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Zhou M, Lageborn CT, Sjölander A, Larsson H, D'Onofrio B, Landén M, Lichtenstein P, Pettersson E. Psychiatric Diagnoses in Parents and Psychiatric, Behavioral, and Psychosocial Outcomes in Their Offspring: A Swedish Population-Based Register Study. Am J Psychiatry 2024; 181:761-773. [PMID: 39086283 DOI: 10.1176/appi.ajp.20230353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
OBJECTIVE Associations were examined between six psychiatric diagnoses in parents and a broad range of psychiatric and nonpsychiatric outcomes in their offspring. METHODS All individuals born in Sweden between 1970 and 2000 were linked to their biological parents (N=3,286,293) through Swedish national registers. A matched cohort design, with stratified Cox regression and conditional logistic regression analyses, was used examine associations between six psychiatric diagnoses in the parents and 32 outcomes in their offspring. All children, including those exposed and those not exposed to parents with psychiatric diagnoses, were followed from their date of birth to the date of emigration from Sweden, death, or December 31, 2013, when the offspring were 14-44 years old. RESULTS In terms of absolute risk, most children who had parents with psychiatric diagnoses were not diagnosed in specialist care themselves, and the proportion of offspring having any of the 16 types of psychiatric conditions ranged from 22.17% (of offspring exposed to parental depression) to 25.05% (of offspring exposed to parental drug-related disorder) at the end of follow-up. Nevertheless, in terms of relative risk, exposure to any of the six parental psychiatric diagnoses increased probabilities of the 32 outcomes among the offspring, with hazard ratios that ranged from 1.03 to 8.46 for time-to-event outcomes and odds ratios that ranged from 1.29 to 3.36 for binary outcomes. Some specificities were observed for parental diagnoses of psychosis and substance-related disorders, which more strongly predicted psychotic-like and externalizing-related outcomes, respectively, in the offspring. CONCLUSIONS The intergenerational transmission of parental psychiatric conditions appeared largely transdiagnostic and extended to nonpsychiatric outcomes in offspring. Given the broad spectrum of associations with the outcomes, service providers (e.g., psychiatrists, teachers, and social workers) should consider clients' broader psychiatric family history when predicting prognosis and planning interventions or treatment.
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Affiliation(s)
- Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Christine Takami Lageborn
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Brian D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
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Kane L, Baucom DH, Daughters SB. Dual-substance use disorder couples: An integrative review and proposed theoretical model. Clin Psychol Rev 2024; 111:102447. [PMID: 38781717 DOI: 10.1016/j.cpr.2024.102447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/17/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Committed romantic relationships between two individuals with Substance Use Disorder (or dual-SUD couples) are prevalent. Dual-SUD couples have poor treatment engagement and outcomes. Research has established a reciprocal link between relationship dynamics (e.g., conflict, intimacy) and substance use. Thus, the couple's relationship presents a distinct social context for both partner's substance use. Dual-SUD couples face unique challenges due to substance use being a shared behavior that may serve as a rewarding source of compatibility, closeness, and short-term relationship satisfaction despite it being at the cost of other alternative sources of substance-free reinforcement. Yet, treatment options for these couples are scarce. Dual-maladaptive health behaviors (e.g., dual-substance use) are challenging to treat; however, theory and preliminary research suggests that transformation of couple's joint motivation toward adaptive health behavior change may result in a more satisfying relationship and improved treatment outcomes for both individuals. The current paper reviews the extant literature on dual-SUD couples from theoretical, empirical, and treatment research and proposes an expanded paradigm regarding how we understand dual-SUD couples with the aim of informing basic research and treatment development.
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Affiliation(s)
- Louisa Kane
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA.
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
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Richardson Velmans S, Joseph C, Wood L, Billings J. A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high-risk patient behaviours. J Psychiatr Ment Health Nurs 2024; 31:325-339. [PMID: 37874310 DOI: 10.1111/jpm.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. AIM The aim of the study was to examine nursing staff experiences of high-risk behaviours in inpatient mental health settings. METHODS Four electronic databases (CINAHL, Medline, PsycINFO, EMBASE) were searched. The protocol for this review was prospectively registered in PROSPERO (Ref: CRD42022334739). A meta-synthesis of nursing staff's experiences of high-risk behaviours in inpatient mental health settings was conducted. RESULTS We identified 30 eligible studies. Six themes were constructed from the meta-synthesis: the social contract of care; the function of risk behaviours; the expectation of risk; risk as a relational concept; navigating contradictions in care; the aftermath. DISCUSSION Nursing staff conceptualize risk as a meaningful behaviour shaped by patient, staff and environmental factors. Managing risk is an ethical dilemma for nursing staff and they require more training and support in ethical risk decision-making. IMPLICATIONS FOR PRACTICE Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours. RELEVANCE STATEMENT Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. This systematic review offers insights into how high-risk behaviours are experienced by nursing staff and makes recommendations about how to improve the understanding and management of them. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.
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Affiliation(s)
| | | | - Lisa Wood
- Division of Psychiatry, University College London, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
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Gil M, Kim SS, Kim D, Han H, Lim B, De Gagne JC. Couple-Oriented Interventions for Mental Health: A Scoping Review. JOURNAL OF FAMILY NURSING 2023:10748407231198249. [PMID: 37846068 DOI: 10.1177/10748407231198249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
The purpose of this research was to systematically examine and collate evidence on couple-oriented interventions for mental health to identify trends in the literature, review research strategies, and suggest directions for future research. A systematic search included studies relating to couple-oriented interventions for preventing mental disorders and/or promoting mental health. We identified a total of 52 studies, which included 55 articles. Our findings revealed that interventions were delivered through various modes, including face-to-face, telephone, and online, with the majority of couple-oriented interventions operating in conjoint sessions. The most common intervention was for selective prevention, targeting patients with cancer and their partners. This review provided evidence of the applicability of theoretical frameworks, dyad analysis, and measurements associated with couple-oriented interventions. Findings can help family nurse practitioners and health care professionals advance strategies to develop and implement evidence-based, couple-oriented interventions for primary prevention of mental disorders and the promotion of mental health.
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Affiliation(s)
- Minji Gil
- Gangneung-Wonju National University, South Korea
| | | | - Daeun Kim
- Ewha Womans University, Seoul, South Korea
| | | | - Boram Lim
- Ewha Womans University, Seoul, South Korea
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Alpert E, Baier AL, Galovski TE. Psychiatric Issues in Women Veterans. Psychiatr Clin North Am 2023; 46:621-633. [PMID: 37500255 DOI: 10.1016/j.psc.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Women veterans have unique life experiences and mental health needs, perhaps in part related to their high rates of exposure to traumatic events including military sexual trauma, combat trauma, and intimate partner violence. We review mental health difficulties among women veterans and describe related functional impairment. Evidence-based treatments are available, but barriers to care remain, including providers' lack of awareness of the unique needs of women veterans. Efforts are needed to increase access to evidence-based interventions, remove barriers to care, and improve provider competency working with this population to maximize clinical outcomes.
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Affiliation(s)
- Elizabeth Alpert
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, 150 South Huntington Avenue (116B-3), Boston, MA 02130, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Allison L Baier
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, 150 South Huntington Avenue (116B-3), Boston, MA 02130, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Tara E Galovski
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, 150 South Huntington Avenue (116B-3), Boston, MA 02130, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Flanagan JC, Leone RM, Melkonian AJ, Jarnecke AM, Hogan JN, Massa AA. Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence. FAMILY PROCESS 2023. [PMID: 37148131 DOI: 10.1111/famp.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Alexander J Melkonian
- Department of Family Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amber M Jarnecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jasara N Hogan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea A Massa
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Camargo CCDO, Neto FL, Tavares H. Engagement and response to a psychoeducation program for family members of inpatients undergoing treatment for substance use disorder. JOURNAL OF MARITAL AND FAMILY THERAPY 2023. [PMID: 37003276 DOI: 10.1111/jmft.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 06/19/2023]
Abstract
The goal of this study was to evaluate a sample of family members, among whom individuals were undergoing inpatient treatment for substance use disorder and identify predictors of engagement in a family support program. A total of 159 family nuclei were analyzed; 36 (22.6%) completed the program and 123 (77.4%) did not complete the program. Compared to nonparticipants, participants were majorly female (91.9%), younger (43.3 years old, SD = 16.5), unemployed, homemakers, and not financially independent (56.7%). The results showed the predominant participation of wives (29.7%) and offspring (mostly daughters, 27.0%). Participants also reported a higher rate of depressive symptoms (p = 0.003) and worse quality of life, primarily environmental. The frequency of domestic violence was higher among participants than among nonparticipants (27.9% vs. 9.0%, p = 0.005). Engagement in family support programs is the first challenge to overcome. The nonparticipants' profile shows the need to adopt engagement strategies that encompass males and facilitate the participation of breadwinning family members.
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Affiliation(s)
- Claudia Cristina de Oliveira Camargo
- Impulsive and Addictive Behaviors Ward/Interdisciplinary Alcohol and Drug Studies Program, Institute of Psychiatry, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Francisco L Neto
- Anxiety Outpatient Program, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Hermano Tavares
- Impulse Control Disorders Outpatient Program, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
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Song J, Jiao H, Wang C. How work-family conflict affects knowledge workers' innovative behavior: a spillover-crossover-spillover model of dual-career couples. JOURNAL OF KNOWLEDGE MANAGEMENT 2023. [DOI: 10.1108/jkm-06-2022-0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Purpose
Innovative behavior is a microfoundation of an organization’s innovation. Knowledge workers are the main creators of innovations. With the boundaries between work and family becoming increasingly ambiguous, the purpose of this study is to explore how the work–family conflict affects knowledge workers’ innovative behavior and when such a conflict arises.
Design/methodology/approach
To test the theoretical model, this study collected data from a time-lagged matched sample of 214 dual-career couples. The data were analyzed with the bias-corrected bootstrapping method.
Findings
The results of this study showed that work-to-family conflict had not only a direct negative effect on knowledge workers’ innovative behavior but also an indirect effect through spouses’ within-family emotional exhaustion and knowledge workers’ family-to-work conflict. If wives’ gender role perceptions are traditional, then the indirect serial mediating effect is weakened, but if such perceptions are egalitarian, then the mentioned effect is aggravated.
Practical implications
In terms of organizational implications, managers could alter their approach by reducing detrimental factors such as work–family conflict to improve knowledge workers’ innovative behavior. Emotional assistance programs for both knowledge workers and their spouses can be used to prevent the detrimental effect of work–family conflict on innovative behavior. As to social implications, placing dual-career couples into a community of likeminded individuals and promoting their agreement on gender role identity will greatly reduce the negative effects of work–family conflict.
Originality/value
Starting from the perspective of the behavior outcome of knowledge management, this study advances the existing knowledge management literature by enriching the antecedents of knowledge workers’ innovative behavior, illuminating a spillover–crossover–spillover effect of work–family conflict on knowledge workers’ innovative behavior and identifying the boundary condition of this transmission process.
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Snippen NC, de Vries HJ, Bosma AR, van der Burg-Vermeulen SJ, Hagedoorn M, Brouwer S. Workers' views on involving significant others in occupational health care: a focus group study among workers with a chronic disease. Disabil Rehabil 2022; 44:8252-8263. [PMID: 34904485 DOI: 10.1080/09638288.2021.2011435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To explore workers' views and considerations on involving their significant others (SOs) in occupational health care. METHODS Four focus group interviews in the Netherlands, with 21 workers who had visited an occupational health physician (OHP) due to work absence caused by a chronic disease. Data was analyzed using thematic analysis. RESULTS We distinguished four main themes: (i) attitudes towards involving SOs, (ii) preferences on how to involve SOs, (iii) benefits of involving SOs, and (iv) concerns with regard to involving SOs. Workers expressed both positive and critical opinions about involving SOs in occupational health care. Benefits mentioned included provision of emotional and informational support by SOs before, during, and after consultations. According to workers, support from SOs can be enhanced by informing SOs about re-integration plans and involving them in decision making. However, workers were concerned about overburdening SOs, and receiving unwanted support from them. CONCLUSIONS According to interviewed workers, engagement of SOs in occupational health care can help workers with a chronic disease in their recovery and return to work. However, they felt it is important to take SO characteristics and the worker's circumstances and preferences into account, and to balance the potential benefits and drawbacks of involving SOs.Implications for rehabilitationThis study suggests that the worker's re-integration process could benefit from informing significant others about the return to work plans, involving them in decision-making, and explicitly discussing how the significant other can support the worker.Occupational health physicians have an important role in informing workers about the possibility and potential benefits of involving their significant others in the re-integration process.The involvement of a significant other in the re-integration process needs to be tailored to the specific situation of the individual worker, taking into account the preferences of both the worker and significant other.Findings suggest that it is important that occupational health physicians, workers and significant others are not only aware of the possible benefits of significant other involvement, but also of potential drawbacks such as interference during consultations, overburdening significant others, and significant others providing unwanted support.
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Affiliation(s)
- Nicole C Snippen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Haitze J de Vries
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Astrid R Bosma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sylvia J van der Burg-Vermeulen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Sciences, Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Fung HW, Lam SKK, Chien WT, Hung SL, Ling HWH, Lee VWP, Wang EK. Interpersonal stress mediates the relationship between childhood trauma and depressive symptoms: Findings from two culturally different samples. Aust N Z J Psychiatry 2022:48674221138501. [PMID: 36440622 DOI: 10.1177/00048674221138501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Childhood trauma is associated with adulthood depressive symptoms, but very few studies explored potential social and interpersonal mediators behind this association. This study made the first attempt to test the potential mediating effects of interpersonal stress in the associations between childhood betrayal and non-betrayal trauma and depressive symptoms. METHOD We analyzed data in a sample of English-speaking adults from diverse backgrounds (from 19 different countries, mainly from Western countries) (N = 468). We then replicated and compared the results with those in another convenience sample of Chinese-speaking younger adults with different cultural backgrounds and mental health status (N = 205). RESULTS The results in both samples indicated that (1) childhood betrayal trauma had a stronger relationship with depressive symptoms than childhood non-betrayal trauma and that (2) interpersonal stress was a significant mediator in the relationship between childhood betrayal trauma and depressive symptoms, even when childhood non-betrayal trauma was included as a covariate. The indirect effect of childhood non-betrayal trauma on depressive symptoms through interpersonal stress was not consistent in two samples. CONCLUSIONS Our findings point to the importance of taking social and interpersonal contexts into account when investigating, preventing and managing depression in trauma-exposed populations. Early social interventions such as family interventions, interpersonal skills training and building social resources may have the potential to change the trajectory of the development of mental health problems in trauma survivors.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Lin Hung
- Department of Social Work, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Henry Wai-Hang Ling
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Edward Ks Wang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Methemoglobinemia in a Patent Presenting with an Undisclosed Intentional Overdose. Harv Rev Psychiatry 2022; 30:361-368. [PMID: 36534838 DOI: 10.1097/hrp.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Thomas FC, Puente-Duran S, Mutschler C, Monson CM. Trauma-focused cognitive behavioral therapy for children and youth in low and middle-income countries: A systematic review. Child Adolesc Ment Health 2022; 27:146-160. [PMID: 33216426 DOI: 10.1111/camh.12435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Trauma-focused cognitive behavioral therapy (TF-CBT) has been identified as a gold standard treatment for childhood posttraumatic stress disorder (PTSD) in Western countries. More recently, TF-CBT has emerged in the literature as an area of interest for children and youth affected by conflict and war in low- and middle-income countries (LMIC). METHODS The present systematic review assesses the current evidence base of TF-CBT for children and youth in LMIC, with a focus on conflict-affected countries. A total of 143 articles were identified, of which 11 articles, representing 1,354 participants, met the proposed inclusion criteria. RESULTS Results showed that the majority of the studies identified were conducted in low-resource community settings in East or Central Africa (n = 8). It was also found that cultural considerations were taken into account in TF-CBT delivery to meet the needs of local populations. Additionally, measures were translated and validated for local use. CONCLUSIONS Findings of outcome data indicated that TF-CBT was effective in treating trauma-related symptoms and improving psychosocial functioning in children and adolescents in LMICs. Given the limited number of published literature available in this area, further studies are needed to conclude when and for whom trauma-focused interventions are most relevant.
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Affiliation(s)
- Fiona C Thomas
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Sofia Puente-Duran
- Department of Psychology, Ryerson University, Toronto, ON, Canada.,Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, ON, Canada
| | | | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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13
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Meis LA, Glynn SM, Spoont MR, Kehle-Forbes SM, Nelson D, Isenhart CE, Eftekhari A, Ackland PE, Linden EB, Orazem RJ, Cutting A, Hagel Campbell EM, Astin MC, Porter KE, Smith E, Chuick CD, Lamp KE, Vuper TC, Oakley TA, Khan LB, Keckeisen SK, Polusny MA. Can families help veterans get more from PTSD treatment? A randomized clinical trial examining Prolonged Exposure with and without family involvement. Trials 2022; 23:243. [PMID: 35354481 PMCID: PMC8965544 DOI: 10.1186/s13063-022-06183-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder occurs in as many as one in five combat veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Trauma-focused treatments, such as Prolonged Exposure, result in clinically significant symptom relief for many. Adherence to these treatments (i.e., session attendance and homework compliance) is vital to ensuring recovery but can be challenging for patients. Engaging families in veterans' treatment could prove to be an effective strategy for promoting treatment adherence while also addressing long-standing calls for better family inclusion in treatment for posttraumatic stress disorder. This paper describes the methods of a pragmatic randomized controlled trial designed to evaluate if family inclusion in Prolonged Exposure can improve treatment adherence. METHODS One hundred fifty-six veterans, with clinically significant symptoms of posttraumatic stress disorder, will be randomized to receive either standard Prolonged Exposure or Prolonged Exposure enhanced through family inclusion (Family-Supported Prolonged Exposure) across three different VA facilities. Our primary outcomes are session attendance and homework compliance. Secondary outcomes include posttraumatic stress disorder symptom severity, depression, quality of life, and relationship functioning. The study includes a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in Prolonged Exposure within VA. DISCUSSION While the importance of family involvement in posttraumatic stress disorder treatment is non-controversial, there is no evidence base supporting best practices on how to integrate families into PE or any other individually focused trauma-focused treatments for posttraumatic stress disorder. This study is an important step in addressing this gap, contributing to the literature for both retention and family involvement in trauma-focused treatments. TRIAL REGISTRATION ClinicalTrials.gov NCT03256227 . Registered on August 21, 2017.
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Affiliation(s)
- Laura A Meis
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA.
- Department of Medicine, University of Minnesota Medical School, Minnesota, USA.
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System, Los Angeles, USA
- Department of Psychiatry & Biobehavioral Science, University of California, Los Angeles, USA
| | - Michele R Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minnesota, USA
- Department of Psychiatry, University of Minnesota Medical School, Minnesota, USA
- Pacific Islands Division, National Center for PTSD, Honolulu, USA
| | - Shannon M Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minnesota, USA
- Women's Division, National Center for PTSD, Honolulu, USA
| | - David Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minnesota, USA
| | - Carl E Isenhart
- VA Desert Pacific Healthcare Network (VISN 22), Long Beach, USA
| | - Afsoon Eftekhari
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Livermore, USA
| | - Princess E Ackland
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minnesota, USA
| | - Erin B Linden
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
| | - Robert J Orazem
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
| | - Andrea Cutting
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
| | - Emily M Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
| | - Millie C Astin
- Atlanta VA Health Care System, Decatur, USA
- Department of Psychiatry and Behavioral Sciences, Emory University Medical Center, Atlanta, USA
| | - Katherine E Porter
- VA Ann Arbor Healthcare System, Ann Arbor, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Erin Smith
- VA Ann Arbor Healthcare System, Ann Arbor, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | | | | | - Tessa C Vuper
- VA Ann Arbor Healthcare System, Ann Arbor, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Taylor A Oakley
- Department of Psychology, University of Missouri-Kansas City, Kansas City, USA
| | - Lila B Khan
- Department of Family Social Science, University of Minnesota, Minneapolis, USA
| | | | - Melissa A Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minnesota, USA
- Department of Psychiatry, University of Minnesota Medical School, Minnesota, USA
- Minneapolis Veterans Affairs Health Care System, Minneapolis, USA
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Schumm JA, Renno S. Implementing Behavioral Couples Therapy for Substance Use Disorders in Real-World Clinical Practice. FAMILY PROCESS 2022; 61:25-42. [PMID: 33904595 DOI: 10.1111/famp.12659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Behavioral couple therapy (BCT) is an evidence-based, manualized treatment that has been primarily developed to treat alcohol use disorder. The treatment model leverages the intimate partner relationship to support recovery. Although the efficacy of BCT is well-supported in randomized controlled trials, little attention has been given to the translation of BCT to everyday practice settings. This article presents recommendations for implementing BCT in such settings. We describe a stepwise approach for getting a couple into BCT and determining whether it is an appropriate treatment for the couple. In addition, we provide recommendations for broadening inclusion criteria for everyday practice settings, including the use of BCT with couples who have drug use disorders with couples where both members exhibit substance use disorders and with couples who choose controlled drinking or drug use versus abstinence. Whereas BCT has mostly been researched in speciality substance use disorder settings, we provide recommendations for its use in general couple therapy settings. Based upon the extant research, we suggest implementing BCT as a standalone treatment or as an add-on to individual counseling for substance use disorders. We provide guidance for delivering BCT through telehealth and encourage future research to investigate this delivery modality. Future research should prioritize investigating the effectiveness of various BCT dissemination strategies and seek to determine what dosage and components of BCT will result in the best outcomes.
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Affiliation(s)
- Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Dayton, OH, USA
- Samaritan Behavioral Health, Inc., Dayton, OH, USA
- OneFifteen, Inc., Dayton, OH, USA
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15
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Mutschler C, Malivoire BL, Schumm JA, Monson CM. Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature. Behav Cogn Psychother 2022; 50:1-22. [PMID: 35190008 DOI: 10.1017/s1352465822000042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a 'gold standard' treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT. AIMS The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment. METHOD A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators. RESULTS The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender. CONCLUSIONS The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.
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Affiliation(s)
| | | | - Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Dayton, OH, USA
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16
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Feasibility and Preliminary Efficacy of a New Online Self-Help Intervention for Depression among Korean College Students' Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042142. [PMID: 35206327 PMCID: PMC8872265 DOI: 10.3390/ijerph19042142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 01/07/2023]
Abstract
Applying innovative online approaches to interventions for preventing depression is necessary. Since depressive emotions are typically shared within the family, the development of interventions involving family members is critical. This study thus aimed to examine the feasibility, acceptability, and preliminary outcomes of a new online self-help intervention, MindGuide, among Korean college students’ families. We developed MindGuide, which integrates cognitive behavioral therapy with mindfulness and an emotional regulation approach. A one-group pretest–posttest design was used to measure the changes in the Center for Epidemiological Studies Depression Scale, the Attitude Toward Suicide scale, and the Satisfaction With Life Scale before and after the intervention. Of the 34 families that began the program, completion rates were 88.2%, 85.3%, and 91.2% for fathers, mothers, and children, respectively. The findings indicated that the MindGuide program is feasible and acceptable for families of Korean college students. The results support the potential effect of MindGuide on reducing depression, improving positive attitudes toward suicide prevention, and enhancing family relationships in participants at risk of depression. However, future research is needed to thoroughly explore and evaluate the efficacy of the MindGuide program.
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Goodman M, Sullivan SR, Spears AP, Crasta D, Mitchell EL, Stanley B, Dixon L, Hazlett EA, Glynn S. A Pilot Randomized Control Trial of a Dyadic Safety Planning Intervention: Safe Actions for Families to Encourage Recovery (SAFER). COUPLE & FAMILY PSYCHOLOGY 2022; 11:42-59. [PMID: 36945697 PMCID: PMC10026708 DOI: 10.1037/cfp0000206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A recent systematic review on family and suicide prevention efforts identified a lack of family-based safety planning interventions for adults. To address this gap, The Safe Actions for Families to Encourage Recovery (SAFER) intervention was created. SAFER is a novel, manualized, 4- session, family-based treatment intervention that provides the tools and structure to support family involvement in Safety Planning Intervention (SPI) for Veterans at moderate risk for suicide. The SAFER intervention includes the use of psychoeducation, communication skills training, and development of a Veteran, and a complementary supporting partner, SPI. This Stage II (2aii) randomized clinical trial (RCT) evaluated the preliminary efficacy of this innovative and much-needed approach. Thirty-nine Veterans and an associated supporting partner were randomized to receive either SAFER or currently mandated (i.e., standard) individual Safety Planning Intervention (I-SPI). Veterans in the SAFER condition as compared to I-SPI exhibited significant monthly decrements in suicide ideation as measured by the Columbia Suicide Severity Rating Scale (B=-0.37; p=.032). Moreover, a treatment-by-time interaction emerged when predicting improvements in Veteran suicide-related coping (B=0.08; p=.028) and supporting partner support of Veteran's coping efforts (B=0.17; p=.032). However, the treatment effect for Veteran coping was not significant in dyadic analyses (B=0.07; p=.151) after controlling for the partner's support (B=0.16; p=.009). Self-reported appraisals of relational factors and self-efficacy were not impacted by condition for either Veterans or supporting partners. This initial efficacy pilot trial suggests that a brief dyad-based SPI has the potential to improve Veteran suicide symptoms and help family members support the Veteran's coping efforts. However more intensive family work may be required for changes in self-perceptions of burdensomeness, belongingness, and caregiver perceptions of the Veteran as a burden. Nonetheless, SAFER's discussion and disclosure about suicide symptoms facilitated more robust development of SPI for the Veteran and their accompanying supporting partner.
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Affiliation(s)
- Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah R. Sullivan
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Angela Page Spears
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Emily L. Mitchell
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Lisa Dixon
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Erin A. Hazlett
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirley Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Research Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Timko C, Rossi FS, Grant KM, Lor MC, Cucciare MA. Concerned others' help utilization and patients' alcohol treatment outcomes. Drug Alcohol Depend 2021; 228:108983. [PMID: 34507007 PMCID: PMC8595707 DOI: 10.1016/j.drugalcdep.2021.108983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study of dyads composed of patients in treatment for alcohol use disorders (AUDs) and their Concerned Others (COs) examined (1) COs' attendance at three types of help (educational sessions, treatment sessions with the patient, and treatment sessions without the patient) during a 3-month period after patients' admission, and (2) whether COs' use of help was associated with better treatment outcomes reported by COs about patients, and patients about themselves. METHODS Dyads (n = 277) were assessed when patients entered AUD treatment and 3 months later (80 %). COs rated their patient's AUD, and patients rated their own AUD, on the Brief Addiction Monitor. At 3-month follow-up, COs answered three items about help (education, treatment with patient, treatment without patient) from their patient's treatment program. Main analyses were analyses of covariance to examine associations between COs' help use and patients' outcomes. RESULTS At 3-month follow-up, COs who had obtained one type of help were significantly more likely to have also obtained the other two types of help. However, relatively few COs (39 %) obtained any type of help. COs who obtained help rated their patient as having more protection against future substance use. And, when COs had obtained help, patients rated themselves as having less risk of future substance use, and had attended a greater number of AA meetings, than when COs had not obtained help. CONCLUSIONS Findings suggest that COs' use of help can benefit patients in AUD treatment. Clinicians and researchers should increase the availability and use of help among COs.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Fernanda S Rossi
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Kathleen M Grant
- Mental Health and Behavioral Science Department, VA Nebraska-Western Iowa Health Care System, Omaha, NE, 68105, USA; Pulmonary Section, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile Streets, Omaha, NE, 68198, USA.
| | - Mai Chee Lor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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Soto-Nevarez A, Reilly A, Stevens E, Bobak TJ, Jason LA. Individuals in sober living: Effects of contact with substance using family members. J Prev Interv Community 2021; 50:124-136. [PMID: 34096471 DOI: 10.1080/10852352.2021.1934943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examines the effects that substance-using family members have on those working to maintain recovery from substance use disorder. Participants (N = 229) were recruited from Oxford Houses (OH) across North Carolina, Texas, and Oregon. A stepwise linear regression with variables including abstinence self-efficacy, gender, substance use, attendance of Alcoholics Anonymous, and conflict with family and non-family was run to examine associations between the amount of substance using family members in the participant's social network. The abstinence self-efficacy mean score, gender, and days of serious conflict with non-family members were significantly associated with total number of substance-using family members in a participant's social network. These results may indicate that OH's serve as a buffer between substance using family members and one's abstinence self-efficacy. It remains unclear if individuals are at an increased risk of relapse from this familial influence when perceived abstinence self-efficacy drops. If so, OH residents could benefit from interventions that help them maintain their perceived abstinence self-efficacy.
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Affiliation(s)
| | - Angela Reilly
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ed Stevens
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Ted J Bobak
- Center for Community Research, DePaul University, Chicago, Illinois, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois, USA
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20
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Polenick CA, Kim Y, DePasquale N, Birditt KS, Zarit SH, Fingerman KL. Midlife Children's and Older Mothers' Depressive Symptoms: Empathic Mother-Child Relationships as a Key Moderator. FAMILY RELATIONS 2020; 69:1073-1086. [PMID: 33927466 PMCID: PMC8078888 DOI: 10.1111/fare.12466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to evaluate the link between midlife children's and older mothers' depressive symptoms, whether this link is exacerbated in highly empathic mother-child relationships (i.e., shared strong feelings of being loved, cared for, and understood in the mother-child tie), and whether these associations vary by children's gender. BACKGROUND Empathic mother-child relationships in later life may intensify the link between midlife children's and older mothers' depressive symptoms. Yet little is known about the emotional implications of the mother-child tie for midlife daughters and sons. METHOD The sample included 234 midlife children (M = 49.75 years) and their mothers (M = 75.27 years) from Wave 1 of the Family Exchanges Study. Linear regressions were estimated to determine the link between midlife children's and older mothers' depressive symptoms and the potential moderating role of highly empathic mother-child relationships. RESULTS Midlife children had greater depressive symptoms when their mothers had greater depressive symptoms in the context of highly empathic mother-child relationships. This association was not moderated by children's gender. CONCLUSION These findings underscore the enduring emotional salience of the mother-child tie and emphasize the importance of relationship characteristics that may heighten the link between midlife children's and their mothers' depressive symptoms. IMPLICATIONS Interventions to prevent or treat depressive symptoms among midlife adults may benefit from accounting for the role that their mothers' depressive symptoms might play in maintaining these symptoms, particularly when mother-child ties are highly empathic.
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Affiliation(s)
- Courtney A. Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Program for Positive Aging, University of Michigan, Ann Arbor, MI 48109
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- Aging & Biopsychosocial Innovations Program, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Yijung Kim
- Department of Gerontology, University of Massachusetts Boston, Boston, MA 02125
| | - Nicole DePasquale
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC 27701
| | - Kira S. Birditt
- Aging & Biopsychosocial Innovations Program, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Steven H. Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802
| | - Karen L. Fingerman
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin TX 78712
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21
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Kim SS, Kim D, Gil M, Lim B, De Gagne JC. Couple- or family-oriented interventions and outcomes for preventing mental health problems and promoting mental health: a scoping review protocol. JBI Evid Synth 2020; 19:432-439. [PMID: 33141800 DOI: 10.11124/jbies-20-00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to map the literature describing couple- and family-oriented interventions and outcomes to prevent mental health problems and promote mental health. INTRODUCTION Literature involving couple- and family-focused mental health interventions has gained increased attention over the past two decades, yet little is known about the efficacy of these interventions for promoting mental health and preventing mental disorders. Despite recognition that the most sustainable method for reducing the increasing burden of mental disorders is primary prevention, there has been no systematic investigation of relevant couple- and family-focused interventions. INCLUSION CRITERIA This scoping review will consider studies that include couples or multiple family members who have participated in couple- and family-focused interventions aimed at primary prevention of mental disorders and promotion of mental health. This study will include experimental, quasi-experimental, and observational study designs, as well as qualitative studies. Conference abstracts, posters, editorials, commentaries, and opinion papers will be excluded. METHODS Multiple databases will be searched, including PubMed (MEDLINE), CINAHL, ERIC, PsycINFO (via EBSCO), Web of Science, Scopus, and Research Information Sharing Service (RISS). Trial registers and gray literature will also be searched. Two independent reviewers will screen the abstract/title of retrieved citations using inclusion and exclusion criteria. After screening titles and abstracts of identified citations, relevant studies will be retrieved in full. Using a data extraction instrument developed specifically for this review, eligible studies will be extracted and presented in diagrammatic or tabular form, accompanied by a narrative summary.
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Affiliation(s)
- Suk-Sun Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Daeun Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Minji Gil
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Boram Lim
- Library, Ewha Womans University, Seoul, South Korea
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Dunlap LJ, O'Farrell TJ, Schumm JA, Orme SS, Murphy M, Murchowski PM. Group Versus Standard Behavioral Couples' Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness. J Stud Alcohol Drugs 2020. [PMID: 32359044 DOI: 10.15288/jsad.2020.81.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners--group behavioral couples' therapy plus individual-based treatment (G-BCT), or standard behavioral couples' therapy plus individual-based treatment (S-BCT). METHOD We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples' therapy.
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Affiliation(s)
- Laura J Dunlap
- RTI International, Research Triangle Park, North Carolina
| | - Timothy J O'Farrell
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts.,Harvard Medical School Department of Psychiatry, Boston, Massachusetts
| | - Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Ellis Human Development Institute, Dayton, Ohio
| | | | - Marie Murphy
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts.,Harvard Medical School Department of Psychiatry, Boston, Massachusetts
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Abstract
Because relationship discord and dissolution are common and costly, interventions are needed to treat distressed couples and to prevent distress among vulnerable couples. We review meta-analytic evidence showing that 60-80% of distressed couples benefit from behavioral and emotion-focused approaches to couple therapy, but we also note that treatment effects are weaker in actual clinical practice than in controlled studies, dissipate following treatment for about half of all couples, and may be explained by factors that are common across models. Meta-analyses of prevention programs reveal reliable but smaller effects, reflecting a need to know more about whether and how communication mediates effects, about how risk and diversity moderate effects, and about how technology-enabled interventions can reduce attrition in vulnerable populations. Interventions for couples are improving and expanding, but critical questions remain about how and for whom they work.
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Affiliation(s)
- Thomas N Bradbury
- Department of Psychology, University of California, Los Angeles, California 90095-1563, USA;
| | - Guy Bodenmann
- Department of Psychology, University of Zurich, CH-8050 Zurich, Switzerland;
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Koffel E, Amundson E, Wisdom JP. Exploring the Meaning of Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Pain. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:67-75. [PMID: 31271434 PMCID: PMC6942230 DOI: 10.1093/pm/pnz144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Insomnia is one of the most common, persistent, and distressing symptoms associated with chronic pain. Cognitive behavioral therapy for insomnia (CBT-I) is the firstline treatment for insomnia, but patient preferences and perspectives about CBT-I within the context of chronic pain are unknown. The current qualitative study sought to understand the experience of CBT-I among patients with chronic pain, including aspects of CBT-I that were found to be difficult (e.g., pain as a specific barrier to adherence/dropout), changes in sleep and pain functioning after CBT-I, and aspects of CBT-I that were appreciated. DESIGN Qualitative semistructured interviews. METHODS We conducted individual semistructured interviews with 17 veterans with chronic pain and insomnia who had recently participated in CBT-I, as well as their CBT-I therapists, and used thematic analysis to identify conceptual themes. RESULTS Results revealed that patients and CBT-I therapists found changing sleep habits during CBT-I challenging due to anxiety and temporary increases in fatigue, but did not identify major pain-related barriers to adhering to CBT-I recommendations; patients experienced better sleep, mood, energy, and socialization after CBT-I despite minimal changes in pain intensity; and patients highly valued CBT-I as a personalized treatment for sleep and strongly recommended it for other patients with chronic pain. CONCLUSIONS Findings of improved sleep and functional outcomes support efforts to incorporate CBT-I into chronic pain treatment, including educating patients and providers about the strong feasibility of improving sleep and quality of life despite ongoing pain.
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Affiliation(s)
- Erin Koffel
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | - Erin Amundson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
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Schumm JA, O'Farrell TJ, Murphy MM, Muchowski P. Efficacy of Behavioral Couples Therapy Versus Individual Recovery Counseling for Addressing Posttraumatic Stress Disorder Among Women With Drug Use Disorders. J Trauma Stress 2019; 32:595-605. [PMID: 31356702 DOI: 10.1002/jts.22415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
Behavioral couples therapy (BCT) for substance use disorder shares similar intervention strategies with empirically supported couples therapies for posttraumatic stress disorder (PTSD). Like couples-based PTSD therapies, BCT includes interventions that may help to improve PTSD, such as increasing positive behavioral exchanges and improving communication. Studies have yet to examine whether BCT, which has demonstrated efficacy for improving substance-related outcomes, is efficacious for reducing PTSD. We conducted a secondary analysis of a randomized clinical trial comparing individually based treatment (IBT) to BCT plus IBT (BCT+IBT) for women with drug use disorders. Women in both conditions received 26 therapy sessions over 13 weeks. Women completed the PTSD Diagnostic Scale at baseline, posttreatment, and quarterly during the 1-year follow-up. Of the 61 women who were randomized to treatment, 51 (83.6%) reported a lifetime traumatic event. Of the 50 women who endorsed a "worst traumatic event," 25 (50.0%) had a baseline PTSD diagnosis. The treatments did not differ on baseline PTSD severity or diagnosis. Women who received BCT+IBT had significant reductions in PTSD severity from baseline to each of four posttreatment follow-ups, ds = 0.34-0.80; there were no changes in the IBT group. Generalized estimating equation results showed that women who received BCT+IBT had significantly lower PTSD severity during follow-up versus those who received IBT, d = 0.35. There were no differences in the proportion of participants diagnosed with PTSD following treatment. This was the first study to show that BCT+IBT is efficacious for reducing PTSD among women with drug use disorders.
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Affiliation(s)
- Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Dayton, Ohio, USA
| | | | - Marie M Murphy
- VA Boston Healthcare System, Brockton, Massachusetts, USA
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Sebastianski M, Gates M, Gates A, Nuspl M, Bialy LM, Featherstone RM, Breault L, Mason-Lai P, Hartling L. Evidence available for patient-identified priorities in depression research: results of 11 rapid responses. BMJ Open 2019; 9:e026847. [PMID: 31256024 PMCID: PMC6609077 DOI: 10.1136/bmjopen-2018-026847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/07/2019] [Accepted: 06/11/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence. DESIGN Eleven rapid responses. DATA SOURCES Single electronic database (PubMed). ELIGIBILITY CRITERIA Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary. RESULTS For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0-179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects. CONCLUSIONS We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.
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Affiliation(s)
- Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Nuspl
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Liza M Bialy
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robin M Featherstone
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lorraine Breault
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Ping Mason-Lai
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Patient Engagement Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Design of a randomized controlled trial examining the efficacy of oxytocin to enhance alcohol behavioral couple therapy. Contemp Clin Trials 2019; 82:1-8. [PMID: 31063869 DOI: 10.1016/j.cct.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/20/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
Combining pharmacological interventions with evidence-based behavioral interventions may help optimize treatment outcomes for alcohol use disorder (AUD). While several effective behavioral interventions for AUD have been developed, the vast majority target individual patients, despite evidence that behavioral interventions for couples have the ability to outperform individual treatments for AUD. Alcohol Behavioral Couples Therapy (ABCT) is an evidence-based behavioral intervention for couples that has been shown to significantly reduce AUD severity as well as improve relationship functioning. Accumulating evidence suggests that the neuropeptide oxytocin has the ability to reduce alcohol craving and consumption, symptoms of tolerance and withdrawal, and ameliorate neurobiological deficits associated with AUD. Furthermore, oxytocin has demonstrated the ability to increase prosocial behavior and cognition, and restore sensitivity to natural rewards such as interpersonal relationships. No study to date has examined the ability of oxytocin to enhance ABCT. Thus, the primary objective of this Phase II study is to examine the effects of oxytocin versus placebo in combination with ABCT in reducing AUD severity and improving relationship functioning. We also will utilize neuroimaging techniques before and after treatment to investigate the underlying pathophysiology of AUD among couples and identify prognostic indicators of treatment outcome. The findings from this study might provide critical new information to help inform clinical practice and accelerate research on the pharmacological treatment of AUD.
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Layman PG, Sanford K, Myers DR, Dolan S, Ellor JW, Morissette SB, Whitacre J, Crow J. Intimate partner cohesion and military unit cohesion: Different types of interpersonal relationships each uniquely predict soldier well-being. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1579606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Keith Sanford
- Department of Psychology, Baylor University, Waco, Texas
| | | | - Sara Dolan
- Department of Psychology, Baylor University, Waco, Texas
| | | | - Sandra B. Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
| | - Janice Whitacre
- Warrior Combat Stress Reset Program, Carl. R. Darnall Army Medical Center, Fort Hood, Texas
| | - Janet Crow
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas
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Flanagan JC, Yonce S, Calhoun CD, Back SE, Brady KT, Joseph JE. Preliminary development of a neuroimaging paradigm to examine neural correlates of relationship conflict. Psychiatry Res Neuroimaging 2019; 283:125-134. [PMID: 30581042 PMCID: PMC6379119 DOI: 10.1016/j.pscychresns.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/02/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023]
Abstract
Social stress in the form of conflict between romantic partners is a salient correlate of substance use disorders (SUD), and also plays an integral role in SUD treatment outcomes. Neuroimaging has advanced the study of social stress on SUD etiology, course, and treatment. However, no neuroimaging paradigms have yet been developed to examine neural responses to conflict among romantic couples. In order to fill this gap in the literature, the goal of this exploratory study was to examine the preliminary feasibility of a novel relationship conflict fMRI paradigm. We compared the effects of an auditory relationship conflict versus a neutral cue on functional connectivity in corticolimbic brain regions, and the associations between neural activities and self-report ratings of relationship adjustment, substance use problems, and intimate partner violence. We also explored sex differences in neural correlates of relationship conflict versus neutral cues. Participants demonstrated increased functional connectivity between the amygdala and the prefrontal cortex during the relationship conflict cue compared to the neutral cue. Intimate partner violence was associated with functional connectivity. Sex differences emerged in neural responses to the relationship conflict cue compared to the neutral cue. Collectively, the findings demonstrate preliminary validity of this novel neuroimaging paradigm for couples.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA.
| | - Shayla Yonce
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Casey D Calhoun
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
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An Evaluation Study of the “RESTART” Program—Short-Term Residential Treatment for Addiction. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9933-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mellentin A, Stenager EN, Stenager E. Preventing suicidal behavior in patients with multiple sclerosis: a scoping review. Expert Rev Neurother 2018; 18:945-952. [PMID: 30451039 DOI: 10.1080/14737175.2018.1549990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Suicidal behavior is a relatively rare occurrence among patients with multiple sclerosis (MS). Nonetheless, it is important to identify and be aware of the constituting risk factors to prevent suicidal behavior among vulnerable patients. Areas covered: This scoped review will shortly outline well-known biological and psychosocial risk factors for suicidal behavior among MS patients and suggest preventive initiatives. The preventive strategies should include a close monitoring of MS pharmacotherapy to prevent progression, and awareness and early identification of psychosocial risk factors across a variety of heathcare and social instances the patient may encounter during their life with the disease. The staff in these instances should be educated in detecting the MS patients at increased risk and refer them to relevant healthcare instances, including the general practitioner, neurologists, psychiatrist, etc. In addition, referral to social instances to support educational, vocational, and home environment to the state of the disease is of utmost importance. Expert commentary: Enhancing quality of life for as long as possible by these means may be held to reduce the risk for psychosocial problems and hence suicidal behavior.
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Affiliation(s)
- Angelina Mellentin
- a Unit for Psychiatric Research, Department of Clinical Research , University of Southern Denmark , Odense , Denmark.,b Unit for Psychiatric Research, Institute of Regional Health Services Research , University of Southern Denmark , Aabenraa , Denmark
| | - Elsebeth Nylev Stenager
- d Department of Regional Health Research , University of Southern Denmark , Odense , Denmark
| | - Egon Stenager
- c Multiple sclerosis clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding) , Hospital of Southern Jutland , Aabenraa , Denmark.,d Department of Regional Health Research , University of Southern Denmark , Odense , Denmark
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Shepherd-Banigan ME, Shapiro A, McDuffie JR, Brancu M, Sperber NR, Van Houtven CH, Kosinski AS, Mehta NN, Nagi A, Williams JW. Interventions That Support or Involve Caregivers or Families of Patients with Traumatic Injury: a Systematic Review. J Gen Intern Med 2018; 33:1177-1186. [PMID: 29736752 PMCID: PMC6025684 DOI: 10.1007/s11606-018-4417-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/17/2018] [Accepted: 03/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Almost 40 million family caregivers care for a loved one with severe physical or cognitive impairments. The purpose of this review is to summarize evidence about the benefits of interventions to support or involve family members/caregivers of patients with trauma-related injury on caregiver, patient, and household outcomes. METHODS English-language peer-reviewed publications in MEDLINE, CINAHL, and PsycINFO from 1995 through December 2016 were identified. Eligible studies included RCT or quasi-experimental studies evaluating interventions designed to support or involve caregivers or family members of patients with TBI, PTSD, or polytrauma. Abstractions were completed by one reviewer and checked by a second; two reviewers independently assessed risk of bias using the Cochrane Effective Practice and Organization of Care Review Criteria. RESULTS Thirteen studies (n = 9 TBI; n = 4 PTSD, n = 0 polytrauma) evaluated psychological or rehabilitation interventions involving caregivers. Interventions did not improve TBI patients' functional status (standardized mean difference [SMD], 0.29 [95% confidence interval [CI], - 0.51 to 1.08]) or psychological symptoms (SMD - 0.25, CI - 0.62 to 0.12). Qualitative analysis shows potential intervention benefit for TBI symptoms. Interventions did not improve TBI caregiver psychological symptoms (SMD - 0.26, CI - 0.57 to 0.05); however, qualitative analysis suggests mixed effects for caregiver burden and quality of life. Positive intervention effects on patients' PTSD symptoms, mental health service use, and PTSD caregivers' psychological symptoms were identified with certain interventions. Strength of evidence ranged from moderate to very low. DISCUSSION Studies showed mixed patterns of intervention effects on caregiver and patient outcomes; evidence about intervention impact is inconclusive. This review is the first to identify caregiving interventions for patients with TBI and polytrauma and extends past reviews about patients with PTSD. Limitations include a small evidence base, low study quality, disparate methods, varied outcome measures, and high heterogeneity. PROSPERO Registration CRD42017053516.
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Affiliation(s)
- Megan E Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Abigail Shapiro
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer R McDuffie
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Mira Brancu
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nina R Sperber
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Courtney H Van Houtven
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Neha N Mehta
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Avishek Nagi
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - John W Williams
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
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Nilsson A, Magnusson K, Carlbring P, Andersson G, Gumpert CH. The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others: A Pilot Randomized Controlled Trial. J Gambl Stud 2018; 34:539-559. [PMID: 28699054 PMCID: PMC5938305 DOI: 10.1007/s10899-017-9704-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Problem gambling creates significant harm for the gambler and for concerned significant others (CSOs). While several studies have investigated the effects of individual cognitive behavioral therapy (CBT) for problem gambling, less is known about the effects of involving CSOs in treatment. Behavioral couples therapy (BCT) has shown promising results when working with substance use disorders by involving both the user and a CSO. This pilot study investigated BCT for problem gambling, as well as the feasibility of performing a larger scale randomized controlled trial. 36 participants, 18 gamblers and 18 CSOs, were randomized to either BCT or individual CBT for the gambler. Both interventions were Internet-delivered self-help interventions with therapist support. Both groups of gamblers improved on all outcome measures, but there were no differences between the groups. The CSOs in the BCT group lowered their scores on anxiety and depression more than the CSOs of those randomized to the individual CBT group did. The implications of the results and the feasibility of the trial are discussed.
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Affiliation(s)
- Anders Nilsson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden.
| | - Kristoffer Magnusson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Clara Hellner Gumpert
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
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Roberts A, Onwumere J, Forrester A, Huddy V, Byrne M, Campbell C, Jarrett M, Phillip P, Valmaggia L. Family intervention in a prison environment: A systematic literature review. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2017; 27:326-340. [PMID: 27104884 DOI: 10.1002/cbm.2001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/03/2015] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The prison population in England and Wales is approximately 85,000, and elevated rates of mental health difficulties have been reported among the prisoners. Despite frequent recommendations for family interventions to optimise prisoner outcomes, the evidence for its use and impact in prison remain unclear. AIM The aim of the study is to conduct a systematic review of published literature on family interventions in prisons. METHODS Embase, PsychINFO and Medline were searched using terms for family interventions and for prisoners or young offenders. No limit was imposed on study design, but, for inclusion, we required that papers were written in English and published in peer-reviewed journals. RESULTS Nine hundred eighty-three titles were retrieved. Twenty-two met criteria for inclusion. Three were case studies, 12 were descriptive, 6 were quasi-experimental and one was a randomised controlled trial. Interventions and study methods were too heterogeneous for meta-analysis. All studies gave positive conclusions about family interventions, but empirical data on effectiveness were slight. CONCLUSIONS Consistency in findings across the wide-ranging studies suggested that family therapies may indeed be helpful for prisoners and their families, so further research is warranted. The fact that a randomised controlled trial proved feasible should encourage researchers to seek more robust data and to determine which form of intervention is effective and in which circumstances. It would also be useful to develop an improved understanding of mechanisms of change. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anna Roberts
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew Forrester
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Vyv Huddy
- South London and Maudsley NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Majella Byrne
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Catherine Campbell
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Manuela Jarrett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Patricia Phillip
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucia Valmaggia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Crockford D, Addington D. Canadian Schizophrenia Guidelines: Schizophrenia and Other Psychotic Disorders with Coexisting Substance Use Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:624-634. [PMID: 28886671 PMCID: PMC5593250 DOI: 10.1177/0706743717720196] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Persons with schizophrenia and other psychotic disorders frequently have coexisting substance use disorders that require modifications to treatment approaches for best outcomes. The objectives of this review were to identify evidence-based practices best practices that improve outcomes for individuals with schizophrenia and substance used disorders. METHOD We reviewed guidelines that were published in the last 5 years and that included systematic reviews or meta-analyses. Most of our recommendations came from 2 publications from the National Institute for Health and Care Excellence (NICE): the 2011 guidance titled Coexisting Severe Mental Illness (Psychosis) and Substance Misuse: Assessment and Management in Healthcare Settings and the 2014 guidance titled Psychosis and Schizophrenia in Adults: Prevention and Management. We placed these recommendations into the Canadian context to create this guideline. RESULTS Evidence supports the inclusion of individuals with coexisting substance use disorders in first-episode psychosis programs. The programs should integrate psychosis and substance use treatments, emphasizing ongoing monitoring of both substance use and patterns and symptoms. The best outcomes are achieved with combined use of antipsychotic medications and addiction-based psychosocial interventions. However, limited evidence is available to recommend using one antipsychotic medication over another or one psychosocial intervention over another for persons with schizophrenia and other psychotic disorders with coexisting substance use disorders. CONCLUSIONS Treating persons who have schizophrenia and other psychotic disorders with coexisting substance use disorders can present clinical challenges, but modifications in practice can help engage and retain people in treatment, where significant improvements over time can be expected.
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Affiliation(s)
- David Crockford
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary
| | - Donald Addington
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary
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O'Farrell TJ, Schumm JA, Murphy MM, Muchowski PM. A randomized clinical trial of behavioral couples therapy versus individually-based treatment for drug-abusing women. J Consult Clin Psychol 2017; 85:309-322. [PMID: 28333533 PMCID: PMC5364810 DOI: 10.1037/ccp0000185] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Behavioral couples therapy (BCT) is more efficacious than individually-based therapy (IBT) for substance and relationship outcomes among substance use disorder patients. This study compared BCT with IBT for drug-abusing women. METHOD Sixty-one women, mostly White, late 30s, with primary substance use disorder other than alcohol (74% opioid), and male partners were randomized to 26 sessions over 13 weeks of BCT plus 12-step-oriented IBT (i.e., BCT + IBT) or IBT. Substance-related outcomes were percentage days abstinent (PDA), percentage days drug use (PDDU), Inventory of Drug Use Consequences. Relationship outcomes were Dyadic Adjustment Scale (DAS), days separated. Data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. RESULTS On PDA, PDDU, and substance-related problems, both BCT + IBT and IBT patients showed significant (p < .01) large effect size improvements throughout 1-year follow-up (d > .8 for most time periods). BCT + IBT showed a significant (p < .001) large effect size (d = -.85) advantage versus IBT on fewer substance-related problems, while BCT + IBT and IBT did not differ on PDA or PDDU (ps > .47). On relationship outcomes, compared to IBT, BCT + IBT had significantly higher male-reported Dyadic Adjustment Scale (p < .001, d = .57) and fewer days separated (p = .01, d = -.47) throughout 1-year follow-up. CONCLUSION BCT + IBT for drug-abusing women was more efficacious than IBT in improving relationship satisfaction and preventing relationship breakup. On substance use and substance-related problems, women receiving both treatments substantially improved, and women receiving BCT + IBT had fewer substance-related problems than IBT. (PsycINFO Database Record
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Affiliation(s)
| | | | - Marie M Murphy
- Families and Addiction Program, VA Boston Healthcare System
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McPherson C, Boyne H, Willis R. The Role of Family in Residential Treatment Patient Retention. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9712-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Nilsson A, Magnusson K, Carlbring P, Andersson G, Hellner Gumpert C. Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling: study protocol for a randomised controlled trial. BMJ Open 2016; 6:e011974. [PMID: 27670519 PMCID: PMC5051398 DOI: 10.1136/bmjopen-2016-011974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/18/2016] [Accepted: 08/31/2016] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Problem gambling is a public health concern affecting ∼2.3% of the Swedish population. Problem gambling also severely affects concerned significant others (CSOs). Several studies have investigated the effect of individual treatments based on cognitive-behavioural therapy (CBT), but less is known of the effect of involving CSOs in treatment. This study aims to compare an intervention based on behavioural couples therapy (BCT), involving a CSO, with an individual CBT treatment to determine their relative efficacy. BCT has shown promising results in working with substance abuse, but this is the first time it is used as an intervention for problem gambling. Both interventions will be internet-delivered, and participants will receive written support and telephone support. METHODS AND ANALYSIS A sample of 120 couples will be randomised to either the BCT condition, involving the gambler and the CSO, or the CBT condition, involving the gambler alone. Measures will be conducted weekly and at 3, 6 and 12 months follow-up. The primary outcome measure is gambling behaviour, as measured by Timeline Followback for Gambling. This article describes the outline of the research methods, interventions and outcome measures used to evaluate gambling behaviour, mechanisms of change and relationship satisfaction. This study will be the first study on BCT for problem gambling. ETHICS AND DISSEMINATION This study has been given ethical approval from the regional ethics board of Stockholm, Sweden. It will add to the body of knowledge as to how to treat problem gambling and how to involve CSOs in treatment. The findings of this study will be published in peer-reviewed journals and published at international and national conferences. TRIAL REGISTRATION NUMBER NCT02543372; Pre-results.
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Affiliation(s)
- Anders Nilsson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Kristoffer Magnusson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Clara Hellner Gumpert
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
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Braitman AL, Kelley ML. Initiation and retention in couples outpatient treatment for parents with drug and alcohol use disorders. Exp Clin Psychopharmacol 2016; 24:174-184. [PMID: 27064819 PMCID: PMC4891275 DOI: 10.1037/pha0000072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The focus of the current study was to identity mental health, relationship factors, substance use related problems, and individual factors as predictors of couples-based substance abuse treatment initiation and attendance. Heterosexual couples with children that met study criteria were invited to attend 12 sessions of outpatient behavioral couples therapy. Men were more likely to initiate treatment if they had a higher income, had greater relationship satisfaction, were initiating treatment for alcohol use disorder only, were younger when they first suspected a problem, and had higher depression but lower hostility or phobic anxiety. Men attended more treatment sessions if they reported less intimate partner victimization, if they sought treatment for both alcohol and drug use disorder, if they were older when they first suspected a substance use problem, and if they were more obsessive-compulsive, more phobic anxious, less hostile, and experienced less somatization and less paranoid ideation. For women, treatment initiation was associated with less cohesion in their relationships, more somatization, and being older when they first suspected an alcohol or drug use problem. Trends were observed between women's treatment retention and being older, experiencing more somatization, and suspecting drug-related problems when they were younger; however, no predictors reached statistical significance for women. Results suggest that different factors may be associated with men and women's willingness to initiate and attend conjoint treatment for substance abuse. (PsycINFO Database Record
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O'Farrell TJ, Schumm JA, Dunlap LJ, Murphy MM, Muchowski P. A randomized clinical trial of group versus standard behavioral couples therapy plus individually based treatment for patients with alcohol dependence. J Consult Clin Psychol 2016; 84:497-510. [PMID: 26963601 PMCID: PMC4873359 DOI: 10.1037/ccp0000089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among patients with alcohol use disorder. To facilitate dissemination, a multicouple, rolling admission Group BCT (G-BCT) format has been suggested as an alternative to the 1 couple at a time, conjoint Standard BCT (S-BCT) format. This randomized study compared outcomes of G-BCT versus S-BCT over a 1-year follow-up. The authors predicted that G-BCT, as compared to S-BCT, would have equivalent (i.e., noninferior) improvements on substance and relationship outcomes. METHOD Participants were patients (N = 101) with alcohol dependence and their heterosexual relationship partners without substance use disorder. Participants were mostly White, in their 40s, and 30% of patients were women. Patients were randomized to either G-BCT plus 12-step-oriented IBT or S-BCT plus IBT. Primary outcomes included Timeline Followback Interview percentage days abstinent and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcome was Dyadic Adjustment Scale. Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. RESULTS Results overall found no support for the predicted statistical equivalency of G-BCT and S-BCT. Rather than the predicted equivalent outcomes, substance and relationship outcomes were significantly worse for G-BCT than S-BCT in the last 6-9 months of the 12-month follow-up period, because G-BCT deteriorated and S-BCT maintained gains during follow-up. CONCLUSION This was the first study of the newer rolling admission group format for BCT. It proved to have worse not equivalent outcomes compared to standard conjoint BCT. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Marie M Murphy
- Families and Addiction Program, VA Boston Healthcare System
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Kelley ML, Bravo AJ, Braitman AL, Lawless AK, Lawrence HR. Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Risk for Child Abuse. J Subst Abuse Treat 2016; 62:10-9. [PMID: 26742725 PMCID: PMC4724525 DOI: 10.1016/j.jsat.2015.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/25/2015] [Accepted: 11/11/2015] [Indexed: 11/26/2022]
Abstract
Risk for child abuse was examined prior to and after behavioral couples treatment (BCT) among 61 couples in which one or both parents were diagnosed with substance use disorder (SUD). All couples were residing with one or more school-age children. Mothers and fathers completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Results of piecewise latent growth models tested whether the number of BCT sessions attended and number of days abstinent from drugs and alcohol influenced relationship satisfaction and its growth over time, and in turn if relationship satisfaction and change in relationship satisfaction influenced risk for child abuse. For both mothers and fathers, attending more BCT sessions lead to a direct increase in relationship satisfaction, which in turn led to stronger reductions in risk for child abuse. This effect was maintained from the post-intervention through the 6-month post-intervention follow-up. For fathers, number of days abstinent significantly influenced reduction in child abuse potential at post-intervention via relationship satisfaction. This indirect effect was not present for mothers. The overall benefits of BCT on mothers' and fathers' risk for child abuse suggest that BCT may have promise in reducing risk for child abuse among couples in which one or both parents have SUD.
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O'Farrell TJ, Schreiner A, Schumm J, Murphy M. Do outcomes after behavioral couples therapy differ based on the gender of the alcohol use disorder patient? Addict Behav 2016; 54:46-51. [PMID: 26709856 DOI: 10.1016/j.addbeh.2015.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This naturalistic study (conducted from 1992 to 1998) of behavioral couples therapy (BCT) compared female and male alcohol use disorder (AUD) patients on improvement and on drinking and relationship outcomes after BCT. We also evaluated gender differences on presenting clinical problems and extent of BCT participation. METHOD Participants were 103 female and 303 male AUD patients (98.5% alcohol dependence, 1.5% alcohol abuse) and their heterosexual partners, mostly White in their forties. Couples received 20-22 BCT sessions over 5-6 months. Drinking outcomes were percentage days abstinent (PDA) and alcohol-related problems. Relationship outcome was Dyadic Adjustment Scale. Outcome data were examined at baseline, post-treatment, and 6- and 12-month follow-up. Presenting problems were demographics, alcohol problem severity, illicit drug use, emotional distress, and relationship adjustment. BCT participation was BCT attendance and BCT-targeted behaviors. RESULTS We found few differences between female and male patients, who did not differ on improvement and outcomes after BCT. Both females and males showed significant large effect size improvements through 12-month follow-up on PDA and alcohol-related problems, and significant small to medium effect size improvements on relationship adjustment. Both females and males had high levels of BCT participation. Gender differences in presenting clinical problems (females being lower on age, years problem drinking, and baseline PDA, and higher on emotional distress) did not translate into gender differences in response to BCT. CONCLUSION Results showed no support for the suggestion that BCT might lead to greater improvement and better outcomes for female than male AUD patients on drinking or on relationship outcomes.
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Affiliation(s)
| | - Amy Schreiner
- VA Boston Healthcare System, Harvard Medical School, Brockton, MA, USA
| | - Jeremiah Schumm
- Cincinnati VA Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Marie Murphy
- VA Boston Healthcare System, Harvard Medical School, Brockton, MA, USA
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Magnusson K, Nilsson A, Hellner Gumpert C, Andersson G, Carlbring P. Internet-delivered cognitive-behavioural therapy for concerned significant others of people with problem gambling: study protocol for a randomised wait-list controlled trial. BMJ Open 2015; 5:e008724. [PMID: 26656017 PMCID: PMC4680021 DOI: 10.1136/bmjopen-2015-008724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/12/2015] [Accepted: 11/04/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION About 2.3% of the adult population in Sweden are considered to suffer from problem gambling, and it is estimated that only 5% of those seek treatment. Problem gambling can have devastating effects on the economy, health and relationship, both for the individual who gambles and their concerned significant other (CSO). No empirically supported treatment exists for the CSOs of people with problem gambling. Consequently, the aim of this study is to develop and evaluate a programme aimed at CSOs of treatment-refusing problem gamblers. The programme will be based on principles from cognitive behavioural therapy (CBT) and motivational interviewing. To benefit as many CSOs as possible, the programme will be delivered via the internet with therapist support via encrypted email and short weekly conversations via telephone. METHODS AND ANALYSIS This will be a randomised wait-list controlled internet-delivered treatment trial. A CBT programme for the CSOs of people with problem gambling will be developed and evaluated. The participants will work through nine modules over 10 weeks in a secure online environment, and receive support via secure emails and over the telephone. A total of 150 CSOs over 18 years of age will be included. Measures will be taken at baseline and at 3, 6 and 12 months. Primary outcomes concern gambling-related harm. Secondary outcomes include the treatment entry of the individual who gambles, the CSO's levels of depression, anxiety, as well as relationship satisfaction and quality of life. ETHICS AND DISSEMINATION The protocol has been approved by the regional ethics board of Stockholm, Sweden. This study will add to the body of knowledge on how to protect CSOs from gambling-related harm, and how to motivate treatment-refusing individuals to seek professional help for problem gambling. TRIAL REGISTRATION NUMBER NCT02250586.
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Affiliation(s)
- Kristoffer Magnusson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Anders Nilsson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Clara Hellner Gumpert
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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LaChance H, Cioe PA, Tooley E, Colby SM, O'Farrell TJ, Kahler CW. Behavioral couples therapy for smoking cessation: A pilot randomized clinical trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:643-52. [PMID: 25642582 PMCID: PMC4768739 DOI: 10.1037/adb0000051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral couples therapy (BCT) has been found to improve long-term abstinence rates in alcohol- and substance-dependent populations but has not been tested for smoking cessation. This pilot study examined the feasibility and acceptability of BCT for smoking-discordant couples. Forty-nine smokers (smoking >10 cigarettes/day) with nonsmoking partners were randomized to receive a couples social support (BCT-S) intervention or an individually delivered, standard smoking cessation treatment (ST). The couples were married or had been cohabiting for at least 1 year, with partners who had never smoked or had not used tobacco in 1 year. Both treatments included 7 weekly sessions and 8 weeks of nicotine replacement therapy. Participants were followed for 6 months posttreatment. The Partner Interaction Questionnaire was used to measure perceived smoking-specific partner support. Participants were 67% male and 88% White. Biochemically verified cessation rates were 40.9%, 50%, and 45% in BCT-S and 59.1%, 50%, and 55% in ST at end of treatment, after 3 month, and after 6 months, respectively, and did not differ significantly between treatment conditions at any time point. Perceived smoking-specific partner support at posttreatment did not significantly differ between treatment groups. Results of this pilot study do not provide support for the efficacy of BCT in smoking-discordant couples.
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Affiliation(s)
| | - Patricia A Cioe
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University
| | - Erin Tooley
- Center for Behavioral and Preventative Medicine, Warren Alpert Medical School, Brown University
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University
| | | | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University
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Schumm JA, O'Farrell TJ, Kahler CW, Murphy MM, Muchowski P. A randomized clinical trial of behavioral couples therapy versus individually based treatment for women with alcohol dependence. J Consult Clin Psychol 2014; 82:993-1004. [PMID: 25045910 PMCID: PMC4244232 DOI: 10.1037/a0037497] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among men with alcohol use disorder (AUD). The present study compared BCT with IBT for women with AUD. METHOD Participants were women with AUD (N = 105) and their male partners without substance use disorder. Participants were mostly White and in their 40s. Women were randomized to equally intensive treatments consisting of either BCT plus 12-step-oriented IBT or IBT only. Primary outcomes included time line follow-back interview percentage days abstinent (PDA) and Inventory of Drug Use Consequences measure of substance-related problems. Secondary outcomes included the Dyadic Adjustment Scale (DAS), Relationship Happiness Scale (RHS), and Revised Conflict Tactics Scales measure of intimate partner violence (IPV). Outcome data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. RESULTS Compared with IBT only, BCT plus IBT had significantly better primary outcomes of higher PDA and fewer substance-related problems during the 1-year follow-up period. Compared with IBT only, BCT had significantly higher male RHS during the 1-year follow-up. Women with lower pretreatment DAS had significantly higher DAS following BCT versus IBT, and there was an increasing advantage for BCT on female DAS over the follow-up. IPV was significantly reduced from pretreatment to follow-up, with no differences between treatment conditions. CONCLUSION RESULTS showed that BCT for women with AUD was more efficacious than IBT in reducing substance use and substance-related problems and improving partner relationships.
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Affiliation(s)
| | | | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences
| | - Marie M Murphy
- Families and Addiction Program, VA Boston Healthcare System
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Horta RL, Vieira LS, Balbinot AD, Oliveira GOD, Poletto S, Teixeira VA. Influência da família no consumo de crack. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Dimensionar a contribuição de características de grupos familiares de usuários de crack tanto em situações de consumo quanto na promoção da cessação do uso da substância. Métodos Estudo observacional, transversal, misto, com delineamento quantitativo (estatísticas descritiva e analítica, por regressão de Poisson robusta) e qualitativo (análise temática de conteúdos de entrevistas individuais semiestruturadas). Resultados Foram analisados dados oriundos de entrevistas com 519 usuários de crack, dos quais 48,3% referiram já ter feito uso compartilhado com algum familiar. A relação mais referida para compartilhamento do crack foi a conjugal, indicada por 30,6% dos entrevistados. A estimativa das razões de prevalência do desfecho abstinência na data da entrevista, por regressão de Poisson robusta controlada para fatores de confusão, para usuários de crack que referiram uso compartilhado com irmãos, foi de 0,940 (IC95%: 0,885-0,999; p = 0,045), tendo os que não referiram como referência. Na dimensão qualitativa, 20 entrevistados expuseram livremente modalidades de envolvimento dos familiares com o uso da droga, alguns indicando oposição ao consumo, outros estímulo, ou oferta, além da influência recíproca entre consumo de crack e conflitos familiares ou um ambiente considerado negativo. Além disso, os entrevistados que informaram ter familiares em tratamento em saúde mental tiveram 9% mais probabilidade de estar em uso cessado por 12 semanas ou mais (RP = 1,09; IC95%: 1,03-1,15; p = 0,005). Conclusão Os grupos familiares aparecem não somente como fator de proteção, mas também como importante fator de risco para o uso do crack, e sua inclusão como grupo primário de atendimento se justifica com essas evidências.
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