Waitlist Control Period Research Articles

Cognitive Inhibition in Trauma Recovery Among Asylum Seekers: Test in a Randomized Trial of Mindfulness-Based Trauma Recovery for Refugees

Emerging evidence suggests that mindfulness-based interventions (MBIs) may be one promising intervention approach within the global mental-health crisis of forced displacement. Little is known about the mechanisms of action of MBIs for trauma recovery or among diverse forcibly displaced people (FDP). Within a single-site randomized waitlist-control trial among 143 traumatized East African asylum seekers living in a high-risk urban postdisplacement setting, cognitive inhibition (CI) of trauma- and threat-related information was measured (modified Sternberg task) before and after Mindfulness-Based Trauma Recovery for Refugees (MBTR-R) or a parallel waitlist-control period. At preintervention, a deficit in the CI of trauma- and threat-related but not positively valenced emotionally evocative information was associated with posttraumatic stress disorder (PTSD) severity. Although MBTR-R led to improved CI of trauma- and threat-related information, this change process did not mediate the therapeutic effect of MBTR-R on PTSD. Findings inform theory implicating CI in PTSD, MBI mechanisms of action, and FDP mental health.

Gait-Adaptability Training in People With Hereditary Spastic Paraplegia: A Randomized Clinical Trial

Background and objectives In people with hereditary spastic paraplegia (HSP), reduced gait adaptability is common and disabling. Gait impairments result from lower extremity spasticity, muscle weakness, and impaired proprioception. The aim of this study was to assess the efficacy of a 5-week gait-adaptability training in people with pure HSP. Method We conducted a randomized clinical trial with a cross-over design for the control group, and a 15-week follow-up period after training. Thirty-six people with pure HSP were randomized to 5 weeks of (i) gait-adaptability training (10 hours of C-Mill training—a treadmill equipped with augmented reality) or (ii) a waiting-list control period followed by 5 weeks gait-adaptability training. Both groups continued to receive usual care. The primary outcome was the obstacle subtask of the Emory Functional Ambulation Profile. Secondary outcome measures consisted of clinical balance and gait assessments, fall rates, and spatiotemporal gait parameters assessed via 3D motion analysis. Results The gait-adaptability training group (n = 18) did not significantly decrease the time required to perform the obstacle subtask compared to the waiting-list control group (n = 18) after adjusting for baseline differences (mean: −0.33 seconds, 95% CI: −1.3, 0.6). Similar, non-significant results were found for most secondary outcomes. After merging both groups (n = 36), the required time to perform the obstacle subtask significantly decreased by 1.3 seconds (95% CI: −2.1, −0.4) directly following 5 weeks of gait-adaptability training, and this effect was retained at the 15-week follow-up. Conclusions We found insufficient evidence to conclude that 5 weeks of gait-adaptability training leads to greater improvement of gait adaptability in people with pure HSP.

Goal attainment in individual and group-based neuropsychological interventions for young adults with dyslexia in a randomized controlled trial

In this study, we investigated the outcome of goal attainment in individual and group-based neuropsychological intervention for young adults with dyslexia. Participants (N = 120) were randomly assigned to individual intervention, group intervention, or wait-list control group. Attainment of goals set personally before the intervention was evaluated after the intervention using Goal Attainment Scaling. The participants were asked to report the number of concrete changes made in their study or working habits at five months (after intervention or wait-list control time), at ten months, and 15 months post-interventions. Potential predictive factors for predicting goal attainment were evaluated including background and cognitive variables, self-reported psychological variables (mood, cognitive and behavioral strategies, self-esteem, quality of life), and self-reported behavioral variables (concrete changes made, time used to work on intervention matters). Based on the results, personal goals were, on average, met especially in individual intervention. Nearly 50% of goal attainment was explained by intervention type, behavioral and cognitive strategies, concrete changes made, cognitive capacity, and used time. Concrete changes, e.g., adopting new strategies and methods in study or working habits, were reported in both interventions and more than during the wait-list control period. The changes seemed long-lasting as fifteen months post-intervention, 76.4% reported still using the learned strategies. A structured and relatively short neuropsychological intervention for dyslexia in either individual or group format can lead to attaining pre-set personal goals and positive behavioral changes that can last up to over a year post-intervention.

The Feasibility and Impact of Practising Online Forest Bathing to Improve Anxiety, Rumination, Social Connection and Long-COVID Symptoms: A Pilot Study.

Long-COVID affects over 144 million people globally. In the absence of treatments, there is a need to establish the efficacy of therapies that improve patient outcomes. Forest bathing has been demonstrated to improve physical and mental outcomes but there is no evidence in Long-COVID patients. Accordingly, this pilot study sought to determine the feasibility and effectiveness of online forest bathing in adults with Long-COVID. Feasibility was assessed by monitoring retention rates and participant feedback. In a waitlist controlled, repeated measures design, 22 Long-COVID patients completed weekly online surveys during a four-week waitlist control period, before engaging in four weekly online forest bathing sessions, completing post-intervention surveys following each session. In terms of retention, 27% did not provide post-intervention data, reasons for non-adherence were: feeling too ill, having medical appointments, or having career responsibilities. Compared with the waitlist control period, there were statistically significant improvements in Anxiety (49% decrease), Rumination (48% decrease), Social Connection (78% increase), and Long-COVID symptoms (22% decrease). Written qualitative comments indicated that participants experienced feelings of calm and joy, felt more connected socially and with nature, and experienced a break from the pain and rumination surrounding their illness. Online Forest bathing resulted in significant improvements in well-being and symptom severity and could be considered an accessible and inexpensive adjunct therapy for Long-COVID patients. Where people have limited access to in-person nature, virtual nature may offer an alternative to improve health and well-being outcomes.

Autonomic Dysregulation in Child Social Anxiety Disorder: An Experimental Design Using CBT Treatment

Models of social anxiety disorder (SAD) stress the relevance of physiological arousal. So far, limited research has been conducted in children with SAD in experimental stress designs. Thus, examining autonomic arousal, children with and without SAD completed a standardized social stressor (Trier Social Stress Test for Children-C; TSST-C). Pre-existing differences to healthy controls (HC) were expected to decrease after receiving cognitive behavior therapy (CBT). Children with SAD (n = 64) and HC children (n = 55) completed a TSST-C. Children with SAD participated in a second TSST-C after either cognitive-behavioral treatment or a waitlist-control period (WLC). As expected, children with SAD showed blunted heart rate reactivity compared to HC children. Further, children with SAD had elevated levels of tonic sympathetic arousal as indexed by skin conductance level compared to HC. Children with SAD showed lower parasympathetic arousal during the baseline compared to HC. Children receiving treatment did not differ from children in the WLC condition in a repeated social stress test. Psychophysiological differences between children with SAD and HC children could be confirmed as indicated by previous research. The lack of physiological effects of the intervention as an experimental manipulation might be related to slower changes in physiology compared to e.g. cognition.

The effect of a multidisciplinary intervention program for overweight and obese children on cardiorespiratory fitness and blood pressure.

Multidisciplinary intervention programs for overweight and obese children mainly focus on reducing bodyweight and body mass index (BMI), but they may also positively impact blood pressure (BP), and cardiorespiratory fitness (CRF), which is a stronger predictor for all-cause mortality than BMI. To evaluate whether Kids4Fit, a multidisciplinary weight reduction program, has a positive effect on CRF and BP in overweight and obese children in socially deprived areas. A quasi-experimental study design with a waiting list control period including children who participated in a multidisciplinary intervention program of 12 weeks was set-up. Blood pressure measurements and shuttle-run test (SRT) were performed at baseline, at the start of the intervention, at the end of intervention and after 52 weeks. The effect of Kids4Fit on BP and on SRT scores were analyzed using mixed models. A total of 154 children were included [mean age 8.5 years (SD 1.8)]. No significant change was seen in systolic BP percentiles at 52 weeks after start of the Kids4Fit intervention (β 0.08, (95%CI -0.06, 0.22)). Diastolic BP percentiles increased significantly over time (β 0.20 (0.08, 0.31)). Effect plots showed an initial significant increase of the SRT scores but this effect diluted after the intervention. A local multidisciplinary intervention program in deprived areas had a significant positive effect on CRF, but this effect diluted after the intervention. Diastolic BP percentiles significantly increased over time. However, systolic BP did not change over time.

A multidisciplinary intervention programme for overweight and obese children in deprived areas.

GPs can refer obese children living in deprived areas to multidisciplinary programmes for a weight loss intervention, though the effectiveness of these local initiatives targeted to this specific group is unknown. To evaluate the effectiveness of the Kids4Fit intervention in deprived areas on child's weight status. Design and setting: cohort study, including a waiting list control period. Subjects: children (N = 154) aged 6-12 years, who signed up for the Kids4Fit intervention programme, led by a dietitian, physiotherapist and child psychologist were included. Measurements of standardized body mass index (BMI-z) and waist circumference were taken at start of the waiting list period, at start and at the end of the intervention and after 52 weeks. Mixed model analyses (random effects models) were used, expressed in effect per week [β with 95% confidence interval (CI)], compared to the waiting list expectancy over the 52-week study period. Mixed model analyses showed a non-significant trend towards a lower BMI-z up to 52 weeks after start of Kids4Fit (β: -0.0024; 95% CI: -0.0053; 0.0004), compared to the waiting list expectancy. A significantly lower waist circumference was found over time compared to the waiting list expectancy (β: -0.0558; 95% CI: -0.0950; -0.0166). No differences were found in lifestyle and health-related quality of life. A local multidisciplinary intervention programme in deprived areas is effective in reducing waist circumference of obese children, compared to a waiting list expectancy, but no significant changes in lifestyle and quality of life were shown.

Mindfulness-based cognitive therapy for severely fatigued multiple sclerosis patients: A waiting list controlled study.

Fatigue is the most common symptom in multiple sclerosis. Evidence-based treatment options are scarce. To study the feasibility and potential effectiveness of mindfulness-based cognitive therapy in severely fatigued multiple sclerosis patients. Non-randomized pilot study with a wai-ting list control period including 59 multiple sclerosis patients with severe fatigue. fatigue severity subscale of the Checklist Individual Strength-20. Secondary measures: Hospital Anxiety and Depression Scale, Life Satisfaction Questionnaire, subscale sleep of the Symptom Checklist-90, Cognitive Failure Questionnaire, Fatigue Catastrophizing Scale, Coping Inventory of Stressful Situations, and Five Facet Mindfulness Questionnaire-Short Form. Measurements were taken before treatment (double baseline), after treatment, and at follow-up (3 months). Adherence rate was 71%. Eight out of 10 participants who completed the intervention were satisfied with the intervention. Significant time effects were found for 7 out of 11 outcome measures (p = 0.006 to < 0.001). The effect size was moderate for all outcome measures that were significant post-treatment and/or at follow-up (Ƞ² = 0.10-0.17). Improvements were maintained at follow-up. Of the completers, 46% showed a clinically relevant change regarding fatigue. Mindfulness-based cognitive therapy is feasible in severely fatigued multiple sclerosis patients and has positive results in the reduction of severe fatigue and several psychological factors.

Relationships between psychosocial outcomes in adolescents who are obese and their parents during a multi-disciplinary family-based healthy lifestyle intervention: One-year follow-up of a waitlist controlled trial (Curtin University’s Activity, Food and Attitudes Program)

BackgroundLimited studies have investigated relationships in psychosocial outcomes between adolescents who are obese and their parents and how psychosocial outcomes change during participation in a physical activity and healthy eating intervention. This study examined both adolescent and parent psychosocial outcomes while participating in a one - year multi-disciplinary family-based intervention: Curtin University’s Activity, Food, and Attitudes Program (CAFAP).MethodsFollowing a waitlist control period, the intervention was delivered to adolescent (n = 56, ages 11–16) and parent participants over 8 weeks, with one-year maintenance follow-up. Adolescent depression and quality of life, family functioning, and parent depression, anxiety, and stress were assessed at six time points: baseline and prior to intervention (e.g., waitlist control period), immediately following intervention, and at 3, 6, and 12 months post-intervention. Relationships between adolescent and parent psychosocial outcomes were assessed using Spearman correlations and changes in both adolescent and parent outcomes were assessed using linear mixed models. Changes in adolescent psychosocial outcomes were compared to changes in behavioural (physical activity and healthy eating) and physical (weight) outcomes using independent samples t-tests.ResultsThe majority of psychosocial outcomes were significantly correlated between adolescents and parents across the one-year follow-up. Adolescent depression, psychosocial and physical quality of life outcomes significantly improved before or following intervention and were maintained at 6-months or one-year follow-up. Parent symptoms of depression, anxiety, and stress were reduced during waitlist and primarily remained improved. Changes in adolescent psychosocial outcomes were shown to be partially associated with behavioural changes and independent of physical changes.ConclusionsAdolescents in CAFAP improved psychosocial and physical quality of life and reversed the typical trajectory of depressive symptoms in adolescents who are obese during a one-year maintenance period. CAFAP was also effective at maintaining reductions in parent symptoms of depression, anxiety, and stress demonstrated during the waitlist period.Trial RegistrationThe trial was registered with the Australian and New Zealand Clinical Trials Registry (No. 12611001187932).

"Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Study Review and Brief Commentary".

Chronic pain exerts an enormous impact on the quality of life of the more than 1 billion people around the globe who are living with this condition [1,2] (IOM, IASP). The economic burden of chronic pain is astounding, and in the United States alone costs over half a trillion dollars annually [1]. Given the costs to humanity there exists a critical need to develop and disseminate interventions that may reduce the impact of chronic pain including associated suffering. In 2014 my colleagues and I published “Pilot study of a compassion meditation intervention in chronic pain” in Journal of Compassionate Health Care [3] http://www.jcompassionatehc.com/content/1/1/4 Compassion had previously been shown to influence emotional processing and reduce negative bias, thereby suggesting it could treat pain and anger in tandem. However, prior work on compassion cultivation training including pain didactics in the intervention. In our 2014 study, we aimed to study the unique effects of compassion cultivation training in people with chronic pain, with a specific focus on pain severity, anger, and acceptance. Indeed, anger has emerged as an increasingly important aspect of the chronic pain experience [4-23]. In people with chronic pain, anger is associated with greater acute and chronic pain intensity [12,16,18,21], disability [24], poorer function [23], reduced pain treatment response [9,10] and impaired relationships with spouses [25]. Anger can be directed towards others as well as towards oneself [26-28] including disappointment and frustration with pain [29], self-blame [30], self-criticism [31] and poor acceptance of one’s physical limitations [32]. Eastern traditions prescribe compassion cultivation to treat persistent anger. Similarly, acceptance has also proven to be a strong correlate of outcomes in chronic pain, with interventions that target and increase acceptance showing promise for reducing pain and its associated emotional and functional burdens.[33-37] We conducted a pilot study of a 9-week group compassion cultivation intervention in chronic pain. The compassion cultivation training course we used is a standardized curriculum developed by the Stanford Center for Compassion and Altrusim Research and Education (CCARE) that is delivered in weekly, 2-hour group classes delivered by a certified instructor (http://ccare.stanford.edu/education/about-compassion-cultivation-training-cct/). Importantly, the program was in no way modified for chronic pain (i.e., did not include any pain education). We used a repeated measures design that included a within-subjects wait-list control period. Twelve chronic pain patients completed the intervention (F=10). Data were collected from patients at enrollment, treatment baseline and post-treatment. Post-treatment results revealed significantly reduced pain severity and anger, and increased pain acceptance, compared to treatment baseline. The findings from this study suggested that compassion cultivated may be broadly relevant as chronic pain treatment. The study participants were not selected for having high anger; thereby suggesting that anger is chronic pain may be underappreciated and overlooked clinically as a therapeutic target. The compassion intervention was found to reduce anger, and anger reductions correlated strongly with reduction in pain severity and increased acceptance. While Acceptance and Commitment Therapy was developed to specifically target and increase acceptance, our results suggest that acceptance may be cultivated indirectly and successfully with compassion. More research is needed on larger samples, and future studies may examine the mechanisms by which compassion interventions reduce pain and negative correlates. Future studies may also examine other pathways – including physical interventions that may indirectly enhance compassion for self and others.

Pilot study of a compassion meditation intervention in chronic pain.

BackgroundThe emergence of anger as an important predictor of chronic pain outcomes suggests that treatments that target anger may be particularly useful within the context of chronic pain. Eastern traditions prescribe compassion cultivation to treat persistent anger. Compassion cultivation has been shown to influence emotional processing and reduce negativity bias in the contexts of emotional and physical discomfort, thus suggesting it may be beneficial as a dual treatment for pain and anger. Our objective was to conduct a pilot study of a 9-week group compassion cultivation intervention in chronic pain to examine its effect on pain severity, anger, pain acceptance and pain-related interference. We also aimed to describe observer ratings provided by patients’ significant others and secondary effects of the intervention.MethodsPilot clinical trial with repeated measures design that included a within-subjects wait-list control period. Twelve chronic pain patients completed the intervention (F= 10). Data were collected from patients at enrollment, treatment baseline and post-treatment; participant significant others contributed data at the enrollment and post-treatment time points.ResultsIn this predominantly female sample, patients had significantly reduced pain severity and anger and increased pain acceptance at post-treatment compared to treatment baseline. Significant other qualitative data corroborated patient reports for reductions in pain severity and anger.ConclusionsCompassion meditation may be a useful adjunctive treatment for reducing pain severity and anger, and for increasing chronic pain acceptance. Patient reported reductions in anger were corroborated by their significant others. The significant other corroborations offer a novel contribution to the literature and highlight the observable emotional and behavioral changes in the patient participants that occurred following the compassion intervention. Future studies may further examine how anger reductions impact relationships with self and others within the context of chronic pain.

A randomised controlled trial of face to face versus pure online self-help cognitive behavioural treatment for perfectionism

Previous research has shown cognitive-behavioural treatment (CBT) to be effective in reducing perfectionism. The present study investigated the efficacy of two formats of CBT for perfectionism (CBT-P), face-to-face and pure online self-help, in reducing perfectionism and associated psychological symptoms. Participants were randomly allocated to face-to-face CBT-P (n = 18), pure online self-help CBT-P (n = 16), or a waitlist control period (n = 18). There was no significant change for the waitlist group on any of the outcome measures at the end of treatment. Both the face-to-face and pure online self-help groups reported significant reductions at the end of treatment for the perfectionism variables which were maintained at the 6-month follow-up. The face-to-face group also reported significant reductions over this time in depression, anxiety, and stress, and a significant pre-post increase in self-esteem, all of which were maintained at the 6-month follow-up. In contrast, the pure online self-help group showed no significant changes on these outcomes. The face-to-face group was statistically superior to the pure online self-help group at follow-up on the perfectionism measures, concern over mistakes and personal standards. The results show promising evidence for CBT for perfectionism, especially when offered face to face, where sustained benefit across a broad range of outcomes can be expected.

A play and joint attention intervention for teachers of young children with autism: A randomized controlled pilot study

The aim of this study was to pilot test a classroom-based intervention focused on facilitating play and joint attention for young children with autism in self-contained special education classrooms. Thirty-three children with autism between the ages of 3 and 6 years participated in the study with their classroom teachers (n = 14). The 14 preschool special education teachers were randomly assigned to one of three groups: (1) symbolic play then joint attention intervention, (2) joint attention then symbolic intervention, and (3) wait-list control period then further randomized to either group 1 or group 2. In the intervention, teachers participated in eight weekly individualized 1-h sessions with a researcher that emphasized embedding strategies targeting symbolic play and joint attention into their everyday classroom routines and activities. The main child outcome variables of interest were collected through direct classroom observations. Findings indicate that teachers can implement an intervention to significantly improve joint engagement of young children with autism in their classrooms. Furthermore, multilevel analyses showed significant increases in joint attention and symbolic play skills. Thus, these pilot data emphasize the need for further research and implementation of classroom-based interventions targeting play and joint attention skills for young children with autism.

The Effect of EEG Biofeedback on Reducing Postcancer Cognitive Impairment

BACKGROUND AND HYPOTHESES: Postcancer cognitive impairment (PCCI) is observed in a substantial number of breast cancer survivors, persisting for as long as 20 years in some subgroups. Although compensatory strategies are frequently suggested, no restorative interventions have yet been identified. This study examined the feasibility of EEG biofeedback ("neurofeedback") and its potential effectiveness in reducing PCCI as well as the fatigue, sleep disturbance, and psychological symptoms that frequently accompany PCCI. This was a 6-month prospective study with a waitlist control period followed by an active intervention. Participants were female breast cancer survivors (n = 23), 6 to 60 months postchemotherapy, with self-reported cognitive impairment. Four self-report outcome measures (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog], Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue], Pittsburgh Sleep Quality Index [PSQI], and Brief Symptom Inventory [BSI]-18) were administered 3 times during a 10-week waitlist control period, 3 times during a 10-week (20-session) neurofeedback training regimen, and once at 4 weeks postneurofeedback. All 23 participants completed the study, demonstrating the feasibility of EEG biofeedback in this population. Initially, the sample demonstrated significant dysfunction on all measures compared with general population norms. Repeated-measures ANOVAs revealed strongly significant improvements (P < .001) on all 4 cognitive measures (perceived cognitive impairment, comments from others, perceived cognitive abilities, and impact on quality of life [QOL]), the fatigue scale, and the 4 psychological scales (somatization, depression, anxiety and global severity index) as well as on 3 of 8 sleep scales (quality, daytime dysfunction, and global). Two of the other sleep scales (latency and disturbance) were significant at P < .01, and 1 (use of medication) at P < .05; 2 were not significant. Improvements were generally linear across the course of training, and were maintained at the follow-up testing. At the follow-up testing, the sample no longer differed significantly from normative populations on 3 of the 4 FACT-Cog measures (impairment, impact on QOL, and comments), FACIT-Fatigue, PSQI sleep quality and habitual efficiency, or any of the BSI-18 measures of psychological disturbance. Data from this limited study suggest that EEG biofeedback has potential for reducing the negative cognitive and emotional sequelae of cancer treatment as well as improving fatigue and sleep patterns.

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Randomized Controlled Trial

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.

Effects of supervision modality and intensity on alliance and outcomes for the supervisee.

Clinical supervision within the health professions is an important quality control mechanism to ensure good client care. The purpose of this study was to assess how supervision structure and process affect supervision outcomes for the supervisee. A repeated measures within groups and between groups (individual or group supervision) design was used to explore the effects of a 6-month supervision program for staff of public sector drug and alcohol health services. Ten supervisors and 42 supervisees were allocated to either individual or group supervision conditions. Measures were completed at 3 points over a 9-month period, including a 3-month waitlist control period of no supervision. Mean supervisee ratings indicated positive evaluations for supervision satisfaction and perceived effectiveness in individual and group conditions. Although an increase in burnout and decrease in wellbeing was observed during the period of supervision, these changes are hypothesized to be related to extraneous organizational issues. Enhanced perceived supervision effectiveness and positive supervisory alliance were associated with lower levels of burnout and higher levels of wellbeing and job satisfaction within the individual supervision condition. Supervisee ratings of alliance were strongly correlated with ratings of perceived supervision effectiveness in individual and group conditions. These results suggest that supervision can have important positive impacts on the supervisee's functioning and wellbeing when that supervision involves a positive alliance.

A Prospective Study to Evaluate a Residential Community Reintegration Program for Patients With Chronic Acquired Brain Injury

Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. A prospective study to evaluate a residential community reintegration program for patients with chronic acquired brain injury. Objective To examine the effects of a residential community reintegration program on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Design A prospective cohort study with a 3-month waiting list control period and 1-year follow up. Setting A tertiary rehabilitation center for acquired brain injury. Participants Patients (N=70) with acquired brain injury (46 men; mean age, 25.1y; mean time postonset, 5.2y; at follow up n=67). Intervention A structured residential treatment program was offered directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome Measures Community Integration Questionnaire (CIQ), Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale, EuroQOL quality of life scale (2 scales), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), and the Global Assessment of Functioning (GAF) scale. Results There was an overall significant time effect for all outcome measures (multiple analysis of variance T 2=26.16; F 36,557 134.9; P=.000). There was no spontaneous recovery during the waiting-list period. The effect sizes for the CIQ, Employability Rating Scale, work hours, and GAF were large (partial η 2=0.25, 0.35, 0.22, and 0.72, respectively). The effect sizes were moderate for 7 of the 8 emotional well-being and quality of life (sub)scales (partial η 2=0.11–0.20). The WHOQOL-BREF environment subscale showed a small effect size (partial η 2=0.05). Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up. Conclusions This study shows that a residential community reintegration program leads to significant and relevant improvements of independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.

Effects of a Combined Physical Activity and Dietary Change Intervention on Weight Loss in Minority Breast Cancer Survivors.

Abstract Background: Hispanic and black women with breast cancer have poorer survival and are more likely to be obese and sedentary than non-Hispanic whites. Regular physical activity, high intake of fruits and vegetables, and lean body mass may improve survival. We report the initial results of a randomized wait-list controlled pilot study to test the effects of 6 months of the community-based Curves® exercise and nutrition program on weight loss among minority BC survivors.Methods: Hispanic/black women with stage 0-IIIa breast cancer who were ≥6 months post-treatment, sedentary and had a BMI≥25kg/m2 were enrolled. Eligible participants were randomized to the Immediate Arm (IA): 6 months of the Curves® exercise and dietary change weight loss program, followed by 6 months of observation; or the Delayed Arm (DA): 6 months of a waitlist control period, followed by 6 months of the Curves® program. The intervention entailed recommending exercise 5 times/wk using the 30-minute Curves® circuit-based exercise program and attending a series of 6 weekly nutrition sessions that promoted a high-vegetable/low-fat diet. All study materials were available in Spanish and English. Participants underwent clinic visits at baseline, 3, 6, 9, and 12 months and were followed with monthly telephone calls during the intervention. Month 6 results are reported here.Results: Forty-two women enrolled in the study (IA, n=22; DA, n=20). Baseline characteristics: mean (±SD) age, 50.7 (±8.9) years; 78.6% Hispanic/21.4% black; breast cancer stage, stage 0 9.5%, stage I 42.9%, stage II 33.3%, stage III 14.2%; mean body mass index (BMI), 33.2 (±5.9) kg/m2; mean % body fat as measured by DEXA, 41.6 (±4.9) %; and mean VO2 max, 18.4 (±3.6). Six month data were collected from 39 women; 2 women were removed from the study due to medical conditions (1 recurrent disease, 1 previously undiagnosed cardiac condition) and 1 women dropped from the study due to being too busy. In the IA, the average number of exercise sessions attended over the 6 month period was 1.1(±0.8) per week (range: 0.04 to 2.9/wk), and all participants attended all 6 nutrition classes either in-person or via phone make-up sessions. After 6 months, women in the IA lost an average of 2.7 (±3.2) kg (range: loss of 9.9 kg to gain of 1.7 kg), had a decrease in percent body fat of 1.5 (±1.5)% (range: loss of 5.9% to gain of 0.2%), and a decrease in VO2max of 1.0 (±3.4) ml/kg/min (range: decrease of 8.6 ml/kg/min to increase of 2.5 ml/kg/min) (within-subject measures p&amp;lt;0.05 for change in weight and percent body fat; all between-arm measures p&amp;gt;0.05). Twelve month data collection will be completed in July 2009 and will be presented at the conference.Conclusions: This 6 month pilot physical activity and dietary change intervention resulted in decreased in body weight and percent body fat among Hispanic and black BC survivors, although this decline was not significantly different than the wait-list control group. Though adherence to the exercise intervention was less than the targeted 5 exercise sessions per week, those that did adhere lost up to 9.9 kg. Further research on barriers to participation, optimal dose, and duration are necessary for future intervention trials. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1038.

Effectiveness of an attachment-focused manualized intervention for parents of teens at risk for aggressive behaviour: The Connect Program

Aggressive, violent and antisocial behaviour in children and adolescents is a growing concern across the globe. Targeting parent-teen relationships is critical in reducing problem behaviour. ‘Connect’ is a manualized ten-week program for parents or alternative caregivers of at-risk teens that focuses on the building blocks of secure attachment: parental sensitivity, cooperation, reflective capacity, and effective dyadic affect regulation. Through didactic and experiential activities, parents develop the competence necessary to identify, understand and respond to the needs of their teen in a manner that provides structure and safety while safeguarding the quality of the parent-teen relationship. In Study 1, twenty parents reported significant increases in perceived parenting satisfaction and efficacy and reductions in adolescents' aggression, antisocial behaviour and other mental health problems following completion of Connect as compared to a waitlist control period. These effects were sustained and additional small effects were noted in decreases in conduct problems, depression and anxiety at a 12-month follow-up. The program was then transported to 17 communities serving 309 parents through standardized training and supervision of group leaders. Study 2 summarizes significant pre- to post-treatment reductions in teen externalizing and internalizing problems; enhanced social functioning; and improvements in affect regulation. Parents also reported significant increases in parenting satisfaction and perceived efficacy and reductions in caregiver burden.