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1
Garety, P. A. "Cognitive Behavioural Therapy for psychosis." Die Psychiatrie 9, no. 02 (April 2012): 111–16. http://dx.doi.org/10.1055/s-0038-1671779.
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SummaryCognitive Behavioural Therapy for psychosis (CBTp), with its theoretical underpinning derived from cognitive models of psychosis, is described. The therapeutic approach is elucidated, in terms of goals, techniques, content and style. Adjustments of the therapy to address the particular problems of psychosis, including building a therapeutic relationship and matching cognitive capacities, are highlighted. The extensive evidence for the effectiveness of CBTp is reviewed and methodological issues in trials noted. The evidence shows that CBTp has small to medium effects on a range of outcomes, including symptoms, affect and functioning, and that the evidence is most consistent for improvements in people with persistent positive symptoms. New developments in CBTp are described, and the promise of developing focused treatments targeting specific psychological processes, such as reasoning or emotional processes, hypothesized as causal mechanisms of distressing symptom persistence. Finally, to support implementation of CBTp in practice, it is concluded that there is a need for dissemination programs, addressing staff attitudes and skills and wider system changes.
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Stern, Richard. "Behavioural-cognitive psychotherapy training for psychiatrists." Psychiatric Bulletin 17, no. 1 (January 1993): 1–4. http://dx.doi.org/10.1192/pb.17.1.1.
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“The therapist can cite Bertrand Russell's observation that the degree of certainty with which one holds a belief is inversely related to the truth of that belief. Fanatics are true believers, scientists are sceptics”. (Beck et al, 1979)I propose to describe the evolution of behavioural treatments, and the more recent leap forward made by cognitive therapy. Exciting new treatments are now available that did not exist when I was a trainee. The accepted term for these treatments is “behavioural-cognitive psychotherapy’ (BCPT). They are behavioural in the sense that emphasis is on observable behaviour, e.g. avoidance of supermarkets in agoraphobia. They are cognitive because many approaches involve working with patients' thoughts, e.g. the negative thinking of depressed patients. The treatment is psychotherapy as it is therapy that works at the mind level, rather than at say the synaptic level as pharmacotherapy does. BCPT combines well with pharmacotherapy, and other therapeutic methods such as social therapy, and so is suitable for a multidisciplinary approach to a psychiatric problem, as well as offering specific techniques for identified disorders.
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Lawlor, Caroline, Katherine Hall, and Lyn Ellett. "Paranoia in the Therapeutic Relationship in Cognitive Behavioural Therapy for Psychosis." Behavioural and Cognitive Psychotherapy 43, no. 4 (March 11, 2014): 490–501. http://dx.doi.org/10.1017/s1352465814000071.
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Background and aims: This study explored therapists’ and clients’ experiences of paranoia about the therapist in cognitive behaviour therapy. Method: Ten therapists and eight clients engaged in cognitive behaviour therapy for psychosis were interviewed using a semi-structured interview. Data were analyzed using thematic analysis. Results: Clients reported experiencing paranoia about their therapist, both within and between therapy sessions. Therapists’ accounts highlighted a number of dilemmas that can arise in responding to clients’ paranoia about them. Conclusions: The findings highlight helpful ways of working with clients when they become paranoid about their therapist, and emphasize the importance of developing a therapeutic relationship that is radically collaborative, supporting a person-based approach to distressing psychotic experience.
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Myerson, Nicole N., Neville J. King, Bruce J. Tonge, David A. Heyne, Dawn A. Young, and Helen Papadopoulos. "Cognitive-behavioural Treatment for Young People Who Have Been Sexually Abused: Developmental Considerations." Behaviour Change 17, no. 1 (April 1, 2000): 37–47. http://dx.doi.org/10.1375/bech.17.1.37.
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AbstractThis article describes the application of cognitive behavioural therapy to three sexually abused young people. We emphasise developmental influences and the nuances of the therapeutic approach. An exposure-based treatment approach was used with the youths. A multimodal assessment evaluation was conducted at pretreatment and posttreatment, and at a 3-month follow-up. Results on outcome measures indicated a positive therapeutic effect for the youths.
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Freeman, Daniel, and Philippa Garety. "Helping patients with paranoid and suspicious thoughts: a cognitive–behavioural approach." Advances in Psychiatric Treatment 12, no. 6 (November 2006): 404–15. http://dx.doi.org/10.1192/apt.12.6.404.
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Paranoid and suspicious thoughts are a significant clinical topic. They regularly occur in 10–15% of the general population, and persecutory delusions are a frequent symptom of psychosis. In the past, patients were discouraged from talking about paranoid experiences. In contrast, it is now recommended that patients are given time to talk about them, and cognitive–behavioural techniques are being used to reduce distress. In this article we present the theoretical understanding of paranoia that underpins this transformation in the treatment of paranoid thoughts and summarise the therapeutic techniques derived. Emphasis is placed on the clinician approaching the problem from a perspective of understanding and making sense of paranoid experiences rather than simply challenging paranoid thoughts. Ways of overcoming difficulties in engaging people with paranoid thoughts are highlighted.
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Watson, Maggie, Debbie Fenlon, Gillian McVey, and Maria Fernandez-Marcos. "A Support Group for Breast Cancer Patients: Development of a Cognitive-Behavioural Approach." Behavioural and Cognitive Psychotherapy 24, no. 1 (January 1996): 73–81. http://dx.doi.org/10.1017/s1352465800016842.
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Cognitive behavioural therapy has been shown to be effective in reducing anxiety and depression in cancer patients when provided within the context of individual sessions. We describe the application of a cognitive behavioural model to a group therapy context. This represents a novel approach to the psychological treatment of cancer patients. Fourteen breast cancer patients attending the Royal Marsden Hospital were included in an assessment of treatment outcome pre-and post-group therapy. Outcome was assessed using the Hospital Anxiety and Depression (HAD) Scale and a study-specific visual analog measure relating to perceived efficacy of the therapeutic techniques. Rationale and organization of group therapy is described along with the preliminary pilot study results.
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Cather, Corinne. "Functional Cognitive-Behavioural Therapy: A Brief, Individual Treatment for Functional Impairments Resulting from Psychotic Symptoms in Schizophrenia." Canadian Journal of Psychiatry 50, no. 5 (April 2005): 258–63. http://dx.doi.org/10.1177/070674370505000504.
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This paper describes a novel cognitive-behavioural approach to treating psychotic symptoms—functional cognitive-behavioural therapy (FCBT)—which was developed with the primary aim of remediating social functioning deficits in patients with residual psychotic symptoms. In FCBT, symptom-focused cognitive-behavioural therapy (CBT) interventions are delivered in the context of working on functional goals: a premise of FCBT is that the therapeutic alliance and patient motivation are enhanced by linking interventions to life goals. The paper outlines the rationale for expanding existing approaches to target social functioning impairment and uses case illustrations to exemplify particular phases of treatment as well as specific CBT interventions. Results from a pilot study of FCBT are summarized, together with suggestions for new research directions.
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Easterbrook, Cheryl Joy, and Trudy Meehan. "The therapeutic relationship and Cognitive Behavioural Therapy: A case study of an adolescent girl with depression." European Journal of Counselling Psychology 6, no. 1 (February 14, 2017): 1–24. http://dx.doi.org/10.5964/ejcop.v6i1.85.
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The therapeutic relationship in Cognitive Behavioural Therapy (CBT) has been argued to play an essential role in positive outcomes in therapy. However, it is described as necessary and yet, secondary to technique, often receiving little attention in the training of CBT therapists. This case study explores a trainee psychologist’s experience of finding difficulty in feeling authentic and the application of CBT techniques with her client. This difficulty informed the research question; what is the value of the therapeutic relationship in CBT? A hermeneutic approach with a strong emphasis on phenomenology, is used to explore the therapeutic process and the therapeutic relationship that developed between therapist and client. Qualitative descriptions of 11 sessions are divided into themes, these are discussed in relation to what happened in therapy, and are then discussed further regarding discovery and process into the therapeutic relationship. Conclusions from this case study could possibly reveal the value of the therapeutic relationship when working from a CBT approach, and how it seemed to enable the client to achieve her goal in therapy.
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Wood, Lisa, Eilish Burke, and Anthony Morrison. "Individual Cognitive Behavioural Therapy for Psychosis (CBTp): A Systematic Review of Qualitative Literature." Behavioural and Cognitive Psychotherapy 43, no. 3 (December 5, 2013): 285–97. http://dx.doi.org/10.1017/s1352465813000970.
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Background: Individual Cognitive Behaviour Therapy for psychosis (CBTp) is the first line recommended psychological intervention for adults diagnosed with schizophrenia. However, little is yet known about service users’ subjective experiences of CBTp. Aims: This study aimed to conduct a systematic review of qualitative literature to examine service user perspective of CBTp. Method: A thematic synthesis of qualitative studies examining service users’ experiences of CBTp was conducted. A total of six studies were included in the analysis. Results: Three superordinate themes were identified: therapeutic alliance; facilitating change; and challenges of applying CBTp. Conclusion: Overall, CBTp is a helpful and acceptable therapeutic approach to service users. Developing a collaborative therapeutic relationship is essential. The applications of CBTp can be problematic and the therapist and client need to work together to overcome these difficulties.
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Tigaret, Cezar M., Tzu-Ching E. Lin, Edward R. Morrell, Lucy Sykes, Anna L. Moon, Michael C. O’Donovan, Michael J. Owen, et al. "Neurotrophin receptor activation rescues cognitive and synaptic abnormalities caused by hemizygosity of the psychiatric risk gene Cacna1c." Molecular Psychiatry 26, no. 6 (February 17, 2021): 1748–60. http://dx.doi.org/10.1038/s41380-020-01001-0.
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AbstractGenetic variation in CACNA1C, which encodes the alpha-1 subunit of CaV1.2 L-type voltage-gated calcium channels, is strongly linked to risk for psychiatric disorders including schizophrenia and bipolar disorder. To translate genetics to neurobiological mechanisms and rational therapeutic targets, we investigated the impact of mutations of one copy of Cacna1c on rat cognitive, synaptic and circuit phenotypes implicated by patient studies. We show that rats hemizygous for Cacna1c harbour marked impairments in learning to disregard non-salient stimuli, a behavioural change previously associated with psychosis. This behavioural deficit is accompanied by dys-coordinated network oscillations during learning, pathway-selective disruption of hippocampal synaptic plasticity, attenuated Ca2+ signalling in dendritic spines and decreased signalling through the Extracellular-signal Regulated Kinase (ERK) pathway. Activation of the ERK pathway by a small-molecule agonist of TrkB/TrkC neurotrophin receptors rescued both behavioural and synaptic plasticity deficits in Cacna1c+/− rats. These results map a route through which genetic variation in CACNA1C can disrupt experience-dependent synaptic signalling and circuit activity, culminating in cognitive alterations associated with psychiatric disorders. Our findings highlight targeted activation of neurotrophin signalling pathways with BDNF mimetic drugs as a genetically informed therapeutic approach for rescuing behavioural abnormalities in psychiatric disorder.
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COLLINS, S., and J. R. CUTCLIFFE. "Addressing hopelessness in people with suicidal ideation: building upon the therapeutic relationship utilizing a cognitive behavioural approach." Journal of Psychiatric and Mental Health Nursing 10, no. 2 (March 27, 2003): 175–85. http://dx.doi.org/10.1046/j.1365-2850.2003.00573.x.
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Kahn, Julia B., Russell G. Port, Cuiyong Yue, Hajime Takano, and Douglas A. Coulter. "Circuit-based interventions in the dentate gyrus rescue epilepsy-associated cognitive dysfunction." Brain 142, no. 9 (July 30, 2019): 2705–21. http://dx.doi.org/10.1093/brain/awz209.
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Abstract Temporal lobe epilepsy is associated with significant structural pathology in the hippocampus. In the dentate gyrus, the summative effect of these pathologies is massive hyperexcitability in the granule cells, generating both increased seizure susceptibility and cognitive deficits. To date, therapeutic approaches have failed to improve the cognitive symptoms in fully developed, chronic epilepsy. As the dentate’s principal signalling population, the granule cells’ aggregate excitability has the potential to provide a mechanistically-independent downstream target. We examined whether normalizing epilepsy-associated granule cell hyperexcitability—without correcting the underlying structural circuit disruptions—would constitute an effective therapeutic approach for cognitive dysfunction. In the systemic pilocarpine mouse model of temporal lobe epilepsy, the epileptic dentate gyrus excessively recruits granule cells in behavioural contexts, not just during seizure events, and these mice fail to perform on a dentate-mediated spatial discrimination task. Acutely reducing dorsal granule cell hyperactivity in chronically epileptic mice via either of two distinct inhibitory chemogenetic receptors rescued behavioural performance such that they responded comparably to wild type mice. Furthermore, recreating granule cell hyperexcitability in control mice via excitatory chemogenetic receptors, without altering normal circuit anatomy, recapitulated spatial memory deficits observed in epileptic mice. However, making the granule cells overly quiescent in both epileptic and control mice again disrupted behavioural performance. These bidirectional manipulations reveal that there is a permissive excitability window for granule cells that is necessary to support successful behavioural performance. Chemogenetic effects were specific to the targeted dorsal hippocampus, as hippocampal-independent and ventral hippocampal-dependent behaviours remained unaffected. Fos expression demonstrated that chemogenetics can modulate granule cell recruitment via behaviourally relevant inputs. Rather than driving cell activity deterministically or spontaneously, chemogenetic intervention merely modulates the behaviourally permissive activity window in which the circuit operates. We conclude that restoring appropriate principal cell tuning via circuit-based therapies, irrespective of the mechanisms generating the disease-related hyperactivity, is a promising translational approach.
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Hull, A., J. Swan, and R. McVicar. "Treating Chronic Depression with Cognitive Behavioural Analysis System of Psychotherapy (CBASP)." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70255-x.
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Background:Patients with Chronic Depression present particular challenges to psychological therapists and the evidence base for CBT with this disorder is weak. However, a large multi-centre clinical trial has demonstrated that Cognitive Behavioural Analysis System of Psychotherapy (CBASP) can be an effective therapy for chronic depression. In CBASP, patients learn how their cognitive and behavioural patterns produce and perpetuate interpersonal problems and how to alter maladaptive patterns of interpersonal behaviour. CBASP focuses primarily on problematic interpersonal situations in the everyday lives of people with chronic depression using a structured intervention called situational analysis. In addition, it places considerable emphasis on the therapeutic relationship as a vehicle for change using a methodology termed disciplined personal involvement. Clinical experience to date suggests that CBASP can be a very effective approach for a difficult to treat disorder.Objectives:In this didactic workshop combining opportunities to hear/see actual CBASP therapy carried out individuals will learn about the model and therapy process and key mechanisms of change will be discussed with role-play used where appropriate to illustrate specific techniques. The theoretical model underpinning CBASP and the empirical evidence will be outlined.
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Alvarez-Jimenez, Mario, Darryl Wade, Sue Cotton, Donna Gee, Tracey Pearce, Kingsley Crisp, Patrick D. McGorry, and John F. Gleeson. "Enhancing Treatment Fidelity in Psychotherapy Research: Novel Approach to Measure the Components of Cognitive Behavioural Therapy for Relapse Prevention in First-Episode Psychosis." Australian & New Zealand Journal of Psychiatry 42, no. 12 (January 1, 2008): 1013–20. http://dx.doi.org/10.1080/00048670802512057.
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Objectives: Establishing treatment fidelity is one of the most important aspects of psychotherapy research. Treatment fidelity refers to the methodological strategies used to examine and enhance the reliability and validity of psychotherapy. This study sought to develop and evaluate a measure specifically designed to assess fidelity to the different therapeutic components (i.e. therapy phases) of the individual intervention of a psychotherapy clinical trial (the EPISODE II trial). Method: A representative sample of sessions stratified by therapy phase was assessed using a specifically developed fidelity measure (Relapse Prevention Therapy–Fidelity Scale, RPT-FS). Each RPT-FS subscale was designed to include a different component/phase of therapy and its major therapeutic ingredients. Results: The measure was found to be reliable and had good internal consistency. The RPT-FS discriminated, almost perfectly, between therapy phases. The analysis of the therapeutic strategies implemented during the intervention indicated that treatment fidelity was good throughout therapy phases. While therapists primarily engaged in interventions from the appropriate therapeutic phase, flexibility in therapy was evident. Conclusions: This study described the development of a brief, reliable and internally consistent measure to determine both treatment fidelity and the therapy components implemented throughout the intervention. This methodology can be potentially useful to determine those components related to therapeutic change.
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Benelmouloud, O., and M. Benabbas. "Difference effect between the psychotherapeutic and chemotherapeutic treatment in treating the panic disorder." European Psychiatry 30, S2 (November 2015): S160—S161. http://dx.doi.org/10.1016/j.eurpsy.2015.09.324.
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ObjectivesThe use of CBT remains the recent techniques in Algeria and its introduction in the therapeutic arsenal field; already insufficient, finds resistances from the part of some practitioners. It is about the study showing the interest of cognitive and behavioural treatment in the panic disorder with agoraphobia.MethodologyIt is about the comparative study of the two types of the population presenting the diagnosis of a panic disorder with agoraphobia. The first group will be treated by antidepressors and the others by the cognitive behavioural treatment. The first population estimated to 50 patients receive only the antidepressors (anafranil) and the other of 50 patients receive the technique of cognitive and behavioural treatment. The two populations will be selected according to the randomisation principle. The study duration is of 3 months and the assessment is done at a day 0, 7, 14, 30 and 90 according to Cottraux anxiety scale and file automatic thought of Beek. The data (given in formation) of scales of two groups will be compared before the first day and the end of the medical care. This comparison will be done by statistical inductive tools for each group 5 to determine if it has a therapeutic effects or not) and between two groups to determine if the psychotherapic access (approach) possess equal therapeutic effects better than chemotherapy.ConclusionThe CBT widely finds its place in Algeria because it offers others characteristics: less onerous, limited in time, easy to practise, variability of techniques. The contribution of the patient in his therapeutic project with an active way. All the patients can be benefited whatever is their associeted organic defects, in reverse the medicines or the indesirable effects and the contra-indications limit its utilization. In Algeria, the practice of this structured psychotherapy is rare and it will be wished that short cycles of formation must be prodigal for the treated personal with psychiatry (nurses, psychologists, students, psychiatrists and general practitioners). To think of introducing a specialized psychotherapy courses for the medical students at the end of the cycle in frame of medical psychology module.
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Sadavoy, Joel. "Integrated Psychotherapy for the Elderly." Canadian Journal of Psychiatry 39, no. 8_suppl (October 1994): 19–26. http://dx.doi.org/10.1177/070674379403908s04.
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The complexity of interacting variables in the geriatric patient imposes the therapeutic necessity to employ all effective therapeutic modalities in an interactive and integrated fashion. This paper examines the efficacy data on brief and longer term therapies as applied to the elderly, most particularly for treatment of depression and bereavement. In determining the development of an integrated psychotherapy treatment plan, the author suggests a decision pathway which incorporates concurrent utilization of theoretical principles derived from psychodynamic, interpersonal and cognitive behavioural theory. This tripartite approach informs the assessment and diagnosis of the patient as well as the specific choice of therapy. Directions for further research are suggested.
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Beshay, E. V. N., S. A. El-Refai, G. S. Sadek, A. A. Elbadry, F. H. Shalan, and A. F. Afifi. "Mesenchymal stem cells combined with albendazole as a novel therapeutic approach for experimental neurotoxocariasis." Parasitology 147, no. 7 (March 17, 2020): 799–809. http://dx.doi.org/10.1017/s003118202000044x.
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AbstractNeurotoxocariasis (NT) is a serious condition that has been linked to reduced cognitive function, behavioural alterations and neurodegenerative diseases. Unfortunately, the available drugs to treat toxocariasis are limited with unsatisfactory results, because of the initiation of treatment at late chronic stages after the occurrence of tissue damage and scars. Therefore, searching for a new therapy for this important disease is an urgent necessity. In this context, cytotherapy is a novel therapeutic approach for the treatment of many diseases and tissue damages through the introduction of new cells into the damaged sites. They exert therapeutic effects by their capability of renewal, differentiation into specialized cells, and being powerful immunomodulators. The most popular cell type utilized in cytotherapy is the mesenchymal stem cells (MSCs) type. In the current study, the efficacy of MSCs alone or combined with albendazole was evaluated against chronic brain insults induced by Toxocara canis infection in an experimental mouse model. Interestingly, MSCs combined with albendazole demonstrated a healing effect on brain inflammation, gliosis, apoptosis and significantly reduced brain damage biomarkers (S100B and GFAP) and T. canis DNA. Thus, MSCs would be protective against the development of subsequent neurodegenerative diseases with chronic NT.
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Halford, Kim, and Matt Sanders. "Behavioural Marital Therapy: Current Status, Limitations, and Directions for Further Research." Behaviour Change 2, no. 1 (March 1985): 36–42. http://dx.doi.org/10.1017/s0813483900008780.
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Behavioural marital therapy (BMT) is a promising approach to the pervasive concern of lack of marital satisfaction. BMT produces gains in marital satisfaction which are statistically significantly superior to no treatment controls. However when more stringent criteria for success are applied, which are of greater clinical relevance, success rates are moderate. It is argued the limitations of BMT efficacy may be due to three faults in the current conceptualization and practice of BMT. Firstly, while some recognition of the role of cognitions has been made, the salient cognitions of distressed couples have not been clearly described in specific social contexts. Secondly, the cognitive interventions used do not relate clearly to identified maladaptive cognitions. Finally, the generalization of therapeutic effects has been assessed insufficiently, and generalization has not been programmed into therapeutic procedures. Specific suggestions are offered which may help to help overcome these problems.
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Chandler, Robert J., Charlotte Swift, and Wendy Goodman. "Treating online inappropriate sexualised behaviour." Journal of Intellectual Disabilities and Offending Behaviour 7, no. 3 (September 12, 2016): 151–60. http://dx.doi.org/10.1108/jidob-11-2015-0045.
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Purpose The purpose of this paper is to evaluate the use of cognitive behavioural approaches to treat a gentleman with a learning disability who had been reported to the police for allegedly making contact with children using social media in an attempt to initiate a romantic relationship using a single case design. Design/methodology/approach An 11 session cognitive behavioural intervention was employed, comprising of index offence analysis, challenging distorted cognitions related to the offence, developing an internal focus for responsibility and psychoeducation with regards to “staying safe” online. Findings Follow up data demonstrated no improvements in victim empathy, nor in agreement ratings in terms of key cognitions associated with responsibility for offending behaviour. Research limitations/implications Whilst treatment efficacy was not established, this case study raises important questions that go beyond the single case design. Whilst the gentleman reported becoming “safer” in terms of initiating contact with unknown people via social media, this could not be substantiated, and is indicative of the cardinal difficulty of monitoring online recidivism. Generalisability of findings to the wider learning disability population is limited by a single case design. Originality/value This is the first published case study to the authors knowledge to evaluate cognitive behavioural approaches to reduce antisocial internet related behaviour in a forensic learning disability setting. Findings of considered within the context of the concept of minimisation of offending behaviour, the concept of “counterfeit deviance”, and also how best to measure therapeutic change within this population.
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Raggi, Alberto, Domenica Tasca, and Raffaele Ferri. "A brief essay on non-pharmacological treatment of Alzheimer’s disease." Reviews in the Neurosciences 28, no. 6 (July 26, 2017): 587–97. http://dx.doi.org/10.1515/revneuro-2017-0002.
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AbstractCurrent pharmacological therapies for Alzheimer’s disease (AD) do not modify its course and are not always beneficial. Therefore, the optimization of quality of life represents the best possible outcome achievable in all stages of the disease. Cognitive and behavioural rehabilitation represents the main therapeutic approach for this purpose, also in order to mitigate indirectly the burden of distress of family caregivers. The aim of this mini-review is to go through this theme by discussing cognitive activation, virtual reality and neuromodulation techniques. The practices summarized in this essay are not alternative but, often, complementary therapies to standardized pharmacological treatment. The present mini-review has found encouraging results but also the need for more conclusive evidence for all types of non-invasive/non-pharmacological treatment of AD.
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Gómez-de-Regil, Lizzette, Damaris F. Estrella-Castillo, and Julio Vega-Cauich. "Psychological Intervention in Traumatic Brain Injury Patients." Behavioural Neurology 2019 (May 2, 2019): 1–8. http://dx.doi.org/10.1155/2019/6937832.
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Objective. To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury. Methods. A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables. Results. The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%). Conclusions. CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.
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Carpenter, Susan P. C. "Development of a Young Man with Prader-Willi Syndrome and Secondary Functional Encopresis." Canadian Journal of Psychiatry 34, no. 2 (March 1989): 123–27. http://dx.doi.org/10.1177/070674378903400210.
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A case review of a twenty-two year old man suffering from Prader-Willi Syndrome, Secondary Functional Encopresis, mental retardation and aggressive behaviour is presented. Emphasis is made in assessing this man from various developmental perspectives. This includes: personality development, cognitive development, physical abilities, sexual development and family life stage. The role of a psychiatrist in treating this complex problem is established. An eclectic approach to treatment is reviewed using many therapeutic modalities found effective with the mentally handicapped. These modalities include: group therapy, play therapy, individual psychotherapy, behavioural therapy, family therapy, and use of medication. A literature review of Prader-Willi Syndrome is included.
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Thomas, Eileen, Juanè Voges, Bonginkosi Chiliza, Dan J. Stein, and Christine Lochner. "Sniffing out olfactory reference syndrome." South African Journal of Psychiatry 23, no. 1 (January 31, 2017): 5. http://dx.doi.org/10.4102/sajpsychiatry.v23i1.1016.
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Olfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success.
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Calabresi, Paolo, Veronica Ghiglieri, Petra Mazzocchetti, Ilenia Corbelli, and Barbara Picconi. "Levodopa-induced plasticity: a double-edged sword in Parkinson's disease?" Philosophical Transactions of the Royal Society B: Biological Sciences 370, no. 1672 (July 5, 2015): 20140184. http://dx.doi.org/10.1098/rstb.2014.0184.
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The long-term replacement therapy with the dopamine (DA) precursor 3,4-dihydroxy-l-phenylalanine (L-DOPA) is a milestone in the treatment of Parkinson's disease (PD). Although this drug precursor can be metabolized into the active neurotransmitter DA throughout the brain, its therapeutic benefit is due to restoring extracellular DA levels within the dorsal striatum, which lacks endogenous DA as a consequence of the neurodegenerative process induced by the disease. In the early phases of PD, L-DOPA treatment is able to restore both long-term depression (LTD) and long-term potentiation (LTP), two major forms of corticostriatal synaptic plasticity that are altered by dopaminergic denervation. However, unlike physiological DA transmission, this therapeutic approach in the advanced phase of the disease leads to abnormal peaks of DA, non-synaptically released, which are supposed to trigger behavioural sensitization, namely L-DOPA-induced dyskinesia. This condition is characterized by a loss of synaptic depotentiation, an inability to reverse previously induced LTP. In the advanced stages of PD, L-DOPA can also induce non-motor fluctuations with cognitive dysfunction and neuropsychiatric symptoms such as compulsive behaviours and impulse control disorders. Although the mechanisms underlying the role of L-DOPA in both motor and behavioural symptoms are still incompletely understood, recent data from electrophysiological and imaging studies have increased our understanding of the function of the brain areas involved and of the mechanisms implicated in both therapeutic and adverse actions of L-DOPA in PD patients.
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Echlin, Holly V., Diana J. Gorbet, and Lauren E. Sergio. "Assessment of a Cognitive-Motor Training Program in Adults at Risk for Developing Dementia." Canadian Geriatrics Journal 23, no. 2 (March 5, 2020): 190–98. http://dx.doi.org/10.5770/cgj.23.394.
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Background
With the prevalence of dementia increasing each year, pre-clinically implemented therapeutic interventions are needed. It has been suggested that cascading neural network failures may bring on behavioural deficits associated with Alzheimer’s disease.
Methods
Previously we have shown that cognitive-motor integration (CMI) training in adults with cognitive impairments generalized to improved global cognitive and activities of daily living scores. Here we employ a novel movement control–based training approach involving CMI rather than traditional cognition-only brain training. We hypothesized that such training would stimulate widespread neural networks and enhance rule-based visuomotor ability in at-risk individuals.
Results
We observed a significant improvement in bimanual coordination in the at-risk training group. We also observed significant decreases in movement variability for the most complex CMI condition in the at-risk and healthy training groups.
Conclusions
These data suggest that integrating cognition into action in a training intervention may be effective at strengthening vulnerable brain networks in asymptomatic adults at risk for developing dementia.
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Leoni, Mauro, Serafino Corti, and Roberto Cavagnola. "Third generation behavioural therapy for neurodevelopmental disorders: review and trajectories." Advances in Mental Health and Intellectual Disabilities 9, no. 5 (September 7, 2015): 265–74. http://dx.doi.org/10.1108/amhid-06-2015-0031.
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Purpose – The purpose of this paper is mainly to present a general review of third generation cognitive-behavioural therapies (CBTs), and to debate whether these approaches are applicable to persons with neurodevelopmental disorders (NDD). Design/methodology/approach – Despite the lack of consistent literature focused on this population, the authors have considered the available general literature on the third generation of CBTs and analysed core issues of the processes within the context of intellectual disabilities and Autism spectrum disorder. Findings – The evidence from typical developing population studies and the emerging literature specific to people with NDD is convincing, but there is a need for studies exploring how and when these therapeutic approaches can be applicable. Two behavioural approaches of third generation therapies – acceptance and commitment therapy and mindfulness-based CBT – appear to have the most potential to be adapted for robust intervention for the broad spectrum of persons with NDD. Research limitations/implications – The number of studies and methodologies applied are a clear limitation and the present paper is only exploratory. Originality/value – The paper supports clinicians to use the emerging protocols, and to replicate and implement procedures and techniques.
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Morrison, Anthony P., Heather Law, Christine Barrowclough, Richard P. Bentall, Gillian Haddock, Steven H. Jones, Martina Kilbride, et al. "Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach." Programme Grants for Applied Research 4, no. 5 (May 2016): 1–272. http://dx.doi.org/10.3310/pgfar04050.
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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Tarran-Jones, Abi, S. J. Summers, Sarah Dexter-Smith, and Sarah Craven-Staines. "Team psychological formulation to create a shared understanding of distress: a qualitative study in an older people’s mental health inpatient setting." Quality in Ageing and Older Adults 20, no. 2 (May 30, 2019): 67–79. http://dx.doi.org/10.1108/qaoa-11-2018-0056.
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Purpose Team psychological formulation is an organisational intervention aimed at developing a shared understanding of a person’s mental health difficulties. There is a lack of evidence regarding the therapeutic value of this approach for older people. The purpose of this paper is to explore how older people and their carers experience a cognitive-behavioural approach to team psychological formulation, within a mental health inpatient service in the UK. Design/methodology/approach A qualitative study using interpretative phenomenological analysis was undertaken. In total, 13 participants were interviewed: five older people/carer dyads, two lone older people and one lone carer. Findings Three overarching themes emerged: “Emotional impact of formulation” captured the mixed emotions that the process evoked in participants. “Making sense?” reflected the therapeutic value that participants experienced and what held them back from making gains in their recovery. “Disempowered people trapped in a biomedical world” illustrated the negative aspects of ward care, which hindered recovery. Research limitations/implications The findings provide insights into the therapeutic value of team psychological formulation and the difficulties in facilitating the process effectively. More consistency is required to ensure that team formulation is standardised. Further research into the outcomes of the approach for older people is recommended. Practical implications Recommendations are proposed for how team psychological formulation can be conducted effectively, using the mnemonic “SETUP”. Originality/value This study focussed on older people’s and their carers’ own perspectives regarding the team psychological formulation approach.
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Guo, Tianwei, Zhuo Guo, Wenyue Zhang, Wenhao Ma, Xinjing Yang, Xueqin Yang, Jiwon Hwang, Xiaotian He, Xinyi Chen, and Tu Ya. "Electroacupuncture and Cognitive Behavioural Therapy for Sub-Syndromal Depression among Undergraduates: A Controlled Clinical Trial." Acupuncture in Medicine 34, no. 5 (October 2016): 356–63. http://dx.doi.org/10.1136/acupmed-2015-010981.
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Background Individuals with sub-syndromal depression (SSD) are at increased risk of incident depressive disorders; however, the ideal therapeutic approach to SSD remains unknown. Objective To evaluate the effects of electroacupuncture (EA) and cognitive behavioural therapy (CBT), alone or in combination, on depressive symptoms. Methods Undergraduate students with SSD were recruited and allocated to one of four groups based on their preferences: EA (n=6), CBT (n=10), EA+CBT (n=6), and untreated control (n=11) groups. Six weeks of treatment were provided in the first three groups. Clinical outcomes were measured using the 17-item Hamilton Depression (HAMD-17) rating scale, Center for Epidemiologic Depression (CES-D) scale, WHO Quality of Life-Brief version (WHOQOL-BREF) questionnaire, and clinical remission rate. Results All 33 subjects were included in an intent-to-treat analysis. Statistically significant improvements in HAMD-17, CES-D, and WHOQOL-BREF scores and a higher remission rate were found in the EA, CBT, and EA+CBT intervention groups compared with the control group (all p<0.05). No significant differences were found between the three intervention groups. HAMD-17 factor score analysis revealed that EA reduced sleep disturbance scores more than CBT or EA+CBT (p<0.05), and CBT reduced retardation scores more than EA (p<0.01). EA+CBT reduced anxiety/somatisation scores more than EA or CBT (p<0.05) and retardation scores more than EA (p<0.05). Conclusions Early intervention may alleviate depressive symptoms in SSD. EA and CBT may have differential effects on certain symptoms. Combination therapy targeting both physical and psychological symptoms may represent an ideal strategy for SSD intervention. However, randomised trials with larger sample sizes are needed. Trial Registration Number ChiCTR-TRC-10000889; Results.
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Lorenz, Romy, Michelle Johal, Frederic Dick, Adam Hampshire, Robert Leech, and Fatemeh Geranmayeh. "A Bayesian optimization approach for rapidly mapping residual network function in stroke." Brain 144, no. 7 (March 16, 2021): 2120–34. http://dx.doi.org/10.1093/brain/awab109.
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Abstract Post-stroke cognitive and linguistic impairments are debilitating conditions, with limited therapeutic options. Domain-general brain networks play an important role in stroke recovery and characterizing their residual function with functional MRI has the potential to yield biomarkers capable of guiding patient-specific rehabilitation. However, this is challenging as such detailed characterization requires testing patients on multitudes of cognitive tasks in the scanner, rendering experimental sessions unfeasibly lengthy. Thus, the current status quo in clinical neuroimaging research involves testing patients on a very limited number of tasks, in the hope that it will reveal a useful neuroimaging biomarker for the whole cohort. Given the great heterogeneity among stroke patients and the volume of possible tasks this approach is unsustainable. Advancing task-based functional MRI biomarker discovery requires a paradigm shift in order to be able to swiftly characterize residual network activity in individual patients using a diverse range of cognitive tasks. Here, we overcome this problem by leveraging neuroadaptive Bayesian optimization, an approach combining real-time functional MRI with machine-learning, by intelligently searching across many tasks, this approach rapidly maps out patient-specific profiles of residual domain-general network function. We used this technique in a cross-sectional study with 11 left-hemispheric stroke patients with chronic aphasia (four female, age ± standard deviation: 59 ± 10.9 years) and 14 healthy, age-matched control subjects (eight female, age ± standard deviation: 55.6 ± 6.8 years). To assess intra-subject reliability of the functional profiles obtained, we conducted two independent runs per subject, for which the algorithm was entirely reinitialized. Our results demonstrate that this technique is both feasible and robust, yielding reliable patient-specific functional profiles. Moreover, we show that group-level results are not representative of patient-specific results. Whereas controls have highly similar profiles, patients show idiosyncratic profiles of network abnormalities that are associated with behavioural performance. In summary, our study highlights the importance of moving beyond traditional ‘one-size-fits-all’ approaches where patients are treated as one group and single tasks are used. Our approach can be extended to diverse brain networks and combined with brain stimulation or other therapeutics, thereby opening new avenues for precision medicine targeting a diverse range of neurological and psychiatric conditions.
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Sharma, Pallavi, Amit Kumar, and Damanpreet Singh. "Dietary Flavonoids Interaction with CREB-BDNF Pathway: An Unconventional Approach for Comprehensive Management of Epilepsy." Current Neuropharmacology 17, no. 12 (November 12, 2019): 1158–75. http://dx.doi.org/10.2174/1570159x17666190809165549.
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cAMP response element binding protein (CREB) is a key transcriptional regulator that regulates the transcription of genes related with neuronal differentiation, synaptic plasticity, learning and memory. Brain derived neurotrophic factor (BDNF), is a CREB dependent gene which plays a pivotal role in the pathogenesis of epilepsy and central comorbid conditions associated with epilepsy. However, the beneficial or detrimental consequences of CREB-BDNF activation on the induction and/or progression of seizures depend specifically on the region of brain involved and the time of activation. The bioactive molecules that alter the activity of CREB in a way to have specialized effects in different brain regions and neural circuits involved could potentially be utilized for therapeutic purposes. Flavonoids are the polyphenolic compounds which lead to phosphorylation of CREB in the hippocampus, followed by increase in extracellular signal regulated kinase (ERK) and BDNF. Several members of flavonoid family have also showed suppression of epileptic seizures via interaction with CREB/BDNF pathway. Moreover, epilepsy is often accompanied by a number of behavioural and psychological comorbid conditions that further gets aggravated by the use of conventional antiepileptic drug therapy. Multiple studies have also supported the beneficial effects of flavonoids in cognitive and memory impairments by upregulation of CREB-BDNF pathway. The current review is an attempt to collate the available preclinical and clinical studies to establish the therapeutic potential of various dietary flavonoids in comprehensive management of epilepsy with relation to CREB-BDNF pathway.
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Brakemeier, E. L., and M. Berger. "ECP07-01 - Cbasp workshop - introduction into the cognitive - behavioral analysis system of psychotherapy (cbasp) to treat depression." European Psychiatry 26, S2 (March 2011): 1804. http://dx.doi.org/10.1016/s0924-9338(11)73508-8.
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The Cognitive Behavioral Analysis of Psychotherapy (CBASP) by James McCullough is the only psychotherapeutic intervention specifically designed for chronic forms of depression. CBASP integrates behavioural, cognitive, interpersonal, and psychodynamic theories and strategies.The approach focuses on problems resulting from maltreatment and inhibition of maturation in early childhood by using the therapeutic relationship in a personal disciplined way. In addition, other interpersonal strategies such as the Significant Other History, the proactive Transference Hypothesis, and the Interpersonal Discrimination Exercise are used to overcome preoperational thinking. By means of another specific technique, the Situation Analysis, patients learn to focus on the negative consequences of their usual behaviour and to use efficient social problem-solving strategies.In a large study involving over 600 patients with chronic Major Depression, CBASP proved to be effective. The combination of an antidepressant and CBASP was the most beneficial treatment condition. Particularly effective was CBASP for the subgroup of chronically depressives with an early childhood trauma.In the workshop the theoretical basis will be taught, the specific techniques will be shown by live and video demonstrations, and they will be practised.
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Wan Mohd Yunus, Wan Mohd Azam, Peter Musiat, and June S. L. Brown. "Systematic review of universal and targeted workplace interventions for depression." Occupational and Environmental Medicine 75, no. 1 (October 26, 2017): 66–75. http://dx.doi.org/10.1136/oemed-2017-104532.
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Depression is increasingly being recognised as a significant mental health problem in the workplace contributing to productivity loss and economic burden to organisations. This paper reviews recently published randomised controlled trials (RCTs) of universal and targeted interventions to reduce depression in the workplace. Studies were identified through searches of EMBASE, MEDLINE/PubMed, PsycINFO, PsycARTICLES Full Text, and Global Health and Social Policy and Practice databases. Studies were included if they included an RCT of a workplace intervention for employees targeting depression as the primary outcome. Twenty-two published RCTs investigating interventions utilising various therapeutic approaches were identified. The cognitive behavioural therapy (CBT) approach is the most frequently used in the workplace, while interventions that combine different therapeutic approaches showed the most promising results. A universal intervention in the workplace that combines CBT and coping flexibility recorded the highest effect size (d=1.45 at 4 months’ follow-up). Most interventions were delivered in group format and showed low attrition rates compared with other delivery formats. Although all studies reviewed were RCTs, the quality of reporting is low. Interventions using different therapeutic approaches with different modes of delivery have been used. Most of these interventions were shown to reduce depression levels among employees in the workplace, particularly those that combine more than one therapeutic approaches.
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Moritz, S., R. Veckenstedt, S. Randjbar, F. Vitzthum, and T. S. Woodward. "Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms." Psychological Medicine 41, no. 9 (January 28, 2011): 1823–32. http://dx.doi.org/10.1017/s0033291710002618.
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BackgroundAlthough antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium-effect size range and at least 50% of patients discontinue medication in the course of treatment. Hence, clinical researchers are intensively looking for complementary therapeutic options. Metacognitive training for schizophrenia patients (MCT) is a group intervention that seeks to sharpen the awareness of schizophrenia patients on cognitive biases (e.g. jumping to conclusions) that seem to underlie delusion formation and maintenance. The present trial combined group MCT with an individualized cognitive-behavioural therapy-oriented approach entitled individualized metacognitive therapy for psychosis (MCT+) and compared it against an active control.MethodA total of 48 patients fulfilling criteria of schizophrenia were randomly allocated to either MCT+ or cognitive remediation (clinical trial NCT01029067). Blind to intervention, both groups were assessed at baseline and 4 weeks later. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS). Jumping to conclusions was measured using a variant of the beads task.ResultsPANSS delusion severity declined significantly in the combined MCT treatment compared with the control condition. PSYRATS delusion conviction as well as jumping to conclusions showed significantly greater improvement in the MCT group. In line with prior studies, treatment adherence and subjective efficacy was excellent for the MCT.ConclusionsThe results suggest that the combination of a cognition-oriented and a symptom-oriented approach ameliorate psychotic symptoms and cognitive biases and represents a promising complementary treatment for schizophrenia.
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Keightley, Michelle, Sabrina Agnihotri, Sivaniya Subramaniapillai, Julia Gray, Jennifer Keresztesi, Angela Colantonio, Helene J. Polatajko, Debra Cameron, and Catherine Wiseman-Hakes. "Investigating a theatre-based intervention for Indigenous youth with fetal alcohol spectrum disorder." Canadian Journal of Occupational Therapy 85, no. 2 (February 20, 2018): 128–36. http://dx.doi.org/10.1177/0008417417719722.
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Background. Theatre-based interventions use artistic media to facilitate social and emotional awareness and have therapeutic benefits for persons with developmental disabilities and mental health problems. The role of these interventions with Indigenous youth who have emotional, behavioural, and cognitive sequelae related to fetal alcohol spectrum disorder (FASD) has not been explored. Purpose. The purpose of this study was to explore the experiences and acceptability of a theatre-based approach for facilitating social communication and engagement in youth with FASD. Method. Participants were three Indigenous youth with FASD. A qualitative exploration of the experiences and acceptability of the intervention was conducted via focus groups held 2 weeks post–program participation with the participants, their caregivers, and program facilitators. The transcripts were analyzed using an inductive thematic approach. Findings. Our results identified perceived postintervention improvements in participants’ development of self-esteem, social skills, and emotional awareness. Implications. A theatre-based arts intervention has the potential to support improvements in social skills for youth with FASD.
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Carona, Carlos, Daniel Rijo, Céu Salvador, Paula Castilho, and Paul Gilbert. "Compassion-focused therapy with children and adolescents." BJPsych Advances 23, no. 4 (July 2017): 240–52. http://dx.doi.org/10.1192/apt.bp.115.015420.
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SummaryCompassion-focused therapy (CFT) is embedded in an evolutionary, functional analysis of psychopathology, with a focus on affiliative, caring and compassion processes. CFT has been applied in a number of adult settings, but its clinical applications in child and adolescent psychopathology and psychotherapy have not been systematically explored. This article describes the applications of CFT in paediatric populations. Specifically, the following developmental considerations are discussed: the unique importance of parent-child and attachment relationships for the development of self-compassion, being open to compassion from others and being compassionate to others; the potential effect of com passion training on the maturing brain (affective regulation systems); and the therapeutic targeting of shame and self-criticism to alleviate psychological distress and enhance the effectiveness of cognitive-behavioural interventions.Learning Objectives• Understand and differentiate the three affect regulation systems and their links to different forms of child and adolescent psychopathology• Recognise the main components of compassionate mind training with children and adolescents, and related specific therapeutic strategies and exercises• Acknowledge the importance of adopting a parent-child approach in CFT
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Saperstein, Alice M., and Matthew M. Kurtz. "Current Trends in the Empirical Study of Cognitive Remediation for Schizophrenia." Canadian Journal of Psychiatry 58, no. 6 (June 2013): 311–18. http://dx.doi.org/10.1177/070674371305800602.
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Cognitive remediation (CR) for schizophrenia is a learning-based behavioural skills training intervention designed to enhance neuro and (or) social cognitive skills, with the ultimate goal of generalization to improve psychosocial outcomes. This review summarizes conceptual approaches to CR for schizophrenia and the evidence for efficacy in clinical research settings. Four issues are at the forefront of ongoing research: the identification of techniques that produce the largest cognitive change, delineation of techniques that enhance transfer of cognitive skills to functional skills, the identification of CR methods that can be personalized to meet the specific cognitive and functional needs of each individual, and, all the while, ensuring that when CR methods are developed in a research setting, they remain scalable for delivery in the larger clinical community. In response to these issues, 3 prominent research trends have emerged: the rise of a new generation of computerized restorative cognitive training, the integration of CR with skills training to promote generalization, and the application of techniques to enhance motivation and learning during CR. As data on the neural basis of learning in people with schizophrenia become available, new technologies that harness the ability of the brain to make sustainable, functional changes may be integrated within a therapeutic context that promotes a personalized approach to learning. The development of transportable and scalable methods of CR that maximize the ability of people with schizophrenia to improve cognition will help them achieve personal goals for recovery.
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Annesley, Phyllis, Leonie Davison, Chris Colley, Liz Gilley, and Louise Thomson. "Developing and evaluating interventions for women firesetters in high secure mental healthcare." Journal of Forensic Practice 19, no. 1 (February 13, 2017): 59–76. http://dx.doi.org/10.1108/jfp-12-2015-0054.
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Purpose The purpose of this paper is to discuss the implementation and evaluation of interventions for women firesetters in high secure mental healthcare at the UK’s National Women’s Service. Design/methodology/approach Two types of Arson treatment programmes for women, one delivered to individuals, the other within a group context, were developed, delivered and evaluated. The evaluation incorporated qualitative and quantitative data, including psychometric measures. Qualitative data were analysed using thematic analysis. Findings The evaluation evidenced very high engagement with and attendance at treatment programmes, and several post-treatment gains. Participants’ ratings of programmes and qualitative feedback were similarly very positive. The study demonstrated that engaging women firesetters in their treatment is paramount and can be facilitated by consistent boundaries around therapy provision balanced with sensitivity, empathy and flexibility; providing interactive and varied teaching methods; ongoing service user involvement and recognising participants’ achievements; employing a mixed cognitive analytic therapy and cognitive behavioural therapy therapeutic approach; having input from fire service staff; and maintaining organisational support for firesetting interventions. Practical implications In all, 12 key recommendations are made for clinicians considering offering treatment programmes for women firesetters. Originality/value Amid few published papers on treating women firesetters this paper guides forensic clinicians in establishing and delivering interventions for women firesetters.
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Brandão, D., T. Assunção, and H. Almeida. "Invisible Effects of Chemotherapy." European Psychiatry 41, S1 (April 2017): S668. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1138.
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IntroductionChemotherapy is an essential component in the treatment and alleviation of oncological diseases. To your application are associated, as well as systemic effects, cognitive impairment in patients. These changes have received increasing attention due to the impact on quality of life of cancer survivors.ObjectivesThis study aims to evaluate the current evidence on the association between chemotherapy and cognitive impairment in cancer patients, especially in the areas affected cognitive function, possible mechanisms of action and consequences on the quality of life of these patients and the importance of identifying strategies intervention in order to minimize these effects.MethodsWe conducted a literature review from literature articles addressing this topic with use of databases: Medline and Pubmed. The following keywords were used: “chemobrain”, “cognitive dysfunction”, “chemotherapy”.ResultsAlthough some states have not found differences, several studies have shown that chemotherapy has implications cognitively. Underlying etiology remains unknown, and proposed several mechanisms to explain these changes: neurotoxicity, microvascular damage and inflamamatory response. Cognitive impairment has significant implications in the daily life of patients both personally, socially and labour. The therapeutic approach focuses on the patient and family education, coping strategies, cognitive rehabilitation and cognitive behavioural therapy.ConclusionsIt is vital to educate patients about the possibility of cognitive change as effect of chemotherapy as well as health professionals in the early identification of these changes. It is essential developing specific intervention strategies to improve the quality of life of the oncologic patient during and after treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Young, Hannah. "Conceptualising bereavement in profound and multiple learning disabilities." Tizard Learning Disability Review 21, no. 4 (October 3, 2016): 186–98. http://dx.doi.org/10.1108/tldr-09-2015-0035.
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Purpose Bereavement and loss are key factors in poor emotional wellbeing among people with profound and multiple learning disabilities (PMLD). However, little attention has been drawn to this group in the grief and disability literature. The purpose of this paper is to make sense of bereavement and loss in people with PMLD, with reference to theoretical contributions to the field and studies of grief reactions. Design/methodology/approach A systematic review revealed 34 relevant published works. These were analysed for relevant contributions. Findings Three main types of theoretical contributions have been made; traditional grief theories, cognitive approaches and attachment-based perspectives. Although a limited number of case studies exist, a range of grief reactions have been reported in people with PMLD. Traditional grief theories and cognitive approaches are somewhat limited in making sense of grief responses in this group, while attachment-based perspectives may prove useful in providing theoretical and therapeutic direction. Research limitations/implications Further research is required to more accurately describe the nature of relationships in people with PMLD. Practical implications Major contributions to the field point to the value of facilitating engagement with the grieving process, through communication around the loss and training for staff. In addition, attachment-based perspectives are offering routes for establishing therapeutic relationships that may help to resolve behavioural difficulties. Originality/value This paper provides an overview of the perspectives within bereavement and disability, drawing together clear theoretical frameworks for future research and practice.
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Vigano, Antonio, and Eduardo Bruera. "Pain Management in Functional Gastrointestinal Disorders." Canadian Journal of Gastroenterology 9, no. 2 (1995): 85–90. http://dx.doi.org/10.1155/1995/802590.
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Pain is a common feature in functional gastrointestinal disorders (FGID). An abnormally low visceral sensory threshold, as well as a number of central, spinal and peripheral pain-modulating abnormalities, have been proposed for this syndrome. Clinical aspects of pain associated with irritable esophagus, functional dyspepsia, biliary dysmotility, inflammatory bowel syndrome and proctalgia fugax are reviewed. Because of its unclear pathophysiology, pain expression is the main target for the successful assessment and management of symptomatic FGID. The sensory, cognitive and affective components of pain intensity expression need to be addressed in the context of a good physician-patient rapport. A multidisciplinary team approach is ideal for the smaller subset of patients with severe and disabling symptoms. Although pharmacotherapy may target specific functional disorders, the role of behavioural techniques and psychotherapy appears much more important for pain management in FGID. Functional performance and quality of life improvement, rather than pain intensity, are the main therapeutic goals in these patients.
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Rivano Fischer, Marcelo, Marie-Louise Schult, Monika Löfgren, and Britt-Marie Stålnacke. "Do quality of life, anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive–behavioural therapy-based programmes." Journal of International Medical Research 49, no. 7 (July 2021): 030006052110274. http://dx.doi.org/10.1177/03000605211027435.
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Objective Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive–behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes. Methods We used a retrospective multicentre pretest–posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions. Results Neither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres. Conclusions These findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.
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Rudnitsky, V., V. B. Nikitina, M. M. Axenov, N. P. Garganeeva, and E. D. Schastnyy. "Stability of Results of Treatment and Therapeutic Compliance of Patients with Organic Non-psychotic Mental Disorders." European Psychiatry 41, S1 (April 2017): S716. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1286.
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IntroductionNon-psychotic mental disorders of organic register tend to have protracted progressive course, to respond poorly to treatment. Traditionally it is explained by features of cerebral-organic process. However, affective, behavioural and cognitive disturbances can be complicated by medico-social problems including treatment-related.ObjectiveTo analyse efficiency and stability of results of the therapy of organic mental disorders and propose approaches and means of their improvement.MethodsClinical-psychopathological, epidemiological, clinical-dynamic, catamnestic, experimental-psychological, medical statistics.ResultsThe most frequent causes of decompensations of organic mental disorders in patients with positive results of the therapy were analyzed. Sixty-four percent (58 patients) after 6 months showed partial recurrence of symptoms and after a year the condition practically returned to the initial one. However, only 12.22% (11 patients) passed recommended course of maintenance therapy to sufficiently full extent, 23.33% (21 persons) have discontinued it due to subjective causes during a month after discharge, about 2/3 of patients during the first two months of the therapy. Patients showed low indicators of therapeutic compliance, low level of therapeutic alliance, little familiarity with the illness and treatment and unrealistic expectations about prospects of the therapy. During insignificant difficulties in the therapy, it usually was discontinued and renewed during relapse of symptoms. A medico-social approach with support of psychotherapeutic and psycho-corrective work and information educational programs were developed.ConclusionProposed psychotherapeutic and educational approach heightens efficiency and stability of treatment and can serve a basis for further improvement of psychiatric, psychotherapeutic and medico-social assistance for patients with organic mental disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Törnquist, Anna, Sarah Rakovshik, Jan Carlsson, and Joakim Norberg. "How Supervisees on a Foundation Course in CBT Perceive a Supervision Session and what they Bring Forward to the Next Therapy Session." Behavioural and Cognitive Psychotherapy 46, no. 3 (September 14, 2017): 302–17. http://dx.doi.org/10.1017/s1352465817000558.
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Background: There is limited research into the effect of supervision in cognitive behavioural therapy (CBT) from the supervisees’ perspective. Aims: The aim of the study was to acquire knowledge from the supervisees’ perspective as to what in particular in the supervision process contributes to the therapy process. Method: Fourteen supervisees on a foundation course participated in the study. A qualitative approach was used with thematic analysis of the participants’ written diaries after supervision and therapy sessions. Results: Analyses of supervisees’ experiences suggested that a variety of therapeutic interventions were easier to implement if one had the supervisor's support and felt free to decide if and when the suggested interventions could best be implemented. Evaluation in the form of positive feedback from the supervisor indicating that the supervisee was ‘doing the right thing’ was perceived to be important. A unifying theme when supervisees felt they were not getting anything out of the supervision was that the supervisees did not have a supervision question. Conclusions: The results of this research suggest that the supervisor's support during training is perceived to be important for the supervisee. Receiving positive feedback from one's supervisor in an evaluation is perceived to have a great impact on whether the therapist implements the suggested therapeutic interventions discussed in the previous supervision.
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Garner, Jane. "Psychotherapies and Older Adults." Australian & New Zealand Journal of Psychiatry 37, no. 5 (October 2003): 537–48. http://dx.doi.org/10.1046/j.1440-1614.2003.01198.x.
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Objective: To confirm clinical experience which suggests that older people are offered psychotherapies significantly less often than younger ones. For those who are able to access psychotherapeutic help the outcome is comparable, sometimes better, than for younger patients. Method: Contemporary and older seminal literature was reviewed for psychodynamic, cognitive–behavioural, reminiscence and systemic family therapies treating older patients. Results: The main findings supported the experience of staff in old age psychiatry that if the reluctance of referrers and sometimes of older patients themselves can be overcome this type of work is valuable and effective. Conclusions: Each patient is unique. Generalizations are not always appropriate, however, with advancing years some common themes emerge in therapeutic work. It may be necessary to make modifications to the therapeutic technique to accommodate the difficulties experienced by people in later life but also to use their strengths. Staff working in this field need to have the capacity to be aware of and to understand their own feelings and prejudices about the second half of life. For patients not offered formal therapy a psychotherapeutic approach will nevertheless enhance their psychiatric care. Although the body of research is growing, more work needs to be done in evaluating all of the psychotherapies offered to older people.
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Livesley, W. John. "Principles and Strategies for Treating Personality Disorder." Canadian Journal of Psychiatry 50, no. 8 (July 2005): 442–50. http://dx.doi.org/10.1177/070674370505000803.
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This paper proposes a systematic framework for treating personality disorder, based on research on the nature and origins of the disorder and treatment outcome. It adopts an eclectic approach that combines interventions from different therapeutic models and delivers them in an integrated and systematic manner. Coordination of multiple interventions is achieved by emphasizing the nonspecific component of therapy, especially the treatment frame and generic interventions. Specific interventions drawn from different treatment models, including medication, are built onto this foundation as needed to tailor treatment to the individual. Coordination and integration are also achieved by conceptualizing treatment as progressing through a series of phases, each addressing different problems with different specific interventions. Five phases are described: safety, containment, regulation and control, exploration and change, and integration and synthesis. During the earlier phases, structured behavioural and cognitive interventions and medication predominate. Later in treatment, these interventions are supplemented with less structured psychodynamic, interpersonal, and constructionist strategies to explore and change maladaptive interpersonal patterns, cognitions, and traits and to forge a more integrated and adaptive self-structure or identity.
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Howie, Patricia, Darren Johnson, and Angela Taylor. "Substance related offending behaviour programme (SROBP): exploring male prisoner’s experiences of treatment and application of learning." Journal of Criminological Research, Policy and Practice 7, no. 3 (August 9, 2021): 197–208. http://dx.doi.org/10.1108/jcrpp-06-2020-0042.
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Purpose Cognitive-behavioural interventions, such as the substance related offending behaviour programme (SROBP), are being implemented across forensic contexts in an attempt to address the detrimental economic, social and personal impacts of substance use and offending. Whilst support exists for the effectiveness of such treatment, there remains to be limited knowledge of offenders’ experiences of treatment and factors that promote treatment efficacy and support desistance. This study aims to develop an idiographical understanding of those processes. Design/methodology/approach Six prisoners who had completed the SROBP were interviewed via a semi-structured schedule to collate their individual experiences of engaging in treatment. Interviews transcripts were analysed by the lead researcher using interpretative phenomenological analysis, and external auditing analysis was conducted by the research supervisors. Findings Three superordinate themes resulted: “Therapeutic processes and relationships,” “Therapeutic outcomes” and “Threats to post treatment recovery.” Participants identified factors which facilitated the effectiveness of treatment and were effective in meeting their needs, although there were other factors that required improvement. Practical implications The important role of motivation at various stages of treatment as this engenders commitment to treatment aims and longer-term recovery. Treatment efficacy is linked with perceived relevance and value of treatment outcomes in supporting desistence from substance use. Pro-social peer relationships are important for effective application of learning and recovery. Attentiveness to participants specific needs is required. The lack of post-programme support has the potential to threaten therapeutic alliances and reinforce experiences of rejection and abandonment. The management of the exit phase from programmes is critical. Originality/value Results are discussed in light of their implications for future working practices in supporting therapeutic processes and rehabilitative culture.
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Bijanki, Kelly R., Yagna J. Pathak, Ricardo A. Najera, Eric A. Storch, Wayne K. Goodman, H. Blair Simpson, and Sameer A. Sheth. "Defining functional brain networks underlying obsessive–compulsive disorder (OCD) using treatment-induced neuroimaging changes: a systematic review of the literature." Journal of Neurology, Neurosurgery & Psychiatry 92, no. 7 (April 27, 2021): 776–86. http://dx.doi.org/10.1136/jnnp-2020-324478.
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Approximately 2%–3% of the population suffers from obsessive–compulsive disorder (OCD). Several brain regions have been implicated in the pathophysiology of OCD, but their various contributions remain unclear. We examined changes in structural and functional neuroimaging before and after a variety of therapeutic interventions as an index into identifying the underlying networks involved. We identified 64 studies from 1990 to 2020 comparing pretreatment and post-treatment imaging of patients with OCD, including metabolic and perfusion, neurochemical, structural, functional and connectivity-based modalities. Treatment class included pharmacotherapy, cognitive–behavioural therapy/exposure and response prevention, stereotactic lesions, deep brain stimulation and transcranial magnetic stimulation. Changes in several brain regions are consistent and correspond with treatment response despite the heterogeneity in treatments and neuroimaging modalities. Most notable are decreases in metabolism and perfusion of the caudate, anterior cingulate cortex, thalamus and regions of prefrontal cortex (PFC) including the orbitofrontal cortex (OFC), dorsolateral PFC (DLPFC), ventromedial PFC (VMPFC) and ventrolateral PFC (VLPFC). Modulating activity within regions of the cortico-striato-thalamo-cortical system may be a common therapeutic mechanism across treatments. We identify future needs and current knowledge gaps that can be mitigated by implementing integrative methods. Future studies should incorporate a systematic, analytical approach to testing objective correlates of treatment response to better understand neurophysiological mechanisms of dysfunction.
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Patel, Shireen, Sam Malins, Boliang Guo, Marilyn James, Joe Kai, Catherine Kaylor-Hughes, Emma Rowley, et al. "Protocol investigating the clinical outcomes and cost-effectiveness of cognitive–behavioural therapy delivered remotely for unscheduled care users with health anxiety: randomised controlled trial." BJPsych Open 2, no. 1 (January 2016): 81–87. http://dx.doi.org/10.1192/bjpo.bp.115.002220.
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BackgroundHealth anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable.AimsTo investigate the clinical outcomes and cost-effectiveness of remotely delivered cognitive–behavioural therapy (CBT) to people with high health anxiety repeatedly accessing unscheduled care (trial registration: NCT02298036).MethodA multicentre randomised controlled trial (RCT) will be undertaken in primary and secondary care providers of unscheduled care across the East Midlands. One hundred and forty-four eligible participants will be equally randomised to receive either remote CBT (6–12 sessions) or treatment as usual (TAU). Two doctoral research studies will investigate the barriers and facilitators to delivering the intervention and the factors contributing to the optimisation of therapeutic outcome.ResultsThis trial will be the first to test the clinical outcomes and cost-effectiveness of remotely delivered CBT for the treatment of high health anxiety.ConclusionsThe findings will enable an understanding as to how this intervention might fit into a wider care pathway to enhance patient experience of care.
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Young, Hannah. "Loss and profound intellectual disabilities: the significance of early separation responses." Advances in Mental Health and Intellectual Disabilities 10, no. 6 (November 7, 2016): 315–23. http://dx.doi.org/10.1108/amhid-09-2016-0023.
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Purpose Intellectual disabilities (ID) may complicate the experience of bereavement and loss, in those with communicative impairments compounded by complex healthcare needs and sensori-motor limitations. Whilst theorists have argued that the cognitive difficulties of people with profound ID impede mourning reactions, none have attempted to make sense of the responses they do exhibit. The current paper discusses this. Design/methodology/approach A select review considers the neurobiology underlying attachment bonds, complications in attachment formation and affect regulation in people with ID, and separation responses of people with profound ID. Findings The current paper demonstrates that by recognising the affective nature of separation distress, an understanding beyond a cognitive conceptualisation is possible. Research limitations/implications It is worth questioning whether people with profound ID are incapable of any meaningful form of person permanence. A critical review could deal with this comparatively by drawing on research of person and object permanence in typically developing children. Practical implications Of specific interest, the bio-behavioural regulators of relationships may help us to appreciate the importance of routine physical health and social care for emotional wellbeing in this group. Originality/value It is argued that by appreciating the basic emotional and regulatory functions of relationships, we can achieve a greater insight into the loss experiences of people with profound ID that will offer therapeutic direction.