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Rodrigues MF, Quagliato L, Appolinario JC, Nardi AE. Online mindfulness-based cognitive therapy for treatment-resistant depression: a parallel-arm randomized controlled feasibility trial. Front Psychol 2024; 15:1412483. [PMID: 39021648 PMCID: PMC11252472 DOI: 10.3389/fpsyg.2024.1412483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/10/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Treatment-resistant depression (TRD) presents a significant challenge, affecting approximately 30% of individuals diagnosed with major depressive disorder and leading to poor treatment responses. Innovations in digital mental health, especially online mindfulness-based cognitive therapy (eMBCT), offer promising avenues for enhancing access to effective mental health care for individuals with TRD in a clinical setting. Objective The aim of this study was to examine the feasibility of eMBCT in an individual clinical context to decrease depressive symptoms for TRD. Methods Conducted at the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil, this parallel-arm, randomized controlled feasibility trial involved outpatients diagnosed with TRD, aged 18 and above. Of the 39 outpatients invited, 28 were randomized into two groups: an intervention group receiving the eMBCT program (n = 15) and a control group (n = 13). The intervention, consisting of an 8-week course, was delivered via live video sessions. Following the assessment period, participants in the control group were offered the eMBCT intervention. Assessments using standardized questionnaires were conducted at the start and end of the study. Results Within the eMBCT group, improvements were observed in depression symptoms (Z = -3.423; p = 0.001; effect size r = 0.78), anxiety symptoms (Z = -3.361; p = 0.001; effect size r = 0.77), with no significant changes in the control group. Comparatively, the eMBCT group showed significant reductions in depression symptoms and improvements in clinical global impressions over the control group (BDI2: U = 30.5; p = 0.015; effect size r = 0.47, CGI1: U = 21.0; p = 0.004; effect size r = 0.56). Conclusion eMBCT in an individual format combined with medication, appears to be a feasible treatment for TRD, decreasing symptoms of depression. In a future trial the control group may have a manualized intervention. Clinical trial registration The Brazilian Clinical Trials Registry: (https://ensaiosclinicos.gov.br/rg/RBR-6zndpbv) and RBR-6zndpbv.
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Hu LY. Psychological aspects and psychotherapy for TRD. PROGRESS IN BRAIN RESEARCH 2023. [DOI: 10.1016/bs.pbr.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Abstract
ZusammenfassungDas Scheitern von Psychotherapien taucht als Thema in der Psychotherapieforschung zwar immer wieder auf, wird aber erst in jüngster Zeit intensiver beforscht, u. a. im Hinblick auf die Frage, wie Scheitern zu definieren ist, wie häufig es vorkommt und welche Variablen Scheitern vorhersagen können. In dieser Übersicht folgt auf eine historische Übersicht mit starkem Bezug auf die Untersuchungen von Hans H. Strupp eine Zusammenfassung systematischer und fallorientierter Betrachtungen von Scheitern in der Psychotherapie. Es werden Studien berichtet, zu den Determinanten und Risikofaktoren von Scheitern sowie zu der Frage, wie der aktuelle Wissensstand zum Scheitern in der psychotherapeutischen Praxis sowohl im klinischen Alltag wie auch in der Aus- und Weiterbildung von psychotherapeutisch Tätigen nutzbar gemacht werden kann.
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Metaphor can influence meta-thinking and affective levels in guided meditation. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Khoshkerdar P, Raeisi Z. The effect of mindfulness‐based stress reduction on body image concerns of adolescent girls with dysfunctional eating attitudes. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Parya Khoshkerdar
- Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran,
| | - Zohreh Raeisi
- Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran,
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Jinich-Diamant A, Garland E, Baumgartner J, Gonzalez N, Riegner G, Birenbaum J, Case L, Zeidan F. Neurophysiological Mechanisms Supporting Mindfulness Meditation–Based Pain Relief: an Updated Review. Curr Pain Headache Rep 2020; 24:56. [DOI: 10.1007/s11916-020-00890-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Foroughi A, Sadeghi K, Parvizifard A, Parsa Moghadam A, Davarinejad O, Farnia V, Azar G. The effectiveness of mindfulness-based cognitive therapy for reducing rumination and improving mindfulness and self-compassion in patients with treatment-resistant depression. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 42:138-146. [PMID: 32696895 DOI: 10.1590/2237-6089-2019-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022]
Abstract
Introduction Depression is one of the most important psychiatric disorders, and the rate of recurrence is high. The heavy cost burden of depression is probably due to treatment-resistant depression. The purpose of this study was to determine the effectiveness of mindfulness-based cognitive therapy (MBCT) in patients with treatment-resistant depression (TRD). Method The present study was a quasi-experimental study conducted with twenty-four patients with treatment-resistant depression. Participants were selected by purposive sampling and randomly assigned to two groups, an experimental group and a control group. The experimental group received MBCT and antidepressants, while the control group received antidepressants only. The Hamilton and Beck Depression Inventory, Self-Compassion Scale, Thought Rumination Scale, and Mindfulness Scale were administered. The treatment program was conducted in eight sessions; with a follow-up period of one month subsequent to treatment termination. Data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics (analysis of variance for repeated measures and Bonferroni's post-hoc test). Results The results showed that MBCT significantly reduced depression and ruminative thinking in the experimental group and also improved mediators such as mindfulness and self-compassion. Patients maintained gains over the one month follow-up period (p < 0.01). Conclusion The present study provides additional evidence for the effectiveness of MBCT for TRD.
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Affiliation(s)
- Aliakbar Foroughi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kheirollah Sadeghi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - AliAkbar Parvizifard
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Parsa Moghadam
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Omran Davarinejad
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghazale Azar
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Abstract
BACKGROUND Depression and post-traumatic stress disorder (PTSD) are leading causes of disability and loss of life by suicide. Currently, there are less than satisfactory medical solutions to treat these mental disorders. Here, we explore recent preclinical and clinical studies demonstrating the potential of using buprenorphine to treat major depressive disorder, treatment-resistant depression, and PTSD. METHOD Bibliographic databases were searched to include preclinical and clinical studies demonstrating the therapeutic potential of buprenorphine and the involvement of the kappa opioid receptor (KOR) in mediating these effects. RESULTS Original clinical studies examining the effectiveness of buprenorphine to treat depression were mixed. The majority of participants in the PTSD studies were males and suffer from chronic pain and/or substance use disorders. Nonetheless, these recent studies and analyses established proof of concept warranting farther investigations. Additionally, KOR likely mediates the antidepressant and some of the anxiolytic effects of buprenorphine. Still, it appears that the full spectrum of buprenorphine's beneficial effects might be due to activity at other opioid receptors as well. CONCLUSIONS Pharmaceuticals' abilities to treat medical conditions directly relates to their ability to act upon the endogenous biological systems related to the conditions. Thus, these recent findings are likely a reflection of the central role that the endogenous opioid system has in these mental illnesses. Further studies are necessary to study the involvement of endogenous opioid systems, and specifically KOR, in mediating buprenorphine's beneficial effects and the ability to treat these medical conditions while minimizing risks for misuse and diversion.
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Affiliation(s)
- Caitlin A Madison
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
| | - Shoshana Eitan
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
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Monnart A, Vanderhasselt MA, Schroder E, Campanella S, Fontaine P, Kornreich C. Treatment of Resistant Depression: A Pilot Study Assessing the Efficacy of a tDCS-Mindfulness Program Compared With a tDCS-Relaxation Program. Front Psychiatry 2019; 10:730. [PMID: 31708808 PMCID: PMC6819945 DOI: 10.3389/fpsyt.2019.00730] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 09/11/2019] [Indexed: 01/30/2023] Open
Abstract
Background: This pilot study explores a therapeutic setting combining transcranial direct current stimulation (tDCS) and mindfulness-based cognitive therapy (MBCT) for patients with drug-resistant depression. tDCS has shown efficacy for depression treatment and improvement could be maintained with the combination with mindfulness, which has shown depression relapse-prevention properties. Methods: Thirty-one treatment-resistant depressed patients have been assigned to our experimental treatment condition [tDCS combined with MBCT (n = 15)] or to a control condition [tDCS combined with relaxation (n = 16)]. Patients have completed both an intensive treatment block (eight consecutive days) and a single remind session 2 weeks after the intensive treatment. Clinical (depression, anxiety, and rumination) and cognitive (general cognitive functioning, mental flexibility, and working memory) symptoms of depression have been assessed through different questionnaires at baseline (t0), after the first block of treatment (t1), and after the remind session (t2). Results: Results seem to indicate a positive impact of both treatment conditions on clinical and cognitive symptoms of depression at t1. However, the treatment condition combining tDCS with mindfulness has been found to better maintain clinical improvements at t2 regarding some clinical [Montgomery-Åsberg Depression Rating Scale (MADRS) and Sadness and Anger Ruminative Inventory (SARI)] and cognitive variables (Digit Span-F and Digit Span-B). Conclusion: Based on the current observations, a multi-disciplinary treatment approach combining tDCS and MBCT might be effective in resistant depressed patients in the long run, even though further clinical research is necessary.
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Affiliation(s)
- Aurore Monnart
- Laboratory of Psychological Medicine and Addictology, CHU Brugmann - ULB Neuroscience Institue (UNI), University of Brussels (ULB), Brussels, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University (UGent), Ghent, Belgium
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Elisa Schroder
- Laboratory of Psychological Medicine and Addictology, CHU Brugmann - ULB Neuroscience Institue (UNI), University of Brussels (ULB), Brussels, Belgium
| | - Salvatore Campanella
- Laboratory of Psychological Medicine and Addictology, CHU Brugmann - ULB Neuroscience Institue (UNI), University of Brussels (ULB), Brussels, Belgium
| | | | - Charles Kornreich
- Laboratory of Psychological Medicine and Addictology, CHU Brugmann - ULB Neuroscience Institue (UNI), University of Brussels (ULB), Brussels, Belgium
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A Comparison Between the Effectiveness of Acceptance and Commitment Treatment and Behavioral Activation Treatment for Depression on Symptoms Severity and Rumination Among Patients with Treatment-Resistant Depression. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.10742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci 2017; 1373:114-27. [PMID: 27398643 DOI: 10.1111/nyas.13153] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/15/2022]
Abstract
Pain is a multidimensional experience that involves interacting sensory, cognitive, and affective factors, rendering the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms-an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy.
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Affiliation(s)
- Fadel Zeidan
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David R Vago
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Ferdek MA, van Rijn CM, Wyczesany M. Depressive rumination and the emotional control circuit: An EEG localization and effective connectivity study. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2016; 16:1099-1113. [PMID: 27572661 PMCID: PMC5153413 DOI: 10.3758/s13415-016-0456-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ruminations are repetitive thoughts associated with symptoms, causes, and consequences of one's negative feelings. The objective of this study was to explore the neuronal basis of depressive rumination in a non-clinical population within the context of emotional control. Participants scoring high or low on the tendency to ruminate scale took part in the EEG experiment. Their EEG data were collected during a state of induced depressive ruminations and compared with positive and neutral conditions. We hypothesized that both groups would differ according to the level of activation and effective connectivity among the structures involved in the emotional control circuit. Clustering of independent components, together with effective connectivity (Directed Transfer Function), was performed using the EEG signal. The main findings involved decreased activation of the left dorsolateral prefrontal cortex (DLPFC) and increased activation of the left temporal lobe structures in the highly ruminating group. The latter result was most pronounced during the ruminative condition. Decreased information from the left DLPFC to the left temporal lobe structures was also found, leading to the conclusion that hypoactivation of the left DLPFC and its inability to modulate the activation of the left temporal lobe structures is crucial for the ruminative tendencies.
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Affiliation(s)
- Magdalena A Ferdek
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
- Psychophysiology Laboratory, Institute of Psychology, Jagiellonian University, PL-30060, Ingardena 6, Krakow, Poland.
| | - Clementina M van Rijn
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Miroslaw Wyczesany
- Psychophysiology Laboratory, Institute of Psychology, Jagiellonian University, PL-30060, Ingardena 6, Krakow, Poland
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Eisendrath SJ, Gillung E, Delucchi KL, Segal ZV, Nelson JC, McInnes LA, Mathalon DH, Feldman MD. A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 85:99-110. [PMID: 26808973 PMCID: PMC4756643 DOI: 10.1159/000442260] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 11/06/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of mindfulness-based cognitive therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD. METHODS This single-site, randomized controlled trial compared 8-week courses of MBCT and the Health Enhancement Program (HEP), comprising physical fitness, music therapy and nutritional education, as adjuncts to TAU pharmacotherapy for outpatient adults with TRD. The primary outcome was change in depression severity, measured by percent reduction in the total score on the 17-item Hamilton Depression Rating Scale (HAM-D17), with secondary depression indicators of treatment response and remission. RESULTS We enrolled 173 adults; mean length of a current depressive episode was 6.8 years (SD = 8.9). At the end of 8 weeks of treatment, a multivariate analysis showed that relative to the HEP condition, the MBCT condition was associated with a significantly greater mean percent reduction in the HAM-D17 (36.6 vs. 25.3%; p = 0.01) and a significantly higher rate of treatment responders (30.3 vs. 15.3%; p = 0.03). Although numerically superior for MBCT than for HEP, the rates of remission did not significantly differ between treatments (22.4 vs. 13.9%; p = 0.15). In these models, state anxiety, perceived stress and the presence of personality disorder had adverse effects on outcomes. CONCLUSIONS MBCT significantly decreased depression severity and improved treatment response rates at 8 weeks but not remission rates. MBCT appears to be a viable adjunct in the management of TRD.
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Affiliation(s)
- Stuart J Eisendrath
- Department of Psychiatry, University of California, San Francisco, Calif., USA
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Abstract
Mindfulness-based interventions (MBIs) are at a pivotal point in their future development. Spurred on by an ever-increasing number of studies and breadth of clinical application, the value of such approaches may appear self-evident. We contend, however, that the public health impact of MBIs can be enhanced significantly by situating this work in a broader framework of clinical psychological science. Utilizing the National Institutes of Health stage model (Onken, Carroll, Shoham, Cuthbert, & Riddle, 2014), we map the evidence base for mindfulness-based cognitive therapy and mindfulness-based stress reduction as exemplars of MBIs. From this perspective, we suggest that important gaps in the current evidence base become apparent and, furthermore, that generating more of the same types of studies without addressing such gaps will limit the relevance and reach of these interventions. We offer a set of 7 recommendations that promote an integrated approach to core research questions, enhanced methodological quality of individual studies, and increased logical links among stages of clinical translation in order to increase the potential of MBIs to impact positively the mental health needs of individuals and communities.
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Affiliation(s)
- Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Zindel V Segal
- Department of Psychology, University of Toronto Scarborough
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Abstract
Wendt, Gone, and Nagata raise some very important questions about harm in psychotherapy and initiate a valuable dialogue between scholars of potentially harmful therapy and multicultural counseling and psychotherapy. This comment enlarges upon the authors’ view that harms cannot be understood independently of goods by providing an argument that goods have an inherent place in psychotherapy and in multicultural viewpoints. The goods of psychotherapy (e.g., justice, respect) are ordinary and widely endorsed rather than esoteric or objectionable. Identifying these goods makes it possible to organize them into a coherent hierarchy that enables an integration of the primarily individual goods of standard psychotherapy and the primarily communal goods of a multicultural perspective. This can facilitate a mutually informative and enriching dialogue between scholars from these two domains. The hope is to encourage a more open discussion of the goods of psychotherapy, thereby fostering a more reflective, progressive discipline.
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Machino A, Kunisato Y, Matsumoto T, Yoshimura S, Ueda K, Yamawaki Y, Okada G, Okamoto Y, Yamawaki S. Possible involvement of rumination in gray matter abnormalities in persistent symptoms of major depression: an exploratory magnetic resonance imaging voxel-based morphometry study. J Affect Disord 2014; 168:229-35. [PMID: 25064808 DOI: 10.1016/j.jad.2014.06.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/14/2014] [Accepted: 06/18/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND A recent meta-analysis of many magnetic resonance imaging (MRI) studies has identified brain regions with gray matter (GM) abnormalities in patients with major depressive disorder (MDD). A few studies addressing GM abnormalities in patients with treatment-resistant depression (TRD) have yielded inconsistent results. Moreover, although TRD patients tend to exhibit ruminative thoughts, it remains unclear whether rumination is related to GM abnormalities in such patients or not. METHODS We conducted structural MRI scans and voxel-based morphometry (VBM) to identify GM differences among 29 TRD patients and 29 healthy age-matched and sex-matched controls. A response style questionnaire was used to assess the respective degrees of rumination in TRD patients. Structural correlates of rumination were examined. RESULTS TRD patients showed several regions with smaller GM volume than in healthy subjects: the left dorsal anterior cingulate cortex (ACC), right ventral ACC, right superior frontal gyrus, right cerebellum (Crus I), and cerebellar vermis. GM volumes in these regions did not correlate to rumination. However, whole-brain analysis revealed that rumination was positively correlated with the GM volume in the right superior temporal gyrus in TRD patients. LIMITATIONS Structural correlates of rumination were examined only in TRD patients. CONCLUSIONS Our data provide additional evidence supporting the hypothesis that TRD patients show GM abnormalities compared with healthy subjects. Furthermore, this report is the first to describe a study identifying brain regions for which the GM volume is correlated with rumination in TRD patients. These results improve our understanding of the anatomical characteristics of TRD.
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Affiliation(s)
- Akihiko Machino
- Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Yoshihiko Kunisato
- Graduate School of the Humanities, Sensyu University, 2-1-1 Higashi Mita, Tama-ku, Kanagawa, Kawasaki 214-8580, Japan
| | - Tomoya Matsumoto
- Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Corporation (JST), 4-1-8 Honmachi, Kawaguchi, Saitama 332-0012, Japan
| | - Shinpei Yoshimura
- Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; Faculty of Psychology, Otemon Gakuin University, 2-1-15 Nishiai, Ibaraki, Osaka 567-8502, Japan
| | - Kazutaka Ueda
- Research Center for Advanced Science and Technology, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8904, Japan
| | - Yosuke Yamawaki
- Laboratory of Molecular and Cellular Pharmacology, Faculty of Pharmatheutical Sciences, Hiroshima International University, 5-1-1 Hirokoshingai, Kure, Hiroshima 737-0112, Japan
| | - Go Okada
- Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Corporation (JST), 4-1-8 Honmachi, Kawaguchi, Saitama 332-0012, Japan
| | - Yasumasa Okamoto
- Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Corporation (JST), 4-1-8 Honmachi, Kawaguchi, Saitama 332-0012, Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Corporation (JST), 4-1-8 Honmachi, Kawaguchi, Saitama 332-0012, Japan.
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Henje Blom E, Duncan LG, Ho TC, Connolly CG, LeWinn KZ, Chesney M, Hecht FM, Yang TT. The development of an RDoC-based treatment program for adolescent depression: "Training for Awareness, Resilience, and Action" (TARA). Front Hum Neurosci 2014; 8:630. [PMID: 25191250 PMCID: PMC4137278 DOI: 10.3389/fnhum.2014.00630] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/28/2014] [Indexed: 01/08/2023] Open
Abstract
Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of depression, with MDD affecting 8–20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of adolescent depression. We therefore propose a new model for the treatment of adolescent depression – Training for Awareness, Resilience, and Action (TARA) – that is based on current understanding of developmental and depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to adolescent depression. Second, we identify the major RDoC domains of function involved in adolescent depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for adolescent depression, as well as broaden the discussion on how to address this challenge.
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Affiliation(s)
- Eva Henje Blom
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden ; Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Larissa G Duncan
- Department of Family and Community Medicine, University of California San Francisco San Francisco, CA, USA ; Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tiffany C Ho
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Colm G Connolly
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Margaret Chesney
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tony T Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
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Irving JA, Segal ZV. [Mindfulness-based cognitive therapy : current status and future applications]. SANTE MENTALE AU QUEBEC 2014; 38:65-82. [PMID: 24719003 DOI: 10.7202/1023990ar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Against the backdrop of dauntingly high prevalence rates of clinical depression and subsequent relapse, Segal, Teasdale and Williams (2002) sought to develop an intervention that would address the long-term sequence of depression. In the past decade, Mindfulness-Based Cognitive Therapy has been supported with a robust evidence base, highlighting its efficacy in the short, and long-term follow-up studies. Currently, novel adaptations of this intervention are being developed and piloted with a wide range of clinical issues that share amplified ruminative processes as a core feature of pathology. This review aims to summarize current and past research on MBCT, and to practically illuminate how this intervention can aid individuals in stepping out of the ruminative spirals that are part-and-parcel with major depressive episode.
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Affiliation(s)
| | - Zindel V Segal
- Centre for Addiction and Mental Health; University of Toronto Scarborough
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Schuman-Olivier Z, Hoeppner BB, Evins AE, Brewer JA. Finding the right match: mindfulness training may potentiate the therapeutic effect of nonjudgment of inner experience on smoking cessation. Subst Use Misuse 2014; 49:586-94. [PMID: 24611853 PMCID: PMC4096689 DOI: 10.3109/10826084.2014.850254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mindfulness training (MT) is an emerging therapeutic modality for addictive disorders. Nonjudgment of inner experience, a component of mindfulness, may influence addiction treatment response. To test whether this component influences smoking cessation, tobacco smokers (n = 85) in a randomized control trial of MT vs. Freedom from Smoking (FFS), a standard cognitive-behaviorally-oriented treatment, were divided into split-half subgroups based on baseline Five Facet Mindfulness Questionnaire nonjudgment subscale. Smokers who rarely judge inner experience (nonjudgment > 30.5) smoked less during follow-up when randomized to MT (3.9 cigs/d) vs. FFS (11.1 cigs/d), p < .01. Measuring trait nonjudgment may help personalize treatment assignments, improving outcomes.
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Affiliation(s)
- Zev Schuman-Olivier
- 1Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Eisendrath SJ, Gillung E, Delucchi K, Mathalon DH, Yang TT, Satre DD, Rosser R, Sipe WEB, Wolkowitz OM. A Preliminary Study: Efficacy of Mindfulness-Based Cognitive Therapy versus Sertraline as First-line Treatments for Major Depressive Disorder. Mindfulness (N Y) 2014; 6:475-482. [PMID: 26085853 DOI: 10.1007/s12671-014-0280-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Major depressive disorder (MDD) is the leading cause of disability in the developed world, yet broadly effective treatments remain elusive. The primary aim of this pilot study was to investigate the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) monotherapy, compared to sertraline monotherapy, for patients with acute MDD. This open-label, nonrandomized controlled trial examined a MBCT cohort (N=23) recruited to match the gender, age, and depression severity of a depressed control group (N=20) that completed 8 weeks of monotherapy with the antidepressant sertraline. The 17-item clinician-rated Hamilton Depression Severity Rating Scale (HAMD-17) was the primary outcome measure of depression to assess overall change after 8 weeks and rates of response and remission. The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) was the secondary outcome measure to further assess depression severity. Both cohorts were demographically similar and showed significant improvement in depression ratings. No difference was found in the degree of change in HAMD-17 scores (t(34) = 1.42, p = .165) between groups. Secondary analysis showed statistically significant differences in mean scores of the QIDS-SR16 (t (32) = 4.39, p < 0.0001), with the MCBT group showing greater mean improvement. This study was limited by the small sample size and non-randomized, non-blinded design. Preliminary findings suggest that an 8-week course of MBCT monotherapy may be effective in treating MDD and a viable alternative to antidepressant medication. Greater changes in the self-rated QIDS-SR16 for the MBCT cohort raise the possibility that patients derive additional subjective benefit from enhanced self-efficacy skills.
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Affiliation(s)
- Stuart J Eisendrath
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143. phone: (415) 476-7868; fax: (415) 476-7449
| | - Erin Gillung
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143
| | - Kevin Delucchi
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143
| | - Daniel H Mathalon
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121
| | - Tony T Yang
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143
| | - Derek D Satre
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143. Division of Research, Kaiser Permanente, 200 Broadway Blvd, Oakland, CA 94612
| | - Rebecca Rosser
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143
| | - Walter E B Sipe
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California-San Francisco, Box 0984-AIP, San Francisco, CA 94143
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Casey MF, Perera DN, Clarke DM. Psychosocial treatment approaches to difficult‐to‐treat depression. Med J Aust 2013; 199:S52-5. [DOI: 10.5694/mja12.10629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 08/16/2012] [Indexed: 01/21/2023]
Affiliation(s)
- Melissa F Casey
- Southern Health, Melbourne, VIC
- School of Psychology and Psychiatry, Monash University, Melbourne, VIC
| | - Dinali N Perera
- School of Psychology and Psychiatry, Monash University, Melbourne, VIC
| | - David M Clarke
- School of Psychology and Psychiatry, Monash University, Melbourne, VIC
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Arean PA. Personalizing behavioral interventions: the case of late-life depression. ACTA ACUST UNITED AC 2013; 2:135-145. [PMID: 23646065 DOI: 10.2217/npy.12.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article reviews the potential utility of behavioral interventions in personalized depression treatment. The paper begins with a definition of personalized treatment, moves to current thinking regarding the various causes of depression, and proposes how those causes can be used to inform the selection of behavioral interventions. Two examples from the late-life depression field will illustrate how a team of researchers at Cornell University (NY, USA) and University of California, San Francisco (CA, USA) created a research partnership to select and study behavioral interventions for older adults with risk factors associated with poor response to selective serotonin reuptake inhibitor medications. The paper ends with a discussion of how the process used by the Cornell University-University of California, San Francisco team can be applied to the selection and development of behavioral interventions for other psychiatric disorders.
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Affiliation(s)
- Patricia A Arean
- University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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Qureshi NA, Al-Bedah AM. Mood disorders and complementary and alternative medicine: a literature review. Neuropsychiatr Dis Treat 2013; 9:639-58. [PMID: 23700366 PMCID: PMC3660126 DOI: 10.2147/ndt.s43419] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides, physical comorbidities, high economic costs, and poor quality of life. Approximately 30%-40% of patients with major depression have only a partial response to available pharmacological and psychotherapeutic interventions. Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional therapies in patients with mood disorders. This review of the literature examines evidence-based data on the use of CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past two decades were retrieved. Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3 fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and bipolar depression, although manic symptoms are not affected and higher doses are required in patients with resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects. Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are effective.
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Affiliation(s)
- Naseem Akhtar Qureshi
- General Administration for Research and Studies, Sulaimania Medical Complex, Riyadh, Saudi Arabia
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Sipe WEB, Eisendrath SJ. Mindfulness-based cognitive therapy: theory and practice. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:63-9. [PMID: 22340145 DOI: 10.1177/070674371205700202] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mindfulness-based cognitive therapy (MBCT) incorporates elements of cognitive-behavioural therapy with mindfulness-based stress reduction into an 8-session group program. Initially conceived as an intervention for relapse prevention in people with recurrent depression, it has since been applied to various psychiatric conditions. Our paper aims to briefly describe MBCT and its putative mechanisms of action, and to review the current findings about the use of MBCT in people with mood and anxiety disorders. The therapeutic stance of MBCT focuses on encouraging patients to adopt a new way of being and relating to their thoughts and feelings, while placing little emphasis on altering or challenging specific cognitions. Preliminary functional neuroimaging studies are consistent with an account of mindfulness improving emotional regulation by enhancing cortical regulation of limbic circuits and attentional control. Research findings from several randomized controlled trials suggest that MBCT is a useful intervention for relapse prevention in patients with recurrent depression, with efficacy that may be similar to maintenance antidepressants. Preliminary studies indicate MBCT also shows promise in the treatment of active depression, including treatment-resistant depression. Pilot studies have also evaluated MBCT in bipolar disorder and anxiety disorders. Patient and clinician resources for further information on mindfulness and MBCT are provided.
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Affiliation(s)
- Walter E B Sipe
- Clinical Instructor of Psychiatry and Pediatrics, Departments of Psychiatry and Pediatrics, University of California, San Francisco, California, USA.
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Abstract
BACKGROUND Patients with major depression respond to antidepressant treatment, but 10%-30% of them do not improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options for treating resistant major depressive disorder, as well as evaluating further therapeutic options. METHODS In addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant articles published in English peer-reviewed journals (1990-2011) were retrieved. Only those papers that directly addressed treatment options for treatment-resistant depression were retained for extensive review. RESULTS Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation. As a corollary, more than a third of patients with treatment-resistant depression tend to achieve remission and the rest continue to suffer from residual symptoms. The latter group of patients needs further study to identify the most effective therapeutic modalities. Newer biomarker-based antidepressants and other drugs, together with non-drug strategies, are on the horizon to address further the multiple complex issues of treatment-resistant depression. CONCLUSION Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is warranted to improve the quality of life of patients with the disorder.
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Affiliation(s)
- Khalid Saad Al-Harbi
- Correspondence: Khalid Saad Al-Harbi, Medical College, King Saud Bin Abdulaziz, University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, Tel +966 1252 0088, Email
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What Have We Learned About Treatment Failure in Empirically Supported Treatments? Some Suggestions for Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2011.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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