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Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6-month follow-up. Eat Weight Disord 2020; 25:1609-1620. [PMID: 31673985 DOI: 10.1007/s40519-019-00798-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The present study evaluated the statistical and clinical significance of symptomatic change at discharge and after 6 months of an intensive residential treatment for patients with eating disorders (ED), and explored the individual factors that may affect therapeutic outcomes. METHODS A sample of 118 female ED patients were assessed at intake and discharge on the following dimensions: BMI, ED-specific symptoms, depressive features, and overall symptomatic distress. A subsample of 59 patients filled out the same questionnaires at a 6-month follow-up after discharge. RESULTS Findings evidenced statistically significant changes in all outcome measures at both discharge and follow-up. Between 30.1 and 38.6% of patients at discharge and 35.2-54.2% at the 6-month follow-up showed clinically significant symptomatic change; additionally, 19.8-29.1% of patients at discharge and 22.9-38.3% at follow-up improved reliably. However, 34.9-39.8% remained unchanged and 2-4.8% worsened. At the 6-month follow-up, 21.3-25.9% showed no symptomatic change and 0-3.7% had deteriorated. Unchanged and deteriorated patients had an earlier age of ED onset and were more likely to suffer a comorbid personality pathology and to be following concurrent pharmacological treatment. CONCLUSIONS Results suggested that intensive and multimodal residential treatment may be effective for the majority of ED patients, and that therapeutic outcomes tend to improve over time. Prevention strategies should focus on early onset subjects and those with concurrent personality pathology. LEVEL OF EVIDENCE Level III, evidence obtained from a longitudinal cohort study.
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Haran FJ, Handy JD, Servatius RJ, Rhea CK, Tsao JW. Acute neurocognitive deficits in active duty service members following subconcussive blast exposure. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:297-309. [PMID: 31269805 DOI: 10.1080/23279095.2019.1630627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Military service members are frequently subjected to subconcussive blast events during training and deployment. Emerging evidence suggests blast exposures of these magnitudes may have long-term consequences for dimensions of cognitive function. Less is known about cognitive sequelae acutely following deployment-related subconcussive blast events. The current study addressed this knowledge gap by assessing the extent to which subconcussive blast exposure affected performance on the Automated Neuropsychological Assessment Metrics 4 TBI-MIL (ANAM). Baseline-referenced and normative comparisons of archival ANAM data were analyzed for a cohort of personnel who were exposed to blast (blast group; n = 27) and personnel who were not exposed to blast (no-blast group; n = 36) that were otherwise asymptomatic for a concussion. The blast group exhibited statistically significant lower scores compared to the no-blast group (between-subjects), baseline assessments (within-subjects), and an age-matched normative population. Normative comparisons revealed that the scores for the reaction time subtests (i.e., procedural and both simple reaction time tasks) were outside the range of normal functioning (1 SD) and reliable change indices revealed clinically meaningful change only for simple reaction time. The results highlight covert effects of subconcussive blast exposure that may warrant further monitoring in the immediate aftermath of a blast event.
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Affiliation(s)
- F J Haran
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland, USA.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Justin D Handy
- Stress and Motivated Behavior Institute, Syracuse, New York, USA
| | - Richard J Servatius
- Stress and Motivated Behavior Institute, Syracuse, New York, USA.,Research & Development, Syracuse VA Medical Center, Syracuse, New York, USA.,Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Christopher K Rhea
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.,Department of Neurology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
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Svaldi J, Schmitz F, Baur J, Hartmann AS, Legenbauer T, Thaler C, von Wietersheim J, de Zwaan M, Tuschen-Caffier B. Efficacy of psychotherapies and pharmacotherapies for Bulimia nervosa. Psychol Med 2019; 49:898-910. [PMID: 30514412 DOI: 10.1017/s0033291718003525] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological, nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the efficacy of these interventions in up to 19 different interventions. METHODS Database search terms were combined for BN and RCTs from database inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome variables. Retrieved RCTs were meta-analyzed using fixed and random effects models. RESULTS RCT (79 trials; 5775 participants) effects post-treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help, pharmacotherapy, and combined therapies. CONCLUSIONS Most psychological and pharmacological interventions revealed to be effective in BN treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration, CBT can be recommended as the best intervention for the initial treatment of BN.
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Affiliation(s)
- Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy,University of Tübingen,Schleichstrasse 4, 72076 Tuebingen,Germany
| | - Florian Schmitz
- Department of Individual Differences and Psychological Assessment,Ulm University,Albert-Einstein-Allee 47, 89081 Ulm,Germany
| | - Julia Baur
- Department of Clinical Psychology and Psychotherapy,University of Tübingen,Schleichstrasse 4, 72076 Tuebingen,Germany
| | - Andrea S Hartmann
- Department of Clinical Psychology and Psychotherapy,Osnabrück University,Knollstrasse 15, 49069 Osnabrück,Germany
| | - Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum,Heithofer Allee 64, 59071 Hamm,Germany
| | - Charlotte Thaler
- Department of Clinical Psychology and Psychotherapy,University of Freiburg,Engelbergerstrasse 41, 79085 Freiburg,Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy,Ulm Medical School,Albert-Einstein-Allee 23, 89070 Ulm,Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy,Hannover Medical School,Carl-Neuberg-Strasse 1, 30625 Hannover,Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy,University of Freiburg,Engelbergerstrasse 41, 79085 Freiburg,Germany
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Curzio O, Maestro S, Rossi G, Calderoni S, Giombini L, Scardigli S, Ragione LD, Muratori F. Transdiagnostic vs. disorder-focused perspective in children and adolescents with eating disorders: Findings from a large multisite exploratory study. Eur Psychiatry 2018; 49:81-93. [PMID: 29413810 DOI: 10.1016/j.eurpsy.2017.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 12/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The transdiagnostic model of eating disorders (ED) proposes common cognitive mechanisms in patients with ED psychopathology. Little is known about their role in the maintenance of ED in children and adolescents. This study aimed to determine whether the relationships between key factors (low self-esteem, weight and shape control, clinical perfectionism, interpersonal problems, distress and mood instability) and core maintaining mechanisms (binge-eating and restraint) would support a transdiagnostic theory in young patients. METHODS A total of 419 patients (mean age 14.7 ± 2.14 years; age range: 7-18 years; males 13.8%) diagnosed with an ED were assessed in six Italian clinical centers in 2013. Multiple comparisons between ED diagnosis, correlation analysis and principal component analysis (PCA) were performed. RESULTS Of the entire collective, 51.5% of patients were diagnosed with Anorexia Nervosa (AN), 12.3% were diagnosed with Bulimia Nervosa (BN) and 36.2% with Eating Disorder Not Otherwise Specified (EDNOS). In PCA, the core ED mechanisms, dietary restraint and binge eating, acted as poles of attraction of the other variables. The AN group was particularly linked to restraint and the BN group was particularly related to "Bulimia". Considering the diagnostic subtypes, there were no significant differences between the anorexic binge-purging group, bulimic purging group and bulimic non-purging group, which constituted a unique cluster related to affective, interpersonal problems and to perfectionism, indicating a very homogeneous subgroup. Restricting anorexic group (AN-R), related to shape concern and anxious-depressed mood, was not linked to the other subtypes. EDNOS appeared to be opposed to the AN-R group; the binge eating disorder group appeared to be independent from others. CONCLUSION Our results suggest the presence of both specific and transdiagnostic mechanisms in ED subtypes, whose knowledge is of relevance for clinical practice.
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Affiliation(s)
- O Curzio
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - S Maestro
- IRCCS Stella Maris Foundation, Pisa, Italy.
| | - G Rossi
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy; G Monasterio Foundation, CNR-Tuscany Region, Pisa, Italy
| | - S Calderoni
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - L Giombini
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | | | - L Dalla Ragione
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | - F Muratori
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Clinton D, Birgegård A. Classifying empirically valid and clinically meaningful change in eating disorders using the Eating Disorders Inventory, version 2 (EDI-2). Eat Behav 2017; 26:99-103. [PMID: 28213339 DOI: 10.1016/j.eatbeh.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
The study examined the ability of the EDI-2 to classify empirically valid and clinically meaningful change using clinical significance and the Reliable Change Index (CS/RCI), and compared CS/RCI to classification based on diagnostic change. Eating disorder (ED) patients (N=363) were assessed at intake and after 36months on measures of ED and psychiatric symptoms, self-image, interpersonal relationships, treatment satisfaction and general outcome. Patients were categorized using a four-way classification scheme as "Deteriorated", "Unchanged", "Improved" or "No ED"; and using a two-way classification scheme as either in remission or not in remission. Compared to similar two- and four-way classification based on diagnostic change, CS/RCI using the EDI-2 total score demonstrated greatest overall utility in explaining outcome variance. The EDI-2 can generate empirically valid and clinically meaningful classification of change. Systematic application of CS/RCI using the EDI-2 benefits both clinicians and researchers by providing a simple, clinically relevant, scientifically robust, and cost-effective means of classifying outcome. It may be especially relevant in alerting clinicians to problem cases in need of additional or alternative treatment strategies.
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Affiliation(s)
- David Clinton
- Centre for Psychiatry Research, Stockholm Health Care Services, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 7 tr, 113 64 Stockholm, Sweden; Institute for Eating Disorders, Kruses gate 8, 0263 Oslo, Norway.
| | - Andreas Birgegård
- Centre for Psychiatry Research, Stockholm Health Care Services, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 7 tr, 113 64 Stockholm, Sweden
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Keith JA, Verdeli H, Vousoura E. Evaluating the Clinical Significance of Depression Treatment. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411400301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Marco JH, Perpiñá C, Botella C. Effectiveness of cognitive behavioral therapy supported by virtual reality in the treatment of body image in eating disorders: one year follow-up. Psychiatry Res 2013; 209:619-25. [PMID: 23499231 DOI: 10.1016/j.psychres.2013.02.023] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 07/23/2012] [Accepted: 02/14/2013] [Indexed: 11/24/2022]
Abstract
Body image disturbance is a significant maintenance and prognosis factor in eating disorders. Hence, existing eating disorder treatments can benefit from direct intervention in patients' body image. No controlled studies have yet compared eating disorder treatments with and without a treatment component centered on body image. This paper includes a controlled study comparing Cognitive Behavioral Treatment (CBT) for eating disorders with and without a component for body image treatment using Virtual Reality techniques. Thirty-four participants diagnosed with eating disorders were evaluated and treated. The clinical improvement was analyzed from statistical and clinical points of view. Results showed that the patients who received the component for body image treatment improved more than the group without this component. Furthermore, improvement was maintained in post-treatment and at one year follow-up. The results reveal the advantage of including a treatment component addressing body image disturbances in the protocol for general treatment of eating disorders. The implications and limitations of these results are discussed below.
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Affiliation(s)
- José H Marco
- Department of Personality, Assessment and Treatment in Health Science, Catholic University of Valencia, Valencia, Spain.
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Vaz AR, Conceição E, Machado PP. Guided self-help CBT treatment for bulimic disorders: Effectiveness and clinically significant change. Psychother Res 2013; 23:324-32. [DOI: 10.1080/10503307.2013.796424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Gale C, Gilbert P, Read N, Goss K. An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clin Psychol Psychother 2012; 21:1-12. [PMID: 22740105 DOI: 10.1002/cpp.1806] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. METHOD Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). RESULTS There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). CONCLUSION This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. KEY PRACTITIONER MESSAGE CFT offers new ways to conceptualize and formulate some of the self-critical and shame-based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging.
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Affiliation(s)
- Corinne Gale
- Mental Health Research Unit, Kingsway, Derby, UK
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Ben-Porath DD, Wisniewski L, Warren M. Outcomes of a Day Treatment Program for Eating Disorders Using Clinical and Statistical Significance. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2010. [DOI: 10.1007/s10879-009-9125-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vocks S, Vogt A, Ertle A, Kosfelder J. Identifikation von erfolgsrelevanten Veränderungen im Prozess einer Körperbildtherapie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2009. [DOI: 10.1026/1616-3443.38.1.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Mehrere Studien belegen gute Ergebnisse für Interventionen zur Verbesserung des Körperbildes bei Patientinnen mit Essstörungen; jedoch fehlen Prozessanalysen der relevanten Wirkfaktoren. Fragestellung: Erfolgsrelevante Veränderungen von Klärungs- und Bewältigungserfahrungen sowie symptomspezifische Intrasession-Veränderungen werden im Verlauf einer standardisierten Körperbildtherapie untersucht. Methode: 54 Patientinnen mit Essstörungen füllten vor und nach jeder Gruppensitzung die Body Image States Scale zur Erfassung der State-Körperunzufriedenheit und am Sitzungsende den Stundenbeurteilungsbogen mit den Wirkfaktoren „Einsicht/Klärung” und „Problembewältigung” aus. Ergebnisse: Bei gleichen Eingangswerten zeigten sich erfolgsabhängige Verläufe für die Körperunzufriedenheit nach Sitzungsende und die erlebte Problembewältigung. Sowohl Klärungs- als auch Problembewältigungsprozesse sind mit der Intrasession-Verbesserung der Körperunzufriedenheit assoziiert. Schlussfolgerungen: Während beide Erfolgsgruppen profitieren, bedarf der differenziell günstigere Verlauf der erfolgreicheren Patienten weiterer und erweiterter Forschung.
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Gaudiano BA. Is symptomatic improvement in clinical trials of cognitive-behavioral therapy for psychosis clinically significant? J Psychiatr Pract 2006; 12:11-23. [PMID: 16432441 DOI: 10.1097/00131746-200601000-00003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although cognitive-behavioral therapy (CBT) is becoming increasingly popular as an adjunctive treatment for psychosis, few studies to date have examined the clinical (in contrast to statistical) significance of treatment gains using standardized methods. The aim of the current study was to investigate the clinical significance of symptomatic reductions reported in trials of CBT for schizophrenia and related disorders using standardized group methods of analysis. An electronic literature search identified 12 studies that met the inclusion criteria of being randomized, controlled trials that compared CBT to routine care alone or to another comparison treatment. The analysis involved the following steps. First, reliable change on symptom measures was examined. Next, the proportion of patients in each study estimated to show clinically significant symptomatic reductions (i.e., two standard deviations) was calculated. When both post-treatment and follow-up data were considered, 42% of CBT conditions compared with only 25% of comparison conditions demonstrated reliable change on at least one psychotic symptom measure per study. Proportions of clinically significant symptomatic improvement in studies showing reliable change were similar between CBT and comparison conditions. Due to the adjunctive nature of CBT for schizophrenia and the limits imposed by the evaluation of group datasets, results of the current study are considered promising but preliminary. Future trials should examine clinical significance using similar standardized methods within studies, as well as broader functional outcome measures, to provide a clearer picture of the benefits derived from this type of intervention.
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Affiliation(s)
- Brandon A Gaudiano
- Psychosocial Research Program, Brown Medical School & Butler Hospital, Providence, RI 02906, USA
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