were not significant. There was a significant main effect (p=.047) of community on sleep medication use, sleep disturbances (p=.009), and global sleep problems (p=.012). Urban grandparents reported more sleep medication (M=1.58+\-1.20) than rural (M=1.06+\-1.27; p=.046) or suburban grandparents (M=1.07+\-1.26; p=.026). Urban grandparents reported more sleep disturbance (M=1.63+\-.64) than rural (M=1.25+\-.55; p&amp;lt;.001) or suburban grandparents (M=1.44+\-.53; p=.080). Urban grandparents reported more global sleep problems (M=10.61+\-3.17) than rural (M=8.28+\-3.43; p=.010) or suburban grandparents (M=8.61+\-2.87; p=.010). Results suggest that level of urbanity impacts sleep health disparities among GRG and urban GRG may be at greater risk for sleep problems. More research (e.g., longitudinal) should examine what contributes to increased sleep problems among urban GRG, but these results suggest that behavioral sleep treatment programs should potentially target environmental and socioeconomic factors unique to urban GRG (e.g., increased noise, decreased safety and security, etc.).

Factors Influencing the Attitudes of Substance Use Disorders: A Review from Patients and Health Care Providers Perspectives

Substance use disorder (SUD) is a long-term uncontrolled use of harmful substances such as illegal drugs, prescription drugs, alcohol and tobacco. Despite growing treatment options, SUD remains a public health challenge. This review explores factors of attitudes and cognition that affect both the SUD patient and therapist perspectives. The review mainly focuses on the role of cognition, stigma, implicit cognitive attitude and general explicit attitude. From patients’ perspective, the perception and awareness of having the disorder as well as the self-stigma to SUD significantly shape their attitude and willingness to seek help and treatments. Implicit attitudes unconsciously influence patients' overall attitudes toward substance use behaviors and substance use behavior treatment, as well as subsequent behaviors. For health care providers, stigma, lack of expertise and training in SUD can lead to negative attitudes and inadequate treatment of SUD patients. This may reduce the effectiveness of patient treatment and the likelihood of recovery. This review emphasizes to recognize the limitations of different studies and encourage next steps for improvement. Limitations of different studies including over-reliance on self-reporting, and lack of long-term studies can be improved by adding more follow-up studies on different aspects to update the data and further validate the research on the impact of different attitudes. This review also encourages to increase and popularize the knowledge of SUD, to increase the training of healthcare professionals on SUD to change and influence the attitudes of patients and healthcare professionals.

Effectiveness of digital modified behavioral activation treatment program for rural older adults with depressive symptoms in Western Hunan: study protocol for a multi-center randomized controlled trial.

Rural older adults experience a high burden of depressive symptoms and significant barriers to accessing mental health services. The Modified Behavioral Activation Treatment (MBAT) has been verified to be effective among rural older adults in China. Due to its structured format and skill-based learning, it is well suited for digital-based delivery. However, only a few studies were from developed countries, and the evidence to support its application in rural China still needs to be provided. Thus, based on the fact that digital health technology has the potential to address the shortage of healthcare resources and the constraints of community mental health services in rural China, the effectiveness of the digital MBAT (D-MBAT) program among rural older adults is worth further evaluation. A multi-center randomized controlled trial will be conducted among 216 rural older adults from Huayuan County and Fenghuang County in Western Hunan. The intervention group will receive the D-MBAT program, while the control group will receive routine care. Depressive and anxiety symptoms, social health, quality of life, and satisfaction will be measured at baseline, one-month, and three-month follow-ups to evaluate the digital MBAT program's effectiveness. Existing digital psychological intervention strategies seldom take into account the needs and preferences of the older adults in low-resource rural areas. Thus, this study aims to develop a D-MBAT program based on person-centered and community-engaged approach to maximize the mental health service of rural older adults with depressive symptoms.A successful D-MBAT program would be a feasible and scalable approach to the management of prevalent mental health conditions of rural older adults in resource-limited Western Hunan. Chinese Clinical Trial Registry ChiCTR2400091193. Registered on 23 October 2024.

A Comprehensive Literature Review of Histopathology of Squamous Cell Carcinoma

Background: The literature on the histopathology of squamous cell carcinoma (SCC), particularly cutaneous squamous cell carcinoma (cSCC), has evolved significantly over the past decade, revealing a complex interplay of histopathologic features, molecular markers, and clinical outcomes. Literature Review: The work by (K. El-Mofty, 2014) explores histopathologic risk factors associated with oral and oropharyngeal SCC variants, particularly those related to HPV. The identification of distinct morphological characteristics shared among keratinizing neoplasms is essential for accurate diagnosis and treatment planning. The article highlights the unique behaviors of HPV-related variants, which may exhibit either favorable prognoses or aggressive metastatic potential, thus necessitating careful evaluation. The role of immunohistochemical markers in the diagnosis and staging of cSCC is further elaborated by (Bălășescu et al., 2022), who identify key characteristics that predict disease progression. Their findings suggest that immunohistochemical markers can enhance diagnostic accuracy, particularly in poorly differentiated cases, thereby informing treatment strategies. Finally, (Gabriel Cocuz et al., 2022) provide a scientometric analysis of current research directions, highlighting the sustained interest in histopathology and immunohistochemistry of cSCC. Their work suggests an ongoing recognition of the importance of personalized diagnostics and targeted therapies to improve patient outcomes. Conclusion: In conclusion, the reviewed literature underscores the complexity of cSCC histopathology and the critical need for accurate diagnosis and staging. The integration of histopathological features with molecular markers and the continual evolution of diagnostic techniques are essential for refining our understanding of SCC behavior and enhancing treatment efficacy. Ongoing research is necessary to address existing challenges and optimize patient management strategies.

One is Good, but are Two Really Better? Outcomes for Dual versus Individual Attendees in a Behavioral Parent-Training Program for Caregivers of Young Children

ABSTRACT Background The Helping Our Toddlers, Developing Our Children’s Skills (HOT DOCS) BPMT program utilizes positive behavior support principles to help caregivers of children birth-5 years address early childhood disruptive behaviors and common developmental challenges experienced by many young children. Objective The present study examined whether there were differences in child outcomes, attendance rates, homework completion rates, levels of caregiver stress, and treatment satisfaction for individual versus dual caregiver participation in the HOT DOCS BPMT. Method Using a quasi-experimental design, caregivers of children ages 0–5 years were assigned to two non-equivalent groups: individual attendee (n = 141) and dual attendee (n = 123). Independent samples t-tests were utilized to compare means between individual and dual attendee groups for number of sessions attended and homework completion. Paired samples t-tests were calculated to compare means between individual and dual attendee groups on HOT DOCS program outcomes, including child behavior, parenting stress, and treatment satisfaction. Results There were no significant differences in outcomes between individual and dual attendee groups. Child behavior outcomes, parenting stress, treatment satisfaction, attendance, and homework completion were similar across both groups. Conclusions Individual caregiver engagement in the HOT DOCS BPMT program might be sufficiently potent to result in desirable outcomes. Future directions should include examining family structure and treatment modality on BPMT outcomes, maintenance of intervention gains, and perceived child behavior outcomes of BPMT non-attending caregivers.

Effects of maternal separation on punishment-driven risky decision making in adolescence and adulthood.

Early life adversity (ELA) is associated with a multitude of neural and behavioral aberrations. To develop treatments to mitigate the effects of ELA, it is critical to determine which aspects of cognition are affected and when these disturbances manifest across the lifespan. Here, we tested the effects of maternal separation, an established rodent model of ELA, on punishment-driven risky decision-making longitudinally in both adolescence (25-55days old) and adulthood (80-100days old). Risk-taking was assessed with the Risky Decision-making Task, wherein rats choose between a small, safe reward and a large reward accompanied by an escalating risk of punishment (foot shock). We observed that rats exposed to maternal separation were more prone to risk-taking than controls during adolescence, and demonstrated reduced latency to make both risky and safe decisions. Interestingly, this augmented risk-taking was no longer evident in adulthood. Males and females displayed comparable levels of risk-taking during adolescence then diverged in adulthood, with adult males displaying a sharp increase in risk-taking. Finally, we observed that risk-taking changed across the lifespan in rats exposed to maternal separation, but not in control rats. Collectively, these data reveal that ELA engenders risk-taking in adolescence but not adulthood, and that sex differences in risky decision-making are not evident until adulthood. This has important implications for the development of both behavioral and biological treatments to improve decision-making during the vulnerable adolescent period.

Psychotherapeutic Interventions for Depressive Symptoms in Community-Dwelling Older Adults: A Systematic Review with Meta-Analysis.

This review investigates psychotherapeutic interventions for reducing depressive symptoms in older adults in a community setting. RCTs were assessed using Joanna Briggs Institute tools. The following databases were searched: CINAHL Plus with Full Text, MedicLatina, MEDLINE with Full Text, and the Psychology and Behavioral Sciences Collection. A meta-analysis of 13 studies with 1528 participants showed a medium, significant pooled effect size at post-intervention (Hedges' g = -0.36, p < 0.001) and substantial heterogeneity. Follow-up analysis of studies indicated a small, non-significant effect (Hedges' g = -0.17, p = 0.27). Group interventions, particularly the "reminiscence protocol", had the largest significant effect. This systematic review and meta-analysis found that in community-dwelling older adults' group psychotherapeutic interventions, particularly the "reminiscence protocol" and "modified behavioral activation treatment" are most effective for reducing depressive symptoms. Individual psychotherapeutic interventions like "prevention of suicide in primary care elderly" and "behavioral activation" also show effectiveness, with group psychotherapeutic interventions being generally more effective than when these treatments are offered in individual psychotherapeutic interventions. Group and individual psychotherapeutic interventions reduce depressive symptoms in community-dwelling older adults, with group psychotherapeutic interventions being more effective.

Toward improved understanding and treatment of self-injurious behaviors in autistic individuals with profound intellectual disability.

Self-injurious behaviors (SIB) commonly occur in autism spectrum disorder (ASD) and span diverse topographies of self-inflicted behaviors ranging from head banging to hitting oneself against hard objects. Despite the high rates of SIB in autistic individuals, relatively little research has focused on psychological factors associated with the development and maintenance of SIB in individuals with autism and moderate-profound intellectual disability (ID). This commentary synthesizes existing literature on SIB and highlights the need for more research focused on psychological correlates and mechanisms in autistic individuals with moderate-profound ID. We highlight the key role of difficulties in emotion regulation (ER)and co-occurring internalizing symptoms in the manifestation of self-harm behaviors in clinical samples and autism. Furthermore, this commentary proposes a framework for understanding the interplay between poor ER and internalizing symptoms in the development and maintenance of SIB in autistic individuals with moderate-profound ID. Specifically, we explore the emergence of SIB in the context of precipitating cues that trigger strong emotions, ER processes and strategy deployment, and co-occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed.

Behavioral symptoms and treatment challenges for patients living with dementia: Hospice clinician and caregiver perspectives.

Dementia affects one in three older adults over age 85 and individuals with dementia constitute the fastest growing population of patients entering hospice care. While cognitive impairment is the hallmark of dementia, behavioral symptoms are reported in nearly all patients with advanced dementia, contributing to both the complexity of end-of-life care and caregiver burden. This qualitative study involved semi-structured interviews with prescribing hospice clinicians and caregivers of patients living with dementia who previously received hospice services. Interviews included questions regarding common behavioral symptoms observed at end of life, side effects of benzodiazepine and antipsychotic medications, perceived effectiveness of medications used, and non-pharmacologic treatment strategies. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major themes. A total of 23 hospice clinicians and 20 family caregivers participated in interviews. Agitation, including physical and verbal aggression, irritability, and anger, was identified as the most concerning behavioral symptom of dementia at end of life; when discussing agitation, clinicians focused on the safety of the patient living with dementia and others, while caregivers were concerned because they perceived it as a change in personality of their loved one. When using antipsychotics and benzodiazepines to address behavioral symptoms, caregivers viewed sedation as a concerning side effect, while clinicians were less concerned and noted this as an anticipated outcome of treatment. Overall, family caregivers perceived medications as more effective than clinicians. Finally, non-pharmacologic interventions are generally preferred over pharmacologic treatments, but were reported as difficult to implement. Study findings can help to inform dialogue between hospice clinicians and caregivers regarding anticipated behavioral changes, as well as risks, benefits, and limitations of medication treatment options for behavioral symptom management. Further work is needed to understand the appropriate level of use of psychotropic medications for end-of-life dementia care.

Behavioral Weight Loss Treatment Promotes Weight Loss by Increasing Eating Disorder Symptoms: A Response to Grilo & Pittman (2024).

We provide commentary on the Grilo and Pittman (2024). Exploring Dietary Restraint as a Mediator of Behavioral and Cognitive-Behavioral Treatments on Outcomes for Patients With Binge-Eating Disorder With Obesity article published in the International Journal of Eating Disorders. Grilo and Pittman show that weight loss in the Behavioral Weight Loss Treatment condition is mediated by an increase in rigid restraint, whereas binge eating is not mediated by rigid restraint. They conclude that this result is a positive outcome for patients with binge-eating disorder and shows that BWL is not harmful in this population. We argue that increasing rigid restraint equates to increasing eating disorder symptoms and is harmful in any population, but specifically in those with an already diagnosed eating disorder. In addition, we point out the major limitations of no follow-up data in the mediation report, no measurement of additional eating disorder symptoms that could represent diagnostic migration, and lack of inclusion of weight stigma as additional problems with the stated conclusions. We recommend that the field moves away from measurement of weight loss as an outcome in those with eating disorders and carefully consider what it means to increase restraint/restriction in eating disorder populations.

Third-Generation Therapies for the Management of Psychoactive Substance Use in Young People: Scoping Review.

Third-generation therapies (TGTs) have been shown to be effective in the treatment of substance use behaviors in college-aged adolescents. These therapies are based on acceptance, mindfulness and psychological flexibility, which enable young people to change their Psychoactive Substance Use (PSU)-related behaviours, develop coping skills to manage difficult emotions and thoughts, reduce experiential avoidance and maintain long-term abstinence. To explore the implementation and potential benefits of third-generation therapies, Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT) and Mindfulness, for the treatment of PSU in college youth. This review includes articles within a 5-year window. A scoping, observational and retrospective review was conducted using the PRISMA method in SCOPUS, PUBMED and Web of Science. eight studies were found, six based on mindfulness, one on dialectical behaviour therapy and one on acceptance and commitment therapy. The results of the studies are promising and emerging for the intervention of the problem. The interventions used show evidence of reducing PSU and other mental health problems such as anxiety, depression and post-traumatic stress. In addition, they allowed patients to increase their well-being and mindfulness.