Use Of Psychological Therapies Research Articles

Learning to cope with the reality of endometriosis: A mixed-methods analysis of psychological therapy in women with endometriosis.

Despite the need and uptake of mental health support by women with endometriosis, no research to date has explored their experience of psychological therapy. We aimed to understand the factors that predict engagement in psychological therapy by Australian women with endometriosis and to qualitative explore their experience of psychological support. Mixed-methods design. A total of 200 women with self-reported endometriosis were recruited from the community. We explored; (1) the demographic and clinical predictors of engagement in psychological therapy, (2) the psychological approaches that seem most valuable to women in the management of endometriosis and (3) their experience engaging in psychological therapy for endometriosis. Nearly half of women reported to have seen a psychologist within the past year, particularly for pain. Younger age (OR, .94; 95% CI, .886-.993), depressive symptoms (OR, 1.05; 95% CI, 1.002-1.099), and working part time compared to full time (OR, 2.17, 95% CI, 1.012-4.668), increased the likelihood of engaging in psychological therapy. Template thematic analysis identified three themes; (1) endometriosis and pain have multi-faceted psychological effects, (2) psychological support is sought to adjust and live with endometriosis and (3) there are helpful and unhelpful psychological tools for women with endometriosis. Our findings support the use of psychological therapy in the management of endometriosis, and the need for psychological therapy to acknowledge the chronicity and impact of symptoms, to enlist multidisciplinary support and to consider alternative options. Further advocacy is required to educate women on the benefits of psychological therapy for endometriosis.

A systematic review of psychological interventions in adults with pulmonary hypertension: Is the evidence-base disproportionate to the problem?

Our understanding of the psychological impact of living with pulmonary hypertension (PH) is growing, particularly for how anxiety and depression present in this group. There is evidence for the use of psychological interventions in other chronic lung conditions; however, trials focusing on adults with PH have yet to be subject to a systematic review. We systematically searched four databases for evidence examining the effectiveness of psychological interventions for adults with PH. A narrative approach has been used to present findings. Overall, 186 unique articles were identified of which four were suitable. Data was gathered from 143 individuals. Cognitive behavioural therapy (CBT), metacognitive therapy (MCT) or counselling were investigated. All three studies reported a significant reduction in anxiety and depression, and some secondary outcomes were also associated with change. The evidence supporting the use of psychological therapies for adults with PH is promising, although limited. There is an urgent need for more research in this area to better understand how we can support this clinical group.

10.Q. Workshop: Imbalance in use and impact of public psychotherapy – A Finnish working-age population register study

Abstract Mental disorders are globally among the leading causes of disability in the working-age population. Psychotherapies have proven to be effective in the improvement of mental health. The current evidence on the benefits of psychotherapies is mainly based on randomized control trials and patient-reported outcomes, whereas the potential impact of long-term psychological therapy on work disability and income is not so well known. This emphasizes the need for longitudinal studies on the effects of psychological therapies in a ‘real-world study setting’, and on the distribution of the availability and the use of psychological therapies in different populations. In Finland, rehabilitative psychotherapy is the major single form of publicly provided psychological therapy. It is targeted at those aged 16 to 67 who are at risk of disability or not being able to study because of mental health problems. It is granted an annual period (maximum three years), a maximum of 80 sessions per year and 200 sessions per 3 years. From 2011 on this psychotherapy has been statutorily granted to all at risk of work disability due mental health disorders. The number of annual users has increased from 15 757 (2010) to 56 682 (2020). This workshop presents the results from a research project investigating the use and real-world effects of long-term psychotherapy in the Finnish working-age population in the 2010s. It shows 1) whether the use of psychotherapy is associated with subsequent work disability and labour market outcomes (income, employment), 2) how the use of long-term psychotherapy differed between socio-demographic groups in the 2010s in Finland, and 3) the extent to which state-subsidized psychotherapy is linked to the distinctive profiles of mental health problems in the population. The five presentations offer new results from the Rise of Mental Vulnerability in Work Life Study drawn from the national registers. The presentations are mostly based on three randomly selected population cohorts which each included 33% of the 18-64-year-old permanent Finnish residents at the baseline. These data were sampled (sampling years: 2010, 2013, 2016) by and derived from the Population Register maintained by Statistics Finland and included information on various socio-demographic characteristics (e.g., gender, occupation class, region, income). These were linked to the national health registers. Information on reimbursed psychotherapy and mental health indicators (sickness absence, psychotropic drugs, disability benefits) were obtained from the Social Insurance Institution of Finland and complemented by the disability pension data from the Finnish Centre for Pensions. The data provide a unique opportunity to observe how the use of state-subsidized long-term psychotherapy was distributed across population groups in the 2010s, and to the extent to which disability trajectories and economic outcomes have developed in different groups during and after psychotherapeutic treatment. Key messages • Psychotherapy is likely to decrease the risk of work disability and improve labour market outcomes. • The provision of long-term psychotherapy is related to social inequality in the working population.

Early intervention in psychosis: An analysis of the characteristics and service needs of patients over the age of 35.

In 2016 NICE updated its guidance, extending the age to which early intervention in psychosis (EIP) services treat patients following their first episode of psychosis, to 65 years, from the previous cut-off of 35 years. The aim of this service evaluation was to identify differences in the demographic details, diagnoses, and treatments between patients below and above 35 years to identify any unmet needs in the latter age category. A total of 100 patients from the caseload were randomly selected, with 50 from each age group, to analyse in further detail. Descriptive statistics was predominantly used due to the relatively small sample size. The over 35 s were predominantly female (62%), whilst the under 35 s were predominantly male (66%). There was a statistically significantly higher rate of substance misuse in the under 35 s. Whilst schizophrenia was the most common diagnosis in both groups, higher rates of delusional disorders and psychosis NOS were observed in the over 35 s. In both age groups, a median of two different medications was used per patient. However, amongst the over 35 s there is less use of psychological therapy and of support, time and recovery workers (STR workers). There are distinct differences between the two age groups including demographic and diagnostic features. Being historically youth based, EIP services needs to ensure that treatments offered are tailored to meet the need of the older age demographic who have different needs.

Women with schizophrenia have worse clinical presentation compared to their men counterpart in Kosovo: a cross-sectional study

Objectives: Gender differences have been reported in schizophrenia and suggested that later onset, predominant affective symptoms and better functioning are reported in women, while higher prevalence with more severe negative symptoms, and higher comorbidity for substance abuse in men. However, since the majority of data come from high-income countries, it is almost unknown whether gender differences exist in people with schizophrenia from socially and economically diverse contexts. The objective of this study is to explore gender differences in socio-demographic and clinical characteristics in a sample of people with schizophrenia in Kosovo, a low- and middle-income country (LMIC). Methods: The study included 101 patients with schizophrenia recruited from community services. Data on demographics, socio-economic characteristics, use of psychological therapy, and medication was collected through direct interviews. Clinical symptoms were assessed by using a combination of self-rated and researcher-rated measures. Gender differences were examined using χ2, independent sample t- tests, and univariate analysis of variance. Results: The sample was composed of 31.7% (n=32) women. Most demographic characteristics did not differ by gender, apart from marital status (higher proportion of women were separated; p=0.010). Women presented with more depressive (p=0.010) and paranoid symptoms (p=0.011), and attended psychological therapy less frequently (50% women vs 80% men; p=0.014). For both genders, attending psychological therapy was associated with lower negative symptoms (p=0.002). Conclusions: Women with schizophrenia had worse clinical presentation compared with men, and reported lower psychological therapy attendance. More research is needed to better describe schizophrenia in LMICs, and to understand whether access to mental health services, particularly psychological therapy, is attributable to clinical or contextual factors. Offering psychological therapy to people with schizophrenia of either gender included here could alleviate the burden of negative symptoms.

“Our feelings are valid” – reviewing the lesbian, gay, and bisexual affirmative approaches in a mental health setting

In recent years, although research into support mechanisms for managing distress experienced by Lesbian Gay and Bisexual (LGB) communities has increased. Stigma-related discrimination related to sexual minority status remains. This is further compounded by stigma against mental illnesses thus creating double jeopardy. This review will outline recent discoveries by exploring existing theories highlighting factors that explain health disparities for cisgender LGB people. It appears that the experience of the LGB population and the use of psychological therapies is varied across the spectrum. Some focus upon symptom reduction as part of the experience, but others talk about not being validated. Some mention minority stress constructs, alongside the psychological mediation framework, which offers a potential theoretical understanding of the experiences of the LGB population who receive psychological therapies.

Гіпносугестивна терапія нічного енурезу у військовослужбовців, які захворіли в зоні збройного конфлікту під час проведення антитерористичної операції

Пряме навіювання гіпнозом було використано для лікування 12 військовослужбовців, у яких розвинувся нічний енурез у зоні збройного конфлікту під час проведення антитерористичної операції. Остаточний клінічний діагноз був встановлений після комплексного клініко-діагностичного обстеження. Використання психотерапевтичних методів лікування дозволило домогтися контрольованого утримання сечі в нічний час у більшості хворих і значно підвищити ефективність комплексного лікування.

Self-help cognitive behavioural therapy for anxiety in pulmonary hypertension: pilot randomised controlled trial.

ObjectivePeople with pulmonary hypertension (PH) are at an increased risk of experiencing anxiety disorders. This study developed and tested the acceptability, feasibility and preliminary effectiveness of a cognitive behavioural self-help intervention for anxiety in adults with PH using a pilot randomised control trial design.MethodsIndividuals with PH recruited from pulmonary hypertension associations were randomised to either receive a newly developed self-help intervention (n=37) or a wait-list condition (n=40). Acceptability was explored using mixed-methods questionnaires. A 2×3 repeated-measures analysis of variance was used to explore anxiety (GAD-7), depression (PHQ-9), health-related quality of life (emPHAsis-10), dyspnoea (D-12), self-mastery (Self-Mastery Scale) and mood-related cognitions and behaviours (CBP-Q) at baseline, post-intervention and 1-month follow up. A mediation analysis was performed to examine potential mechanisms of change.ResultsDropout was low at 15.6%. All participants would recommend the intervention to another person with PH and felt it had helped with their anxiety. Participants in the intervention group reported a reduction in anxiety, depression and cognitive and behavioural processes linked with mood disorders, compared to the control group. Change in unhelpful cognitions and behaviours mediated the relationship between intervention condition and change in anxiety and depression.DiscussionThe intervention was found to be acceptable, feasible and safe. Anxiety at baseline was higher than previously observed, which could be associated with the additional burden caused by COVID-19 as the intervention was trialled during the pandemic. Findings add to the growing evidence supporting the use of psychological therapies, including cognitive behavioural therapy, in this clinical group.

From the margins to the NICE guidelines: British clinical psychology and the development of cognitive behaviour therapy for psychosis, 1982–2002

Although histories of cognitive behaviour therapy have begun to appear, their use with people with psychosis diagnoses has received relatively little attention. In this article, we elucidate the conditions of possibility for the emergence of cognitive behaviour therapy for psychosis (CBTp) in England between 1982 and 2002. We present an analysis of policy documents, research publications and books, participant observation, and interviews with a group of leading researchers and senior policy actors. Informed by Derksen and Beaulieu’s articulation of social technologies, we show how CBTp was developed and stabilised through the work of a variety of overlapping informal, academic, clinical, professional, and policy networks. The profession of clinical psychology played a key role in this development, successfully challenging the traditional ‘division of labour’ where psychologists focused on ‘neurosis’ and left ‘psychosis’ to psychiatry. Following Abbott's systems approach to professions, we identify a number of historical factors that created a jurisdictional vulnerability for psychiatry while strengthening the jurisdictional legitimacy of clinical psychology in providing psychological therapies to service users with psychosis diagnoses. The National Institute for Health and Clinical Excellence played a significant role in adjudicating jurisdictional legitimacy, and its 2002 schizophrenia guidelines, recommending the use of psychological therapies, marked a radical departure from the psychiatric consensus. Our analysis may be of wider interest in its focus on social technologies in a context of jurisdictional contestation. We discuss the implications of our study for the field of mental health and for the relationship between clinical psychology and psychiatry.

Comparing the Differences in Children’s Perceptions of Parental Conflict, Self-Differentiation and Being Triangulated in Individuals with and without Functional Constipation Due to Pelvic Floor Dysfunction

Conflicting family relationships in childhood lead to poor health in adulthood and can be a risk factor for diseases. Pelvic Floor Dysfunction (PFD) is one of the functional diseases that can originate from psychological conditions. This study compared children’s perceptions of parental conflict, self-differentiation and triangulation in patients with PFD type of functional constipation and non-infected counterparts. Results indicated the rate of parental conflict and triangulation is high in PFD patients and they have low self-differentiation. These results could help design therapeutic protocols to accelerate the treatment of PFD, and the use of psychological therapies in addition to drug therapies.

Audit: children & young peoples's services depression pathway Tees, Esk & Wear Valley Trust wide compliance

BackgroundThis complete cycle consists of an audit assessing compliance with the evidence based person-centred pathway of care for Depression in Children and Young People across the Trust, completion of an action plan and re-audit of progress, aiming to improve patient care. The pathway was derived from NICE Quality Standard 48/Clinical Guideline 28, updated for NICE Guideline 134 (2019) and includes comprehensive assessment considering comorbidities, social, educational and family context, parent/carer Mental Health assessment and plan for treatment including psychological therapies as first line treatment in mild depression.MethodThe Audit tool was compiled from the above evidence based pathway and NICE guidance. Each of the 26 community teams were requested to select 5 cases on the pathway who had completed a minimum of 6 treatment sessions (final sample size n = 61). The results were analysed for compliance against the pathway and compared with previous results by the clinical audit team.ResultThe results showed areas of good practice, maintained and improved on re-audit, with over 90% compliance in key evidence based areas regarding consideration of comorbidity, social and educational context and 100% compliance in offering psychological interventions.Improvement was obtained in some areas highlighted in the previous audit e.g. poor recording of ICD 10 diagnosis in medical records, 19%, improved to 30%, and less than 40% recording of symptom tracking via the RCADS (Revised Children's Anxiety and Depression Scale) monitoring improved to over 50%. There had been a failure to record identification or referral to other pathways/services for mild depression in the 16-18 age group with 0% compliance; this improved to 82% and 100% respectively.Areas still needing improvement were highlighted including recording of weekly monitoring of medication side-effects for first 4 weeks (43%) and a referral of parent/carers to mental health services after identifying issues (40%).Response to the audit also improved significantly from 29% of teams not responding in the initial audit to a limitation of only 1 of 26 (4%) at re-audit.ConclusionThis audit cycle has demonstrated that use of an evidence based approach has been instrumental in improving patient care. The Audit evidenced areas of good practice in holistic assessment and use of psychological therapies and importantly highlighted areas of significant improvement needed including initial monitoring of medication response and referral onwards of parents/carers with mental health issues. Continuous improvement in patient care is planned via a targeted action plan, and further re-audit.

Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: a WHO systematic review and meta-analysis.

Chronic pain in childhood is an international public health problem. We conducted a systematic review and meta-analysis to provide a summary of the published evidence of pharmacological, physical, and psychological therapies for children with chronic pain conditions. We searched CENTRAL, MEDLINE, EMBASE, and PsycINFO from inception to April 2020; clinical trial registries; and other sources for randomised controlled trials or comparative observational trials. We extracted critical outcomes of pain intensity, quality of life, physical functioning, role functioning, emotional functioning, sleep, and adverse events. We assessed studies for risk of bias and certainty of the evidence using GRADE. We included 34 pharmacological (4091 participants), 25 physical therapy (1470 participants), and 63 psychological trials (5025 participants). Participants reported a range of chronic pain conditions. Most studies were assessed to have unclear or high risk of bias across multiple domains. Pharmacological, physical, and psychological therapies showed some benefit for reducing pain, posttreatment, but only physical and psychological therapies improved physical functioning. We found no benefit of any treatment modality for health-related quality of life, role functioning, emotional functioning, or sleep. Adverse events were poorly reported, particularly for psychological and physical interventions. The largest evidence base for the management of chronic pain in children supports the use of psychological therapies, followed by pharmacological and physical therapies. However, we rated most outcomes as low or very low certainty, meaning further evidence is likely to change our confidence in the estimates of effects. This protocol was registered on PROSPERO (CRD42020172451).

Longitudinal follow-up of a novel classification system for irritable bowel syndrome: natural history and prognostic value.

Conventionally, irritable bowel syndrome (IBS) is subgrouped using predominant stool form, yet it is a complex disorder, with multiple biopsychosocial contributors. We previously derived and validated a latent class model subgrouping people with IBS into seven clusters based on gastrointestinal and extraintestinal symptoms and psychological profile. To conduct longitudinal follow-up examining the natural history and prognostic value of these clusters. Participants completed a 12-month follow-up questionnaire. We applied our model to these data, comparing cluster membership between the two time points in those still meeting Rome IV criteria at follow-up, including stratifying the analysis by predominant stool pattern, and level of psychological burden, at baseline. We examined whether baseline cluster predicted the course of IBS, and whether starting new treatment was associated with changing cluster. Eight hundred and eleven participants met Rome IV criteria for IBS at baseline, of whom 452 (55.7%) responded, and 319 (70.6%) still met Rome IV criteria for IBS at follow-up. Of these, 172 (53.9%) remained in the same IBS cluster as at baseline and 147 changed cluster. Cluster membership stratified according to psychological comorbidity was more stable; 84% of those in a cluster with high psychological burden at baseline remained in such a cluster at follow-up. People in clusters with high psychological burden at baseline had more severe symptoms (P<0.001), received a higher mean number of subsequent treatments (P<0.001), and were more likely to consult a doctor than people in clusters with low psychological burden (P<0.001). There was no significant association between starting a new treatment and changing cluster at follow-up. Longitudinal follow-up demonstrated little transition between clusters with respect to psychological burden, and these appeared to predict disease course. Directing treatment according to cluster, including earlier use of psychological therapies, and exploring how this approach influences outcomes in IBS, should be examined.

Comparison of the Cognitive-behavioral Therapy and Acceptance and Commitment Therapy on Resilience and Diagnostic Factors in Patients with Chronic Pain

Introduction: The need for research was felt that chronic pain is one of the most common pains in patients with psychological problems and the use of psychological therapies. This study aimed to compare the performance of CBT and ACT on resilience and diagnostic factors (CBC-ESR-CRP) in patients with chronic pain in Tehran.Method:This study was applied in terms of purpose and quasi-experimental in terms of research design method and was pre-test and post-test with thecontrol group. The statistical population in this study consisted of all people with chronic pain disorders who referred to private orthopedic clinics in Tehran and sampling was done with a purposive approach. 36 people were selected by purposive samplingmethod. After selection was based on entry and exit criteria, 24 people were selected and randomly assigned to two experimental groups (cognitive therapy group and act therapy group) and control (a group of 12 people). Participants completed Resilience Questionnaire (Conner-Davidson Resilience) before and after the interventions. Results: The findings of this study showed that both ACT and CBT approaches have the necessary effect on resilience, and diagnostic factors (of course, on two of them, ESR-CRP). The findings show that there is no significant difference between the ACT and CBT approachesConclusion: Therefore, CBT and ACT were effect on resilience and diagnostic factors (CBC-ESR-CRP) in patients with chronic pain.Declaration of Interest: None

Changing practice: assessing attitudes toward a NICE-informed collaborative treatment pathway for bipolar disorder.

Bipolar disorder is a chronic mental health condition, which can result in functional impairment despite medication. A large evidence base supports use of psychological therapies and structured care in the treatment of mood disorders, but these are rarely implemented. e-Pathways are digital structures that inform and record patient progress through a healthcare system, although these have not yet been used for bipolar disorder. To assess the perceived benefits and costs associated with implementing a collaborative NICE-informed e-pathway for bipolar disorder. Healthcare professionals and people with bipolar disorder attended a workshop to share feedback on e-pathways. Data were collected through questionnaires (n = 26) and transcription of a focus group, analysed qualitatively by a framework analysis. Patients and healthcare professionals welcomed the development of an e-pathway for bipolar disorder. There were five elements to the framework: quality and delivery of care, patient-clinician collaboration, flexibility and adaptability, impact on staff and impact on healthcare services. Identification of benefits and costs ensures that future development of e-pathways addresses concerns of healthcare professionals and people with bipolar disorder, which would be essential for successful implementation. Recommendations for this development include making e-pathways less complicated for patients, ensuring sufficient training and ensuring clinicians do not feel their skills become invalidated. Limitations of the study, and directions for future research, are discussed.

Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes

Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12–18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05–0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2–208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.

Historic psychedelic drug trials and the treatment of anxiety disorders.

In this paper, we systematically review literature from 1940 to 2000 relating to the combined use of psychological therapies and psychedelic drugs in the treatment of ICD-10 anxiety disorders. The databases Ovid MEDLINE(R), PsycINFO, and Multidisciplinary Association for Psychedelic Studies (MAPS) were searched for case reports and trials involving humans in the treatment of ICD-10 anxiety and related disorders. Twenty-four studies are described; four describe anxiety symptoms in diverse patient groups, 14 studies describe historic diagnoses that usefully correspond with ICD-10 anxiety disorders, six studies pooled results or failed to detail results specific to contemporary ICD-10 anxiety disorders. Two of the 24 studies reported are individual case reports while two of them were inadequate in terms of the reporting of outcome measures. Thus 20 studies were ultimately included in the summary analysis. Three of the 20 studies reviewed described improvements in anxiety by standardized measures (p < .05) and two studies found that this effect was dose related. Of the 20 studies included in the final analysis, 94 of 145 (65%) cases of "psychoneurotic anxiety reaction" as defined by Diagnostic and Statistical Manual of Mental Disorders-I showed improvement that ranged from moderate improvement to full recovery. Despite methodological inadequacies, the results from previous studies are encouraging and should be used to guide and inform further investigation. The majority of studies indicate that a combination of psychedelic drug administration and psychological therapy was most beneficial. We found no study suggesting that the pharmacological action of psychedelic drugs in isolation is sufficient.

Young people’s beliefs about psychological therapy for psychosis: a Q-Methodological study

Background: The evidence base for the use of psychological therapies in the treatment of psychosis is growing, however engagement can be difficult and outcomes are variable. Beliefs, attitudes and expectations may have an important influence on whether individuals engage with therapy and on clinical outcomes, however, these beliefs have not been adequately explored.Aims: To examine what young people in Early Intervention Services (EIS) think about psychological therapies for psychosis.Method: Thirty participants were recruited from EIS across five NHS trusts to examine young people’s beliefs about psychological therapy.Results: Four distinct factors, or sets of beliefs, about therapy emerged: (1) Therapy is helpful and gives hope for the future; (2) Therapy is just talking, people need medication; (3) Therapy is useful but stigmatising; (4) Therapy is better than medication. Positive views towards different aspects of therapy were present in all four accounts. Other important issues were raised, including concerns about stigma and opposing beliefs about medication.Conclusion: These four factors provide useful insights into young people’s beliefs about psychological therapy. Individuals’ beliefs and expectations should be recognised and explored in order to promote greater engagement in and better outcomes from therapy.

Brain mechanisms impacted by psychological therapies for pain: identifying targets for optimization of treatment effects.

Psychological therapies, such as cognitive behavioral therapy, are widely used multifaceted approaches that have been shown to improve pain-related functioning. A small but growing number of studies have used brain imaging to support the use of psychological therapies for pain. Although these studies have led to an increased understanding of how therapies may engage neural systems, there are multiple technical and conceptual challenges to consider. Based on the current literature, several components of effective psychological therapies for pain may be supported by changes in neural circuitry, which are most consistently represented by diminished activation and/or reduced hyperconnectivity in brain regions related to pain processing, emotion, and cognitive control. Findings may vary based on methodological approaches used and may also differ depending on targets of treatment. To provide a nuanced understanding of the current literature, specific targets and components of effective treatments for which a neural basis has been investigated are reviewed. These treatment components include catastrophic thinking about pain, increasing self-efficacy, mindfulness, anxiety symptom reduction, and exposure-based approaches. In general, such strategies have the potential to normalize regional hyperactivations and reduce hyperconnectivity in brain regions associated with nociceptive processing, cognition, and emotion, although additional research is needed. By determining if there are indeed distinct brain mechanisms engaged by different components of psychological therapy and evidence for specific changes in neural function after these interventions, future therapies may be more optimally tailored for individuals afflicted with chronic pain.

Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease.

Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease.