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Javadi V, Ahmadi F, Ebrahimi LS, Dadashi M, Mousavi SE. Internet-based UP-A intervention on treatment of stress, anxiety, depression, and psychological flexibility among adolescents with sub-clinical diagnosis of emotional disorders during the COVID-19 pandemic: a clinical trial. BMC Psychol 2024; 12:526. [PMID: 39358797 PMCID: PMC11448009 DOI: 10.1186/s40359-024-01735-4] [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: 10/08/2022] [Accepted: 04/15/2024] [Indexed: 10/04/2024] Open
Abstract
This clinical trial aims to assess the effectiveness of internet-based Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) during the COVID-19 pandemic in reducing stress, anxiety, and depression, and psychological flexibility. 40 adolescents with subclinical features of emotional disorder randomly divided into two groups of intervention and control. The participants first completed DASS-21 and AAQ-2 questionnare online. Then, the intervention group received 12 sessions of UP-A through video calls on WhatsApp, 2 days per week each for 45 min. UP-A is an emotion-focused, cognitive-behavioral therapy consisting of 5 core modules or components that target temperamental characteristics, particularly neuroticism and resulting emotion dysregulation. Eventually the stress, anxiety, and depression levels decreased in intervention group and their psychological flexibility increased immediately and 3 months after the intervention. Clinical trial registration This study was registered by Iranian Registry of Clinical Trials (Prospective, ID: IRCT20210428051113N1, Registration date: 14/06/2021; https://en.irct.ir/trial/55900 ).
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Affiliation(s)
- Vahideh Javadi
- Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farzaneh Ahmadi
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Leila Salek Ebrahimi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Dadashi
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyedeh Elnaz Mousavi
- Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
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López-Pinar C, Lara-Merín L, Macías J. Process of change and efficacy of acceptance and commitment therapy (ACT) for anxiety and depression symptoms in adolescents: A meta-analysis of randomized controlled trials. J Affect Disord 2024; 368:633-644. [PMID: 39303882 DOI: 10.1016/j.jad.2024.09.076] [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] [Received: 05/03/2024] [Revised: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Recent literature suggests that acceptance and commitment therapy (ACT) may be an effective approach for treating symptoms of depression and anxiety symptoms in adolescents. This review meta-analyzes the efficacy of ACT on adolescent depression and anxiety, emphasizing the role of process variables (i.e., psychological flexibility). METHODS We systematically searched MedLine, PsycInfo and Scopus for randomized controlled trials (RCT) investigating the effect of ACT on anxiety/depression in adolescents. Studies were combined using the inverse variance method in a random effects model. Additional subgroup and meta-regression analyses were performed, and risk of bias was assessed. The review was pre-registered (PROSPERO registration number: CRD42023483300). RESULTS Our review included 27 RCTs with a total of 2860 participants. ACT did not outperform CBT but was significantly more effective than other active controls (e.g., treatment as usual) for depression symptoms and inactive controls for all outcomes. ACT was more effective than inactive controls for all outcomes. Improvements in psychological flexibility significantly predicted reductions in between-group depression and anxiety. Younger age and a higher percentage of women predicted better outcomes for some outcomes. LIMITATIONS It should be noted that this results may be limited by the fact that all included studies were rated as having a high risk of bias. This is mainly due to the self-reported nature of the measures and the lack of crucial methodological information (e.g., process of randomization and allocation, treatment fidelity assessment). CONCLUSION Our findings support ACT's efficacy for adolescents, particularly in treating depression symptoms. The proposed mechanism of change (psychological flexibility) plays a significant role in the improvements. ACT is comparable in efficacy to CBT, suggesting its potential as an alternative to traditional cognitive-behavioral approaches.
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Affiliation(s)
- Carlos López-Pinar
- Department of Psychology, European University of Valencia, Valencia, Spain.
| | - Lucía Lara-Merín
- Department of Psychology, European University of Valencia, Valencia, Spain
| | - Juanjo Macías
- Department of Psychology, European University of Valencia, Valencia, Spain
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Thompson EM, Albertella L, Viskovich S, Pakenham KI, Fontenelle LF. Internet-based acceptance and commitment therapy for obsessive-compulsive symptoms: A randomized controlled trial. Behav Res Ther 2024; 180:104595. [PMID: 38885592 DOI: 10.1016/j.brat.2024.104595] [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: 02/09/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
Subthreshold obsessive-compulsive symptoms (OCS) are associated with increased distress, help seeking behaviours, and functional problems, and may predict progression into further mental health problems. This study investigated the effectiveness of a four-module internet-based acceptance and commitment therapy (iACT) for adults with OCS compared to internet-based progressive relaxation training (iPRT). Eighty-nine adults with OCS participated in a single-blinded randomised controlled trial of iACT or iPRT. Self-report assessments of OCS, psychological flexibility, and quality of life, among others, were measured at baseline, post-treatment, and at three-month follow-up. Both iACT and iPRT showed large pre-post improvements in OCS (b = 6.32, p < 0.001, d = 0.8) and medium improvements in psychological flexibility (b = -0.38, p = 0.011, d = 0.47) and quality of life (b = -5.26, p = 0.008, d = 0.58), with no significant differences in effects between groups. All improvements were maintained at follow-up. There were no differences in attrition or adherence between groups. iACT was rated more favourably by participants at post-treatment, and there were some differences in qualitative feedback across groups. These findings suggest both iPRT and iACT may be helpful in improving mental health in adults with OCS, but that iACT may be more acceptable.
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Affiliation(s)
- Emma M Thompson
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia.
| | - Shelley Viskovich
- School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Kenneth I Pakenham
- School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Leonardo F Fontenelle
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, 770 Blackburn Road, Clayton, Victoria, 3168, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ) & D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
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Rutschmann R, Romanczuk-Seiferth N, Gloster A, Richter C. Increasing psychological flexibility is associated with positive therapy outcomes following a transdiagnostic ACT treatment. Front Psychiatry 2024; 15:1403718. [PMID: 39077631 PMCID: PMC11284814 DOI: 10.3389/fpsyt.2024.1403718] [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] [Received: 03/19/2024] [Accepted: 06/20/2024] [Indexed: 07/31/2024] Open
Abstract
Objectives Increasing psychological flexibility is considered an important mechanism of change in psychotherapy across diagnoses. In particular, Acceptance and Commitment Therapy (ACT) primarily aims at increasing psychological flexibility in order to live a more fulfilling and meaningful life. The purpose of this study is to examine 1) how psychological flexibility changes during an ACT-based treatment in a transdiagnostic day hospital and 2) how this change is related to changes in symptomatology, quality of life, and general level of functioning. Methods 90 patients of a psychiatric day hospital participated in the study. Psychological flexibility, symptomatology, and quality of life were assessed at three measurement time points (admission, discharge, and 3-month follow-up). The level of functioning was assessed at admission and discharge. Differences in psychological flexibility were tested via two-sided paired samples t-tests. Correlations of residualized change scores were calculated to detect associations between changes in psychological flexibility and other outcomes. Results Psychological flexibility increased significantly from pre-treatment to post-treatment (d = .43, p <.001) and from pre-treatment to follow-up (d = .54, p <.001). This change was significantly correlated to a decrease in symptomatology (r = .60 -.83, p <.001) and an increase in most dimensions of quality of life (r = -.43 - -.75, p <.001) and general level of functioning (r =-.34, p = .003). Discussion This study adds further evidence for psychological flexibility as a transdiagnostic process variable of successful psychotherapy. Limitations are discussed.
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Affiliation(s)
- Ronja Rutschmann
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Andrew Gloster
- Faculty of Behavioral Sciences and Psychology, University of Lucerne, Lucerne, Switzerland
| | - Christoph Richter
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Kaulsdorf, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Gruner NG, Cullen JM, Crosby JM, DeCross SN, Mathes B, Garner L, Gironda C, Hu Y, Krompinger JW, Elias JA, Twohig MP. Investigating an Acceptance and Commitment Therapy-Based Exposure Therapy Intervention in Treatment-Refractory OCD and Related Disorders: Changes in Psychological Flexibility, Treatment Engagement, and Treatment Perceptions. J Cogn Psychother 2024; 38:255-272. [PMID: 38991743 DOI: 10.1891/jcp-2022-0033] [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] [Indexed: 07/13/2024]
Abstract
While exposure therapy is the most effective psychological treatment for obsessive-compulsive disorder (OCD), anxiety, and traumatic stress-related disorders, it is not universally effective, indicating a need for further treatment optimization. This study investigated a shift in approach to exposure therapy with 29 treatment-refractory adults in an OCD clinic not responding to standard treatment, comprising habituation-based exposure therapy. Participants completed standard exposure as a continuation of standard clinic treatment, followed by an acceptance and commitment therapy (ACT) consultation session to assess psychological inflexibility processes interfering with treatment progress, and then an ACT-based exposure targeting behavior change through increasing psychological flexibility. After each exposure, participants and independent raters reported levels of psychological flexibility, rituals, distress, treatment engagement, and treatment perceptions. We observed that the shift to ACT-based exposure was associated with greater psychological flexibility, treatment engagement, treatment acceptability, and treatment preference. These findings suggest that there may be situations where ACT-based exposure has particular utility.
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Affiliation(s)
- Nate G Gruner
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jenifer M Cullen
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jesse M Crosby
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | | | - Brittany Mathes
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Lauryn Garner
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Christina Gironda
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Yuanjun Hu
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jason W Krompinger
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
| | - Jason A Elias
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA
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Twohig MP, Seydavi M, Capel LK, Levin ME, Akbari M. Scoping Review of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder in Iran. J Cogn Psychother 2024; 38:211-226. [PMID: 38991742 DOI: 10.1891/jcp-2023-0009] [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] [Indexed: 07/13/2024]
Abstract
Acceptance and commitment therapy (ACT) for obsessive-compulsive disorder (OCD) has been found efficacious in randomized clinical trials (RCTs), but the two widely known RCTs were conducted within the United States with predominantly White samples. Research that evaluates treatments like ACT for OCD outside the typical Western cultures is needed. The current scoping review summarizes the key characteristics and findings from 18 RCTs that evaluated ACT for OCD in Iran. These RCTs are largely unknown in the broader scientific literature despite representing the vast majority of ACT for OCD trials, in part because the majority are published in Persian. The preponderance of RCTs treated participants in groups, and most protocols did not include exposure exercises. Of 18 trials, 5 were single sex. Use of selective serotonin reuptake inhibitors (SSRIs) was common with all participants on stable doses at pretreatment in many of the trials. Methodological quality was low to medium. ACT was inconsistent against nontraditional comparison conditions, slightly favorable to empirically validated treatments, and favorable compared with the waitlist and SSRIs. The process of change data indicated that ACT increased the psychological flexibility more than cognitive behavior therapy or SSRIs. These results highlight that findings on ACT for OCD from Western populations replicate and generalize to individuals in Iran. These findings also offer insights gained from studying ACT in Iran and significantly expand the literature based on ACT for OCD that can be integrated into scholarship by all researchers.
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Affiliation(s)
- Michael P Twohig
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Leila K Capel
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
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Macri JA, Rogge RD. Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review. Clin Psychol Rev 2024; 110:102432. [PMID: 38615492 DOI: 10.1016/j.cpr.2024.102432] [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: 12/22/2021] [Revised: 12/15/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
The current systematic and meta-analytic review sought to integrate a growing number of studies examining dimensions of psychological flexibility as treatment mechanisms for Acceptance and Commitment Therapy (ACT). Analyses of 77 records (67 unique studies; Ntotal = 9123 participants) from comprehensive searches of multiple databases suggested that ACT interventions led to reduced inflexibility (i.e., lowered global inflexibility, lack of present moment awareness, cognitive fusion, experiential avoidance, self-as-content, & inaction) and increased flexibility (i.e., committed action/contact with values, global flexibility/acceptance, & defusion). Those changes remained significant when ACT was compared with waitlist or active treatments and were significantly linked to corresponding drops in psychological distress, supporting their roles as ACT treatment mechanisms. Moderation analyses revealed that the use of student samples, exclusion of clinically symptomatic individuals, and comparisons of ACT with other active treatments weakened these effects whereas offering ACT as an individual therapy and excluding individuals in extreme crisis (i.e., with suicidal ideation) strengthened them. The meta-analytic findings and systematic review suggested specific recommendations for future clinical work and research on ACT mechanisms: (1) Evaluate both psychological flexibility and inflexibility as distinct treatment mechanisms, (2) Evaluate specific dimensions of psychological flexibility/inflexibility as mechanisms with multidimensional scales (CompACT, MPFI), (3) Broaden treatment outcomes to include forms of wellbeing (peace of mind, vitality, connectedness), (4) Assess mechanisms and outcomes repeatedly throughout treatment to model the process of therapeutic change, (5) Investigate non-specific factors (therapeutic alliance, treatment adherence) as mechanisms, and (6) Explore treatment mechanisms in effectiveness studies.
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Affiliation(s)
- Jenna A Macri
- Department of Psychology, University of Rochester, USA
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Chen H, Chen J, Lan J. Acute manipulation of Drd1 neurons in the prefrontal cortex bidirectionally regulates anxiety and depression-like behaviors. Neurosci Lett 2024; 832:137805. [PMID: 38705453 DOI: 10.1016/j.neulet.2024.137805] [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: 02/07/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND CONTEXT The medial prefrontal cortex (mPFC) has been implicated in modulating anxiety and depression. Manipulation of Drd1 neurons in the mPFC resulted in variable neuronal activity and, consequently, strikingly different behaviors. The acute regulation of anxiety- and depression-like behaviors by Drd1 neurons, a major neuronal subtype in the mPFC, has not yet been investigated. PURPOSE The purpose of this study was to investigate whether acute manipulation of Drd1 neurons in the mPFC affects anxiety- and depression-like behaviors. STUDY DESIGN Male Drd1-Cre mice were injected with an adeno-associated virus (AAV) expressing hM3DGq or hM4DGi. Clozapine-n-oxide (CNO, 1 mg/kg, i.p.) was injected 30 min before the behavioral tests. METHODS Male Drd1-Cre mice were injected with AAV-Ef1α-DIO-hM4DGi-mCherry-WPRE-pA, AAV-Ef1α-DIO-hM3DGq-mCherry-WPRE-pA or AAV-Ef1α-DIO-mCherry-WPRE-pA. Three weeks later, whole-cell recordings after CNO (5 μM) were applied to the bath were used to validate the functional expression of hM4DGi and hM3DGq. Four groups of mice underwent all the behavioral tests, and after each of the tests, the mice were allowed to rest for 3-4 days. CNO (1 mg/kg) was injected intraperitoneally 30 min before the behavior test. Anxiety-like behaviors were evaluated by the open field test (OFT), the elevated plus maze test (EPMT), and the novelty-suppressed feeding test (NSFT). Depression-like behaviors were evaluated by the sucrose preference test (SPT) and force swimming test (FST). For all experiments, coronal sections of the targeted brain area were used to confirm virus expression. RESULTS Whole-cell recordings from brain slices demonstrated that infusions of CNO (5 µM) into mPFC slices dramatically increased the firing activity of hM3DGq-mCherry+ neurons and abolished the firing activity of hM4DGi-mCherry+ neurons. Acute chemogenetic activation of Drd1 neurons in the mPFC increased the time spent in the central area in the OFT, increased the time spent in the open arms in the EMPT, decreased the latency to bite the food in the NSFT, increased the sucrose preference in the SPT, and decreased the immobility time in the FST. Acute chemogenetic inhibition of Drd1 neurons in the mPFC decreased the time spent in the central area in the OFT, decreased the time spent in the open arms in the EMPT, increased the latency to bite the food in the NSFT, decreased the sucrose preference in the SPT, and increased the immobility time in the FST. CONCLUSIONS The present study showed that acute activation of Drd1 neurons in the mPFC produced rapid anxiolytic- and antidepressant-like effects, and acute inhibition had the opposite effect, revealing that Drd1 neurons in the mPFC bidirectionally regulate anxiety- and depression-like behaviors. CLINICAL SIGNIFICANCE The findings of the present study regarding the acute effects of stimulating Drd1 neurons in the mPFC on anxiety and depression suggest that Drd1 neurons in the mPFC are a focus for the treatment of anxiety disorders and depression.
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Affiliation(s)
- He Chen
- Department of Neurosurgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Jun Chen
- Department of Neurosurgery, Nanning First People's Hospital, Nanning 530000, China; Phase I Clinical Trial Laboratory, Nanning First People's Hospital, Nanning 530000, China
| | - Jie Lan
- Department of Neurosurgery, Nanning First People's Hospital, Nanning 530000, China.
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Ong CW, Ciarrochi J, Hofmann SG, Karekla M, Hayes SC. Through the extended evolutionary meta-model, and what ACT found there: ACT as a process-based therapy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2024; 32:100734. [PMID: 39355135 PMCID: PMC11444665 DOI: 10.1016/j.jcbs.2024.100734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2024]
Abstract
This article is part of a special issue in the Journal of Contextual Behavioral Science devoted to process-based therapy (PBT) or a process-based approach to therapy and the role it plays in harmonizing existing evidence-based treatments. In the present discussion, we focus on acceptance and commitment therapy (ACT) and how it fits into the PBT framework. We describe how viewing ACT through a PBT framework and its organizing rubric-the extended evolutionary meta-model (EEMM)-provides fertile ground to expand the ACT and psychological flexibility models, transforming ACT into a more inclusive and flexible version of itself and giving clinicians wider berth with respect to delivering ACT. The PBT approach allows ACT to incorporate therapeutic elements that are not traditionally part of the framework, including include cognitive reappraisal, interpersonal therapy dynamics, physiological downregulation, and the principle of nonattachment. Importantly, ACT maintains its foundational principles throughout this integration. We provide a case example of how to use PBT methods to conceptualize an ACT case, to illustrate PBT-infused ACT in practice. Finally, we outline possible future directions for ACT as it continues to evolve inside of PBT.
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Roberge C, Meunier S. Development and Initial Validation of a Questionnaire Measuring Self-management Strategies that Promote Psychological Health at Work. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:238-250. [PMID: 37584756 DOI: 10.1007/s10926-023-10131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Self-management strategies have been identified as a promising avenue to promote mental health and functioning at work. However, the absence of a validated questionnaire to assess the use of strategies that can be adopted in the workplace has limited empirical research on this topic. This study seeks to develop and validate a questionnaire measuring mental health self-management strategies used by workers to promote their mental health and functioning at work: the Workplace Mental Health Self-Management Questionnaire (WMHSQ). METHODS An initial list of 72 self-management strategies was generated from the content of 25 interviews conducted with workers experiencing depressive or anxiety symptoms. Content experts on mental health at work identified the 47 most relevant items. To validate the WMHSQ, 365 workers completed the WMHSQ and criterion-related measures (depressive and anxiety symptoms, work functioning, self-management and coping). Two weeks later, 235 participants completed the WMHSQ once again. RESULTS Principal component analysis revealed a four-factor solution composed of 21 self-management strategies: Managing Thoughts and Emotions, Managing Recovery, Managing Relationships and Managing Tasks. The WMHSQ shows adequate internal consistency and test-retest reliability. Correlational analyses support convergent and concurrent validity. LIMITATIONS Since this is an initial psychometric validation of the WMHSQ, only an exploratory factor analysis was performed. It will therefore be important to validate the structure of this new psychometric tool through confirmatory factor analysis in a subsequent study. CONCLUSIONS The strategies identified in the WMHSQ can form the basis for developing practical tools and interventions to promote mental health self-management at work.
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Affiliation(s)
- Camille Roberge
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montreal, H2X 3P2, Canada.
| | - Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke West, Montreal, H2X 3P2, Canada
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Carlson AS, Stegall MS, Sirotiak Z, Herrmann F, Thomas EBK. Just as Essential: The Mental Health of Educators During the COVID-19 Pandemic. Disaster Med Public Health Prep 2024; 18:e6. [PMID: 38234124 PMCID: PMC10904175 DOI: 10.1017/dmp.2023.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic deleteriously impacted physical and mental health. In the summer of 2020, return-to-learn plans were enacted, including virtual, hybrid, and in-person plans, impacting educators and students. We examined (1) how return-to-learn plan was related to depressive and social anxiety symptoms among educators and (2) how psychological flexibility related to symptoms. METHODS Educators (N = 853) completed a survey via Qualtrics that assessed internalizing symptoms, psychological flexibility, and occupational characteristics. Two one-way analyses of variance (ANOVAs) examined between-group differences in return-to-learn plans across depression and social anxiety. Two hierarchical linear regressions examined the relation between psychological flexibility components and depressive and social anxiety symptoms. RESULTS Median T-scores were well above the national normative means for General Depression (median T-score: 81) and Social Anxiety (median T-score: 67). There were no significant differences between reopening plans in general depression nor social anxiety T-scores. Psychological flexibility accounted for 33% of the variance in depressive symptoms and 24% of the variance in social anxiety symptoms. CONCLUSIONS Results indicated high levels of psychiatric symptoms among educators during COVID-19, and psychological flexibility was associated with lower symptoms. Addressing educator mental health is of utmost importance in future research.
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Affiliation(s)
| | - Manny S Stegall
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Zoe Sirotiak
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Felipe Herrmann
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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Jiang X, Sun J, Song R, Wang Y, Li J, Shi R. Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials. Front Psychol 2024; 14:1253266. [PMID: 38250124 PMCID: PMC10796538 DOI: 10.3389/fpsyg.2023.1253266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024] Open
Abstract
Objective This study aimed to systematically review and meta-analyze the clinical efficacy of acceptance and commitment therapy (ACT) in patients with cancer and psychological distress. Methods Randomized controlled trials (RCTs) from seven English electronic databases were systematically investigated from inception to 3 October 2023. A total of 16 RCTs from 6 countries with 711 participants were included in this study. Estimated pooled effect sizes (ESs) were calculated via inverse-variance random-effects or fixed-effects (I2 ≤ 50%) model and presented by standardized mean difference (SMD). Subgroup analyses were performed to reduce confounding factors and heterogeneity, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of the pooled ESs. Results The pooled ESs revealed that statistically significant improvements in anxiety [postintervention SMD = -0.41 (95% confidence interval (CI), -0.71, -0.11); p = 0.008; I2 = 65%; follow-up SMD = -0.37 (95% CI, -0.66, -0.08); p = 0.01; I2 = 29%], depression [postintervention SMD = -0.45 (95% CI, -0.63, -0.27); p < 0.001; I2 = 49%; follow-up SMD = -0.52 (95% CI, -0.77, -0.28); p < 0.001; I2 = 0%], and psychological flexibility [postintervention SMD = -0.81 (95% CI, -1.50, -0.11); p = 0.02; I2 = 84%; follow-up SMD = -0.71 (95% CI, -1.12, -0.31); p = 0.0006; I2 = 38%] in ACT-treated participants were observed compared to patients treated with control conditions. However, other outcomes, such as physical symptom alleviation, were not significantly associated. Conclusion The findings of this systematic review and meta-analysis suggest that ACT is associated with improvements in anxiety, depression, and psychological flexibility in patients with cancer. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320515.
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Affiliation(s)
- Xing Jiang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian Sun
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruiwen Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yue Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinglian Li
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Rongwei Shi
- Department of Internal Medicine, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Arch JJ, Fishbein JN, Finkelstein LB, Luoma JB. Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them. Behav Ther 2023; 54:971-988. [PMID: 37863588 PMCID: PMC10665126 DOI: 10.1016/j.beth.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Acceptance and commitment therapy (ACT) emphasizes a focus on theory-driven processes and mediating variables, a laudable approach. The implementation of this approach would be advanced by addressing five challenges, including (a) distinguishing ACT processes in measurement contexts, (b) developing and rigorously validating measures of ACT processes, (c) the wide use of psychometrically weaker ACT process measures and the more limited use of stronger measures in earlier work, (d) the inconsistency of past evidence that ACT processes are sensitive or specific to ACT or mediate ACT outcomes specifically, and (e) improving statistical power and transparency. Drawing on the existing literature, we characterize and provide evidence for each of these challenges. We then offer detailed recommendations for how to address each challenge in ongoing and future work. Given ACT's core focus on theorized processes, improving the measurement and evaluation of these processes would significantly advance the field's understanding of ACT.
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Affiliation(s)
- Joanna J Arch
- University of Colorado Boulder and University of Colorado Cancer Center.
| | | | | | - Jason B Luoma
- Portland Psychotherapy Clinic, Research and Training Center
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14
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Evey KJ, Steinman SA. A Systematic Review of the Use of Acceptance and Commitment Therapy to Treat Adult Obsessive-Compulsive Disorder. Behav Ther 2023; 54:1006-1019. [PMID: 37863582 DOI: 10.1016/j.beth.2022.02.009] [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: 05/31/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 10/22/2023]
Abstract
The present review aims to critically evaluate available literature on the use of acceptance and commitment therapy (ACT) to treat adult obsessive-compulsive disorder (OCD) and to draw conclusions about using ACT to reduce OCD symptoms in adults with OCD. Databases (PsycINFO, PsycARTICLES, MEDLINE, and PubMed), Google Scholar, and article references were used to identify relevant studies through October 10, 2020. This review includes both peer-reviewed, published articles (n = 15) and unpublished theses and dissertations (n = 2) to increase the breadth of the review as suggested by PRISMA guidelines. Reviewed articles utilized ACT and at least one measure of OCD symptom severity. Information on methodological, measurement, statistical, and analytical characteristics of the included studies were extracted to determine the quality of the available studies and to inform the conclusions of this review. Seventeen studies (n = 17) with 336 participants from three countries were evaluated. The current evidence suggests that ACT can be used to reduce symptoms of OCD in adults. A conclusion supporting the use of ACT to reduce OCD symptoms can be made because of several strengths within this body of literature (e.g., use of validated OCD symptom measures, inclusion of treatment manuals, use of multiple assessment points, etc.). However, because a majority of the included studies are quasi-experimental and single-subject studies, more stringent research (i.e., randomized controlled trials) with large, diverse samples is needed to strengthen this conclusion. Additionally, dismantling studies exploring the components of ACT that lead to OCD symptom improvement are needed.
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15
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Akhouri D, Hamza, Kumar S, Reyazuddin M. Acceptance and commitment therapy as an add-on treatment for the management of patients with obsessive-compulsive disorder. Ind Psychiatry J 2023; 32:S179-S185. [PMID: 38370965 PMCID: PMC10871435 DOI: 10.4103/ipj.ipj_213_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/09/2023] [Accepted: 08/19/2023] [Indexed: 02/20/2024] Open
Abstract
Background Obsessive compulsive disorder (OCD) is a chronic and long-lasting illness affecting approximately 2% of the population. Up to 40%-60% of patients with OCD do not have satisfactory outcomes, thereby leading to disability in performing daily routine activities. Acceptance and commitment therapy (ACT) provides a substitute for old-fashioned psychotherapies, as it involves the client directly experiencing the problematic emotion, that is, anxiety and obsessions in the case of OCD. Aim To observe the effect of ACT on patients with OCD and compare its effect on obsessive compulsive symptoms, thought control, thought and action fusion, acceptance and action, and depression. Materials and Methods A total of 62 patients diagnosed with OCD as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in the age range between 18 and 60 years, having duration of illness less than two years, both male and female, literate and illiterate, hailing from rural and urban background, were included in the study. For pre- and post-assessment Yale-Brown Obsessive and Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS), acceptance and commitment questionnaire, thought control questionnaire, and thought and action fusion questionnaire were used in this study, and ACT was used for management of OCD. Results There is a significant difference between the groups treated with ACT and those treated as usual, on every domain of thought control questionnaire (TCQ) -- distraction (t = 9.07), social control (t = 11.13), worry (t = 11.93), punishment (t = 16.78), and re-appraisal (t = 16.47). Significance is also seen in the thought and action fusion in the moral domain (t = 16.22), the likelihood domain (t = 16.49), and others (t = 9.23). On Y-BOCS, HDRS, and acceptance and action questionnaire (AAQ) both groups show a significant difference between each other. Conclusion The findings of the present study indicate that ACT is a productive method for patients with OCD as it encourages the patient to accept and integrate their lived experiences, challenges effective responses, and recognizes and eliminates the controlling dimensions.
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Affiliation(s)
- Deoshree Akhouri
- Department of Psychiatry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Hamza
- Department of Psychiatry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shravan Kumar
- Department of Psychiatry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - M. Reyazuddin
- Department of Psychiatry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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16
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McKay D, O'Donohue W. Conceptual, Psychometric, Methodological and Value Problems in Acceptance and Commitment Therapy: Introduction to the Special Section, "A Critical Appraisal of Acceptance and Commitment Therapy". Behav Ther 2023; 54:929-938. [PMID: 37863585 DOI: 10.1016/j.beth.2023.07.004] [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: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 10/22/2023]
Abstract
There is a voluminous and expanding literature regarding ACT, from descriptions of its theory to its stated roots in relational frame theory, the particulars of its therapy techniques and exercises, favored metaphors, randomized controlled trials, to many self-help books for a wide variety of problems. The therapy is widely marketed through workshops and many self-help books. ACT is associated with its own journal and its own professional organization, the Association for Contextual Behavioral Science (ACBS). This literature is interpreted by ACT proponents as demonstrating the causal efficacy of ACT for a wide range of problems and, at times, even being superior to treatment as usual, which are often more traditional forms of cognitive behavior therapy (CBT). This special section contains a series of 6 papers examining these claims. Correctly understanding and evaluating the claims of ACT proponents is warranted because these can have direct implications for treatment decisions by therapists attempting to deliver the most effective treatment for their clients' problems. The papers, individually and as a whole, urge considerable caution, particularly because much of its research has involved serious measurement problems, problematic research designs, and a unique and problematic conceptualization and perhaps the practice of values and ethics. These papers call for methodological improvements and a commitment to more traditional values associated with science so that ACT can be more fairly evaluated to accurately understand its assets and limitations.
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17
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Lee SW, Choi M, Lee SJ. Is Acceptance and Commitment Therapy Effective for Any Obsessive-Compulsive Symptom Dimensions? Psychiatry Investig 2023; 20:991-996. [PMID: 37899223 PMCID: PMC10620332 DOI: 10.30773/pi.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE Acceptance and commitment therapy (ACT) has been recently introduced for treating obsessive-compulsive disorder (OCD). Although there are data supporting the efficacy of ACT, only few studies have investigated the effectiveness of ACT against any obsessivecompulsive (OC) symptom dimension or a specific dimension alone. METHODS In total, 64 patients with OCD received an 8-session ACT group program. All measures were evaluated before and after treatment. The Dimensional Obsessive-Compulsive Scale was used to assess OCD severity across the four empirically supported symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, and symmetry). ACT processes were evaluated using the Acceptance and Action Questionnaire-II (AAQ-II), Acceptance and Action Questionnaire for Obsessions and Compulsions (AAQOC), and Cognitive Fusion Questionnaire. RESULTS After an 8-week program, there were significant reductions in all four OC symptom dimensions after ACT. The unacceptable thoughts and contamination domains had medium effect size. The responsibility for harm and symmetry dimensions had small effect size. The unacceptable thoughts dimension was significantly correlated with all ACT process measures. The symmetry dimension was significantly correlated with AAQ-OC and AAQ-II scores while the responsibility for harm dimension was correlated with AAQ-II alone. However, the contamination dimension was not associated with any process measures. CONCLUSION ACT may be effective for managing all four symptom dimensions with small to moderate effect size. Moreover, depending on the symptom dimension, there may be different relationship patterns between symptom reduction and changes in ACT processes.
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Affiliation(s)
- Sang Won Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Mina Choi
- Institute of Biomedical Engineering Research, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
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18
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Browning ME, Lloyd-Richardson EE, Satterfield SL, Trisal AV. A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility. Behav Cogn Psychother 2023; 51:396-413. [PMID: 37226518 DOI: 10.1017/s1352465823000188] [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] [Indexed: 05/26/2023]
Abstract
BACKGROUND Experiencing racial microaggressions has clear effects on physical and psychological health, including obsessive-compulsive disorder symptoms (OCS). More research is needed to examine this link. Psychological flexibility is an important process to examine in this work. AIMS This study aimed to examine if, while controlling for depression and anxiety, experiences of microaggressions and psychological flexibility helped explain OCD symptoms within a university-affiliated sample (undergraduate, graduate and law students). This was a pilot exploration of the relationships across themes. METHOD Initial baseline data from a longitudinal study of psychological flexibility, OCD symptoms, depression, anxiety and experience of microaggressions was utilized. Correlations and regressions were utilized to examine which OCD symptom dimensions were associated with experiencing racial microaggressions in addition to anxiety and depression, and the added role of psychological flexibility was examined. RESULTS OCD symptoms, experiences of microaggressions and psychological flexibility were correlated. Experiences of racial microaggressions explained responsibility for harm and contamination OCD symptoms above and beyond psychological distress. Exploratory results support the relevance of psychological flexibility. CONCLUSION Results support other work that experiences of racial microaggressions help explain OCS and they add some support for psychological flexibility as a relevant risk or protective factor for mental health in marginalized populations. These topics should be studied longitudinally with continued consideration of all OCD themes, larger sample sizes, intersecting identities, clinical samples, and continued exploration of psychological flexibility and mindfulness and values-based treatments.
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Affiliation(s)
- Morgan E Browning
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA02747, USA
| | | | - Sidney L Satterfield
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA02747, USA
| | - Akshay V Trisal
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA02747, USA
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19
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Shahidullah JD, Roberts H, Parkhurst J, Ballard R, Mautone JA, Carlson JS. State of the Evidence for Use of Psychotropic Medications in School-Age Youth. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1454. [PMID: 37761415 PMCID: PMC10528957 DOI: 10.3390/children10091454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger "whole-child" approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The paper concludes with a discussion about supporting the use of medication treatments in schools, including considerations for ensuring effective family-school-health system collaboration to best meet youth mental health needs.
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Affiliation(s)
- Jeffrey D. Shahidullah
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Holly Roberts
- Department of Psychology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - John Parkhurst
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Rachel Ballard
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Jennifer A. Mautone
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19146, USA;
| | - John S. Carlson
- Department of Counseling, Educational Psychology, & Special Education, Michigan State University, East Lansing, MI 48824, USA
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20
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Colautti L, Magenes S, Rago S, Camerin S, Zanaboni Dina C, Antonietti A, Cancer A. Creative thinking in Tourette's syndrome: A comparative study of patients and healthy controls. J Clin Exp Neuropsychol 2023; 45:482-497. [PMID: 37667639 DOI: 10.1080/13803395.2023.2251644] [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: 04/11/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Tourette's syndrome is a neurological disorder characterized by tics, that may interfere with patients' everyday life. Research suggested that creative thinking (namely, divergent and convergent thinking) could help patients cope with their symptoms, and therefore it can be a resource in non-pharmacological interventions. The present study aimed at investigating (i) possible differences in creative thinking between Tourette's syndrome patients and healthy controls and (ii) whether creative thinking can support patients in coping with their symptomatology. METHODS A group of 25 Tourette's syndrome patients and 25 matched healthy controls underwent an assessment of creative thinking, fluid intelligence, and depressive symptoms. Creative thinking was compared between patients and healthy controls after controlling for fluid intelligence and depressive symptoms. Moreover, the moderating role of divergent and convergent thinking on the subjective impact of tics was tested in a group of 30 patients. RESULTS Tourette's syndrome patients outperformed healthy controls in convergent thinking. Moreover, divergent thinking was found as a significant moderator of the relationship between tics severity and the subjective impact in Tourette's syndrome patients. CONCLUSIONS Findings highlighted the specific impact of convergent and divergent thinking on Tourette's syndrome patients. Considering the supportive role of creative thinking in Tourette's syndrome, our results confirm that higher levels of divergent thinking may reduce the tic-related discomfort. These findings suggest the potential positive implications of creative thinking in non-pharmacological interventions for Tourette's syndrome.
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Affiliation(s)
- Laura Colautti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Sara Magenes
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Fraternità e Amicizia Società Cooperativa Sociale ONLUS, Milan, Italy
| | - Sabrina Rago
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Stefania Camerin
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Carlotta Zanaboni Dina
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Tourette Syndrome Centre, IRCCS, San Raffaele,Milan, Italy
| | | | - Alice Cancer
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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21
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Li X, Du ZJ, Xu JN, Liang ZM, Lin S, Chen H, Li SJ, Li XW, Yang JM, Gao TM. mGluR5 in hippocampal CA1 pyramidal neurons mediates stress-induced anxiety-like behavior. Neuropsychopharmacology 2023; 48:1164-1174. [PMID: 36797374 PMCID: PMC10267178 DOI: 10.1038/s41386-023-01548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
Pharmacological manipulation of mGluR5 has showed that mGluR5 is implicated in the pathophysiology of anxiety and mGluR5 has been proposed as a potential drug target for anxiety disorders. Nevertheless, the mechanism underlying the mGluR5 involvement in stress-induced anxiety-like behavior remains largely unknown. Here, we found that chronic restraint stress induced anxiety-like behavior and decreased the expression of mGluR5 in hippocampal CA1. Specific knockdown of mGluR5 in hippocampal CA1 pyramidal neurons produced anxiety-like behavior. Furthermore, both chronic restraint stress and mGluR5 knockdown impaired inhibitory synaptic inputs in hippocampal CA1 pyramidal neurons. Notably, positive allosteric modulator of mGluR5 rescued stress-induced anxiety-like behavior and restored the inhibitory synaptic inputs. These findings point to an essential role for mGluR5 in hippocampal CA1 pyramidal neurons in mediating stress-induced anxiety-like behavior.
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Affiliation(s)
- Xin Li
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhuo-Jun Du
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jun-Nan Xu
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhi-Man Liang
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Song Lin
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hao Chen
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Shu-Ji Li
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xiao-Wen Li
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jian-Ming Yang
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Tian-Ming Gao
- State Key Laboratory of Organ Failure Research, Institute of Brain Diseases, Nanfang Hospital, Southern Medical University; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangdong Province Key Laboratory of Psychiatric Disorders, Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
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22
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Hühne V, Chacur C, de Oliveira MVS, Fortes PP, Bezerra de Menezes GM, Fontenelle LF. Considerations for the treatment of obsessive-compulsive disorder in patients who have comorbid major depression. Expert Rev Neurother 2023; 23:955-967. [PMID: 37811649 DOI: 10.1080/14737175.2023.2265066] [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: 05/22/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that affects a significant number of individuals worldwide. Major depressive disorder (MDD) is among the most common comorbidities reported in people with OCD. The emergence of MDD in individuals with OCD can be attributed to the increased severity of OCD symptoms and their profound impact on daily functioning. Depressive symptoms can also modify the course of OCD. AREAS COVERED In this review, the authors explore potential shared neurobiological mechanisms that may underlie both OCD and MDD, such as disturbed sleep patterns, immunological dysregulations, and neuroendocrine changes. Furthermore, they address the challenges clinicians face when managing comorbid OCD and MDD. The authors also discuss a range of treatment options for OCD associated with MDD, including augmentation strategies for serotonin reuptake inhibitors (e.g. aripiprazole), psychotherapy (especially CBT/EPR), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and deep brain stimulation (DBS). EXPERT OPINION Although there is no 'rule of thumb' or universally acceptable strategy in the treatment of OCD comorbid with MDD, many clinicians, including the authors, tend to adopt a unique transdiagnostic approach to the treatment of OCD and related disorders, focusing on strategies known to be effective across diagnoses. Nevertheless, the existing 'cisdiagnostic approaches' still retain importance, i.e. specific therapeutic strategies tailored for more severe forms of individual disorders.
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Affiliation(s)
- Verônica Hühne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Carina Chacur
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcos Vinícius Sousa de Oliveira
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Pedro Pereira Fortes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Gabriela M Bezerra de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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Buchholz JL, Abramowitz JS, Hellberg SN, Ojalehto HJ, Twohig M. Different Psychological Processes in Traditional and ACT-Enhanced ERP for Obsessive-Compulsive Disorder. J Cogn Psychother 2023; 37:239-251. [PMID: 37463698 DOI: 10.1891/jcp-2021-0004] [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: 07/20/2023]
Abstract
Background: Acceptance and commitment therapy (ACT) has been shown to promote willingness to experience intrusive thoughts among individuals with obsessive-compulsive disorder (OCD). Exposure with response prevention (ERP) delivered from an ACT framework (i.e., ACT+ERP) may facilitate changes in how patients relate to their unwanted internal experiences.Aims: Accordingly, the present study aimed to examine the effect of ACT+ERP on appraisals of intrusive thoughts, relative to standard ERP.Methods: Forty-eight adults who received 16 treatment sessions as part of a randomized controlled trial comparing standard ERP to ACT+ERP completed the Interpretation of Intrusions Inventory (III) at pre-treatment, post-treatment, and follow-up.Results: Results showed a significant main effect of time for all III subscales, suggesting that appraisals of intrusive thoughts shift over the course of treatment. The effect of the condition × time interaction, however, differed between the III subscales. Specifically, a significant interaction emerged for the control of thoughts subscale, such that individuals who received ACT+ERP experienced greater reductions in beliefs about the need to control thoughts. The interaction term was not significant for importance of thoughts or responsibility subscales.Conclusions: Findings suggest that augmenting ERP with ACT enhances change in beliefs about the need to control thoughts, but not in beliefs about responsibility and the importance of thoughts. Clinical implications and future research directions will be discussed.
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Affiliation(s)
| | | | | | - Heidi J Ojalehto
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Petersen JM, Twohig MP. Sexual Orientation Intrusive Thoughts and Well-Being: The Mediating Role of Psychological Inflexibility. J Cogn Psychother 2023; 37:142-155. [PMID: 37258302 DOI: 10.1891/jcp-2021-0005] [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: 06/02/2023]
Abstract
Sexual orientation intrusive thoughts are a debilitating form of obsessive-compulsive disorder. The present study aimed to elucidate how psychological inflexibility and dysfunctional beliefs may impact the relationships of sexual orientation intrusive thoughts and obsessive-compulsive (OC) symptoms with well-being. A total of 181 undergraduate students completed measures of sexual orientation intrusive thoughts, OC symptoms, psychological inflexibility, dysfunctional beliefs, and well-being. Results indicated positive correlations between psychological inflexibility, sexual orientation intrusive thoughts, dysfunctional beliefs, and OC symptoms, along with negative correlations between well-being and sexual orientation intrusive thoughts, OC symptoms, dysfunctional beliefs, and psychological inflexibility. Psychological inflexibility acted as a mediator between sexual orientation intrusive thoughts and well-being and between OC symptoms and well-being. Dysfunctional beliefs were not a significant mediator. These results suggest that psychological inflexibility may partially explain the association between OC symptoms and well-being, pointing toward the need for future research on the impact of psychological inflexibility on well-being in the context of OC symptoms.
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Wang D, Lin B, Liang H, Deng Y, Zhang L. Mediating role of psychological flexibility in the effect of obsessive-compulsive symptoms on sleep quality among nurses during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2023:1-10. [PMID: 37359595 PMCID: PMC10097520 DOI: 10.1007/s12144-023-04546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 06/28/2023]
Abstract
Front-line nurses suffered unprecedented mental distress and severe insomnia during the COVID-19 pandemic. Present study aimed to explore the relationship between obsessive-compulsive symptoms and sleep quality and examine the potential mediating role of psychological flexibility between obsessive-compulsive symptoms and sleep quality. A total of 496 nurses from a Chinese large-scale Class 3 A Comprehensive Hospital were included in an online cross-sectional survey and completed the revised obsessive-compulsive inventory (OCI-R), Multidimensional Psychological Flexibility Inventory (MPFI) and Pittsburgh Sleep Quality Index (PSQI). As predicted, obsessive-compulsive symptoms were negatively associated with psychological flexibility and sleep quality, and psychological flexibility was positively associated with sleep quality. In addition, the relationship between obsessive-compulsive symptoms and sleep quality was partially mediated by psychological flexibility, which can provide some reference for the treatment of the obsessive-compulsive disorder (OCD) and insomnia, and lead to improvements in clinical and psychotherapy planning.
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Affiliation(s)
- Difan Wang
- School of Psychology, Central China Normal University, Luoyu Road No.152, Hongshan District, Wuhan, 430079 China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan, China
- Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
- Department of field internal medicine, Psychological Counseling and Health Management Center, Graduate School of Medical College of Chinese PLA Hospital, Beijing, 100853 China
| | - Bingyan Lin
- School of Foreign Languages, Harbin University of Science and Technology, Harbin, 150000 China
| | - Heting Liang
- School of Psychology, Central China Normal University, Luoyu Road No.152, Hongshan District, Wuhan, 430079 China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan, China
- Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
| | - Yu Deng
- School of Foreign Languages, Harbin University of Science and Technology, Harbin, 150000 China
| | - Lin Zhang
- School of Psychology, Central China Normal University, Luoyu Road No.152, Hongshan District, Wuhan, 430079 China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan, China
- Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
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26
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Cooper DDJ, Perkes IE, Lam-Po-Tang J, Farrell LJ, Brakoulias V, Grisham JR. Finding help for OCD in Australia: development and evaluation of a clinician directory. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2023.2189003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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27
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Assessing psychological inflexibility in text: An examination of the inflexitext program. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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28
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Sideli L, Santoro G, Fontana A, Guglielmucci F, Caretti V, Schimmenti A. The Relationship Between Obsessive-Compulsive Symptoms and Dissociation: A Systematic Review and Meta-Analysis. J Trauma Dissociation 2023; 24:362-379. [PMID: 36820493 DOI: 10.1080/15299732.2023.2181477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This systematic review and meta-analysis aimed to investigate the relationship between dissociation and obsessive-compulsive symptoms (OCS) and disorder (OCD). Specifically, the study aimed to (a) estimate the pooled prevalence of dissociative disorders among individuals with OCD; (b) systematically review the prevalence of OCD among individuals with dissociative disorders; (c) compare the severity of dissociative symptoms between individuals with OCD and non-clinical controls; (d) estimate the association between OCS and dissociative symptoms in the clinical and non-clinical populations. A systematic search was carried out in biomedical databases from inception to January 2022 according to PRISMA guidelines. A total of 41 studies met inclusion criteria (n = 9,438, 34.3% males). The pooled prevalence of dissociative disorders in adult samples with OCD was 8% (95% CI [3, 15], k = 5). Studies on adolescent and adult patients with dissociative disorders found that 17-32% reported comorbid OCD, while a prospective study of patients with early-onset dissociative disorders found no evidence of association with OCD. Individuals affected by OCD reported more dissociative symptoms than non-clinical controls (g = .67, 95% CI [.18, 1.16], k = 9). A moderate correlation between dissociative symptoms and OCS was detected (r = .43, 95% CI [.36, .51], k = 18). Sensitivity analyses showed small/moderate correlations between dissociative experiences and specific types of obsessions and compulsions. Findings suggest that dissociative symptoms are moderately related to OCS in both clinical and non-clinical populations. Interventions aimed to reduce dissociation might improve treatment response of patients suffering from OCD.
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Affiliation(s)
- Lucia Sideli
- Department of Human Science, LUMSA University, Rome, Italy
| | - Gianluca Santoro
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Enna, Italy
| | - Andrea Fontana
- Department of Human Science, LUMSA University, Rome, Italy
| | - Fanny Guglielmucci
- Department of Philosophy, Communication and Arts, University of Rome 3, Roma, Italy
| | | | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Enna, Italy
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Morimoto H, Kishita N, Kondo H, Tanaka N, Abe Y, Muto T. Reliability and validity of the Japanese version of the experiential avoidance in caregiving questionnaire (EACQ). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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30
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Eadeh HM, Adamowicz JL, Markon K, Thomas EBK. Using network analysis to examine connections between Acceptance and Commitment Therapy (ACT) processes, internalizing symptoms, and well-being in a sample of undergraduates. J Affect Disord 2023; 320:701-709. [PMID: 36209776 PMCID: PMC9675720 DOI: 10.1016/j.jad.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating internalizing symptoms. Understanding which ACT processes are most closely linked to certain symptoms may help develop targeted treatments. Network analysis an approach to gain insight into the interconnection between processes and the downstream benefits of targeting a particular process. However, limited work to date has explored networks involving ACT processes specifically. METHODS Undergraduate students (N = 447; 76.5 % female; 89.5 % White/Non-Hispanic) completed online questionnaires. The ACT processes assessed included experiential avoidance (AAQ-II), openness, awareness, and engagement (CompACT), and tacting ability (TOF), and internalizing symptoms/well-being (IDAS-II). Zero-order and partial correlation networks were examined as well as resulting communities. RESULTS In the association network, dysphoria and experiential avoidance, and suicidality (in the concentration network only) were central nodes. In community analyses, experiential avoidance had the strongest influence in the association network, whereas well-being had the strongest influence in the concentration network. Auto-detected communities were also evaluated. LIMITATIONS The present study was cross-sectional and included a largely White, female, undergraduate sample. This limits generalizability to more diverse, clinical, or general community populations. Potential concerns about data are also noted including low reliability on the TOF and two skewed domains on the IDAS-II which may impact stability of centrality metrics. CONCLUSIONS Well-being, dysphoria, and suicidality may be important process-based treatment targets. Further work is needed with diverse samples and using longitudinal designs to examine within person change of the associations between ACT processes and internalizing symptoms.
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Affiliation(s)
- Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA
| | - Jenna L Adamowicz
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA
| | - Kristian Markon
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, IA, USA.
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31
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Castle D, Feusner J, Laposa JM, Richter PMA, Hossain R, Lusicic A, Drummond LM. Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore? Compr Psychiatry 2023; 120:152357. [PMID: 36410261 PMCID: PMC10848818 DOI: 10.1016/j.comppsych.2022.152357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite significant advances in the understanding and treatment of obsessive compulsive disorder (OCD), current treatment options are limited in terms of efficacy for symptom remission. Thus, assessing the potential role of iterative or alternate psychotherapies is important. Also, the potential role of digital technologies to enhance the accessibility of these therapies, should not be underestimated. We also need to embrace the idea of a more personalized treatment choice, being cognisant of clinical, genetic and neuroimaging predictors of treatment response. PROCEDURES Non-systematic review of current literature on emerging psychological and digital therapies for OCD, as well as of potential biomarkers of treatment response. FINDINGS A number of 'third wave' therapies (e.g., Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy) have an emerging and encouraging evidence base in OCD. Other approaches entail employment of elements of other psychotherapies such as Dialectical Behaviour Therapy; or trauma-focussed therapies such as Eye Movement Desensitisation and Reprocessing, and Imagery Rescripting and Narrative Therapy. Further strategies include Danger Ideation Reduction Therapy and Habit Reversal. For these latter approaches, large-scale randomised controlled trials are largely lacking, and the precise role of these therapies in treating people with OCD, remains to be clarified. A concentrated 4-day program (the Bergen program) has shown promising short- and long-term results. Exercise, music, and art therapy have not been adequately tested in people with OCD, but may have an adjunctive role. Digital technologies are being actively investigated for enhancing reach and efficacy of psychological therapies for OCD. Biomarkers, including genetic and neuroimaging, are starting to point to a future with more 'personalised medicine informed' treatment strategizing for OCD. CONCLUSIONS There are a number of potential psychological options for the treatment of people with OCD who do not respond adequately to exposure/response prevention or cognitive behaviour therapy. Adjunctive exercise, music, and art therapy might be useful, albeit the evidence base for these is very small. Consideration should be given to different ways of delivering such interventions, including group-based, concentrated, inpatient, or with outreach, where appropriate. Digital technologies are an emerging field with a number of potential applications for aiding the treatment of OCD. Biomarkers for treatment response determination have much potential capacity and deserve further empirical testing.
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Affiliation(s)
- David Castle
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Jamie Feusner
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1RB, Canada
| | - Judith M Laposa
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario M6J 1H4, Canada
| | - Peggy M A Richter
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Frederick W Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, 2075 Bayview, Toronto, Ontario M4N 3M5, Canada
| | - Rahat Hossain
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Ana Lusicic
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Lynne M Drummond
- Service for OCD/ BDD, South-West London and St George's NHS Trust, Glenburnie Road, London SW17 7DJ, United Kingdom
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Chiesi F, Marunic G, Tagliaferro C, Lau C. The psychometric properties and gender invariance of the Italian version of the Perceived Vulnerability to Disease Questionnaire (I-PVDQ) during the COVID-19 pandemic. BMC Psychol 2022; 10:321. [PMID: 36581890 PMCID: PMC9797899 DOI: 10.1186/s40359-022-01023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Perceived Vulnerability to Disease Questionnaire (PVDQ) measures beliefs associated with personal susceptibility to infectious diseases and behaviors or perceptions in the presence of potential risk of pathogen transmission. Given the onset of the Severe Acute Respiratory Syndrome Coronavirus 2 global pandemic, otherwise known as the COVID-19 pandemic, the construct being measured may function differently based on affective, behavioral, and cognitive changes along with the need to change norms and lifestyles in a global context. The present study aims to test the psychometric properties and the gender invariance of the Italian adaptation of the PVDQ to confirm that the scale can be used with Italian-speaking people, and that it functions effectively during a pandemic. METHODS A total of 509 participants filled out an online questionnaire including the Italian version of the I-PVDQ (I-PVDQ) and several measures of psychological constructs. Reliability and factor analyses (single and multigroup) were conducted. Bayesian correlation tests and Bayesian independent sample t-tests were used to assess the validity of I-PVDQ. RESULTS Exploratory factor analysis supported the two-factor structure of the I-PVDQ, and factor loadings loaded appropriately onto perceived infectability (PI) and germ aversion (GA). In terms of invariance, the scale showed configural, metric, scalar, and strict invariance across genders. Decisive evidence in favor of correlation with the measure of COVID-19 related fears for both PI and GA was found. There was strong evidence for observed correlations with COVID-19 related constructs such as intolerance to uncertainty, psychological inflexibility, resilience, stress, and anxiety. Women showed higher GA than men, while there were no gender differences in PI. CONCLUSIONS Taken together, these results suggest that the I-PVDQ confirms the psychometric properties of the original version and that can be used to detect PVD when it is affected by environmental circumstances since its functioning is preserved during a pandemic.
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Affiliation(s)
- Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child's Health (NEUROFARBA), Section of Psychology, University of Florence, Via San Salvi 12-Padiglione 26, 50135, Florence, Italy.
| | - Georgia Marunic
- Department of Neuroscience, Psychology, Drug, and Child's Health (NEUROFARBA), Section of Psychology, University of Florence, Via San Salvi 12-Padiglione 26, 50135, Florence, Italy
| | | | - Chloe Lau
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Lee SW, Choi M, Lee SJ. A randomized controlled trial of group-based acceptance and commitment therapy for obsessive-compulsive disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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A Review of Acceptance and Commitment Therapy for Adolescents: Developmental and Contextual Considerations. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Landi G, Pakenham KI, Mattioli E, Crocetti E, Agostini A, Grandi S, Tossani E. Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 26:44-55. [PMID: 36060527 PMCID: PMC9420208 DOI: 10.1016/j.jcbs.2022.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale-Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.
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Affiliation(s)
- Giulia Landi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Kenneth I Pakenham
- School of Psychology, The University of Queensland, Brisbane QLD, Australia
| | - Elisa Mattioli
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | | | - Alessandro Agostini
- Department of Experimental, Diagnostic and Specialty Medicine DIMES St.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Silvana Grandi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Eliana Tossani
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
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Leadbitter K, Smallman R, James K, Shields G, Ellis C, Langhorne S, Harrison L, Hackett L, Dunkerley A, Kroll L, Davies L, Emsley R, Bee P, Green J. REACH-ASD: a UK randomised controlled trial of a new post-diagnostic psycho-education and acceptance and commitment therapy programme against treatment-as-usual for improving the mental health and adjustment of caregivers of children recently diagnosed with autism spectrum disorder. Trials 2022; 23:585. [PMID: 35869533 PMCID: PMC9306249 DOI: 10.1186/s13063-022-06524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autism is a neurodevelopmental disability affecting over 1% of UK children. The period following a child's autism diagnosis can present real challenges in adaptation for families. Twenty to 50% of caregivers show clinically significant levels of mental health need within the post-diagnostic period and on an ongoing basis. Best practice guidelines recommend timely post-diagnostic family support. Current provision is patchy, largely unevidenced, and a source of dissatisfaction for both families and professionals. There is a pressing need for an evidenced programme of post-diagnostic support focusing on caregiver mental health and adjustment, alongside autism psycho-education. This trial tests the clinical and cost-effectiveness of a new brief manualised psychosocial intervention designed to address this gap. METHODS This is a multi-centre two-parallel-group single (researcher)-blinded randomised controlled trial of the Empower-Autism programme plus treatment-as-usual versus usual local post-diagnostic offer plus treatment-as-usual. Caregivers of children aged 2-15 years with a recent autism diagnosis will be recruited from North West England NHS or local authority centres. Randomisation is individually by child, with one "index" caregiver per child, stratified by centre, using 2:1 randomisation ratio to assist recruitment and timely intervention. Empower-Autism is a group-based, manualised, post-diagnostic programme that combines autism psycho-education and psychotherapeutic components based on Acceptance and Commitment Therapy to support caregiver mental health, stress management and adjustment to their child's diagnosis. The comparator is any usual local group-based post-diagnostic psycho-education offer. Receipt of services will be specified through health economic data. PRIMARY OUTCOME caregiver mental health (General Health Questionnaire-30) at 52-week follow-up. SECONDARY OUTCOMES key caregiver measures (wellbeing, self-efficacy, adjustment, autism knowledge) at 12-, 26- and 52-week follow-up and family and child outcomes (wellbeing and functioning) at 52-week endpoint. SAMPLE N=380 (approximately 253 intervention/127 treatment-as-usual). Primary analysis will follow intention-to-treat principles using linear mixed models with random intercepts for group membership and repeated measures. Cost-effectiveness acceptability analyses will be over 52 weeks, with decision modelling to extrapolate to longer time periods. DISCUSSION If effective, this new approach will fill a key gap in the provision of evidence-based care pathways for autistic children and their families. TRIAL REGISTRATION ISRCTN 45412843 . Prospectively registered on 11 September 2019.
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Affiliation(s)
- Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK.
| | - Richard Smallman
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Gemma Shields
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophie Langhorne
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Louisa Harrison
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Latha Hackett
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Leo Kroll
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Linda Davies
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Penny Bee
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
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Dialectical Behavior Therapy and Acceptance and Commitment Therapy: Areas of Overlap and Distinction. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Landi G, Pakenham KI, Crocetti E, Tossani E, Grandi S. The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study. J Affect Disord 2022; 307:69-78. [PMID: 35378147 PMCID: PMC8972980 DOI: 10.1016/j.jad.2022.03.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Published reports on the adverse mental health impacts of the initial phase of the COVID-19 pandemic suggest an emerging global mental health crisis. However, the trajectories of these mental health impacts over multiple COVID-19 peaks and corresponding lockdowns are unknown. This study explored the trajectories of anxiety and depression over two consecutive lockdowns during the first nine months of the pandemic in Europe (April 2020-January 2021) and examined whether they varied as a function of different psychological flexibility and inflexibility profiles. METHODS A total of 569 Italians completed online surveys at four assessment points. Trajectories of anxiety and depression were examined with latent growth modeling and according to different psychological flexibility and inflexibility profiles. RESULTS Anxiety increased linearly throughout the study period, whereas depression displayed a quadratic trajectory evidencing a decrease with the easing of the first lockdown followed by an increase during the second lockdown. Furthermore, two profiles were identified that displayed different anxiety and depression trajectories. Compared to the psychologically flexible profile, the psychologically inflexible profile reported significantly higher anxiety and depression which remained higher across the study period. LIMITATIONS A reliance on self-report measures and convenience sampling constitute key study limitations. CONCLUSIONS Results suggest that high psychological inflexibility is a risk factor for prolonged elevated anxiety and depression during the COVID-19 pandemic, whereas high psychological flexibility is a protective factor. Psychological flexibility and inflexibility should be targeted by preventive public health interventions that harness evidence-based strategies shown to effectively target these factors.
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Affiliation(s)
- Giulia Landi
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy; Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023 Cesena, Italy.
| | - Kenneth I. Pakenham
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Elisabetta Crocetti
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy
| | - Eliana Tossani
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023 Cesena, Italy
| | - Silvana Grandi
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023 Cesena, Italy
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Fishbein JN, Judd CM, Genung S, Stanton AL, Arch JJ. Intervention and mediation effects of target processes in a randomized controlled trial of Acceptance and Commitment Therapy for anxious cancer survivors in community oncology clinics. Behav Res Ther 2022; 153:104103. [DOI: 10.1016/j.brat.2022.104103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
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Grove L, Roche AI, Doyle R, Stowe ZN, Thomas EBK. ACT-Informed Treatment of Co-morbid Psychiatric Disorders in the Postpartum Period: A Case Report. Clin Case Stud 2022. [DOI: 10.1177/15346501221091273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The literature describing psychological interventions for co-occurring obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) is limited. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention that targets functionally avoidant behavior underlying both OCD and PTSD. The current case report describes how an ACT-informed approach to treatment was implemented over 14 sessions to treat co-occurring OCD and PTSD in a 9-months postpartum adult woman. The patient was initially referred to psychotherapy by her psychiatrist and showed high motivation to engage in treatment. This case presentation outlines how the intervention targeted core ACT processes while also incorporating components from both exposure and response prevention (ERP) and cognitive processing therapy (CPT) to address the patient’s presenting concerns. Measurements of OCD and PTSD symptom severity, as well as of depressive and anxiety symptoms, over the course of treatment are included. Health-related comorbidities, psychiatric medications, and implications are discussed.
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Affiliation(s)
- Lindsey Grove
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine, Madison, WI, USA
| | - Anne I. Roche
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Rena Doyle
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine, Madison, WI, USA
| | - Zachary N. Stowe
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine, Madison, WI, USA
| | - Emily B. K. Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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Soondrum T, Wang X, Gao F, Liu Q, Fan J, Zhu X. The Applicability of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12050656. [PMID: 35625042 PMCID: PMC9139700 DOI: 10.3390/brainsci12050656] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Acceptance and commitment therapy (ACT), a third-generation cognitive behavioral therapy (CBT), has proved its efficacy amidst various mental disorders. A growing body of studies has shown that ACT can improve obsessive-compulsive disorder (OCD) severity in recent years. To assess the effect of ACT on OCD, we carried out a systematic review and meta-analysis to provide a basis for therapists to use different psychological dimensions of ACT for OCD. Methods: PubMed, the Cochrane Library, EMBASE, EBSCO Host, and literature references were searched until May 2021. Randomized controlled trials (RCTs) and other study designs assessing the effect of ACT among adults suffering from OCD were examined. Results: Fourteen studies, including 413 participants, published between 2010 and 2021 were identified. ACT made statistically significant progress in the Yale–Brown Obsessive–Compulsive Scale (YBOCS) compared with control conditions. Conclusion: After reviewing all the ACT studies, we acknowledge the plausibility of ACT in treating OCD and improving its symptoms for the clinical population. ACT can also be an adjunct therapy for other well-established treatments. It also favors targeting psychological inflexibility. Further well-controlled and high-quality RCTs are required for a better conclusion in further studies.
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Affiliation(s)
- Tamini Soondrum
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Feng Gao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Qian Liu
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Jie Fan
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
- Correspondence: ; Tel.: +86-135-7485-2322
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Thompson BL. Is ACT-Informed Exposure a Viable Treatment for Excoriation Disorder? A Multiple Baseline Study. Behav Modif 2022; 47:71-92. [PMID: 35485352 DOI: 10.1177/01454455221091778] [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: 11/16/2022]
Abstract
This study piloted the use of ACT-informed exposure as an adjunct to habit reversal training (HRT) for excoriation disorder (ExD). Using a nonconcurrent multiple baseline single case design, four participants completed sessions of exposure and HRT. Repeated measures and self-report data were collected on skin picking and psychological flexibility. Two participants completed HRT followed by exposure, and two participants completed exposure followed by HRT. Results support the effectiveness of HRT in reducing picking. Results suggest exposure may have some impact in reducing picking, but effects were weaker compared to HRT. Contrary to predictions, repeated measures and self-report data did not indicate consistent improvement in psychological flexibility during exposure phases. As any reduction in picking may be clinically meaningful and all participants maintained gains at follow-up, there is some indication that exposure may be a second-line treatment worth further study. Limitations and future areas of research are discussed.
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Affiliation(s)
- Brian L Thompson
- Portland Psychotherapy Clinic, Research, & Training Center, OR, USA
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Laurito LD, Loureiro CP, Faro L, Dias RV, Torres B, Moreira-de-Oliveira ME, Santos-Ribeiro SD, de Menezes GB, Fontenelle LF, Davis CH, Twohig MP. Acceptance and Commitment Therapy for obsessive compulsive disorder in a Brazilian context: Treatment of three cases. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Petersen JM, Davis CH, Renshaw TL, Levin ME, Twohig MP. School-Based Acceptance and Commitment Therapy for Adolescents With Anxiety: A Pilot Trial. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Exploring the role of psychological inflexibility, rumination, perfectionism cognitions, cognitive defusion, and self-forgiveness in cognitive test anxiety. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00805-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Woolf-King SE, Firkey M, Foley JD, Bricker J, Hahn JA, Asiago-Reddy E, Wikier J, Moskal D, Sheinfil AZ, Ramos J, Maisto SA. Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers. AIDS Behav 2022; 26:3029-3044. [PMID: 35303190 PMCID: PMC8931450 DOI: 10.1007/s10461-022-03649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.
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Psychological flexibility as a potential change factor in cognitive behavioural therapy of OCD. Behav Cogn Psychother 2022; 50:381-391. [PMID: 35241198 DOI: 10.1017/s1352465822000091] [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: 11/05/2022]
Abstract
BACKGROUND To gain a better understanding about which aspects of the treatment work for obsessive-compulsive disorders (OCD), the investigation of possible change factors is essential. Psychological flexibility (PsyF) has been of interest in research on successful OCD therapy for some time. Exposure interventions and cognitive strategies in cognitive behavioural therapy (CBT) for OCD may enhance PsyF. To date, however, no process studies have been published that clarify the role of PsyF as a possible change factor for the reduction of OCD symptoms. AIMS This study investigates whether PsyF works as a mediator in successful CBT treatment of OCD. METHOD The study recruited 112 adults diagnosed with OCD in a multi-modal in-patient treatment with specific CBT including exposure and response prevention (ERP). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to measure OCD symptoms and three self-constructed items to assess PsyF. PsyF was conceptualised as the capability of patients to accept stressful feelings and thoughts. Data were collected weekly. For statistical analysis at the process level, longitudinal multi-level models (MLMs) with random intercepts and linear growth curves were estimated to test for mediation of PsyF on Y-BOCS. RESULTS OCD symptoms decreased significantly and PsyF increased in patients throughout the course of therapy. MLM revealed that higher average values in PsyF were associated with lower Y-BOCS sum values, but only values between subjects significantly predicted the degree of obsessions and compulsions. CONCLUSIONS Although research shows that PsyF is enhanced by CBT and also shows a connection with Y-BOCS values, its role as a mediator could not be confirmed.
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Effect of Acceptance and Commitment Therapy Combined with Music Relaxation Therapy on the Self-Identity of College Students. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8422903. [PMID: 35186241 PMCID: PMC8853795 DOI: 10.1155/2022/8422903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 11/18/2022]
Abstract
This paper analyzes various effects of acceptance and commitment therapy combined with music relaxation therapy on the self-identity of the college students. Through open recruitment and following the principle of voluntary and confidential, 80 college students were selected from our school, and then they were divided into two groups: the control group (40 cases) and the observation group (40 cases). The observation group received acceptance and commitment therapy combined with music relaxation therapy. For the control group, conventional mental health interventions were administered. Two months after intervention, psychological status, mental resilience, and quality of life scores were compared between the two groups. Before intervention, there was no significant difference in SAS and SDS scores between the two groups
. After intervention, SAS and SDS scores were significantly higher than those in the control group, and the difference between the two groups was statistically significant
. Before intervention, there was no significant difference in the scores of toughness, strength, and optimism between the two groups
. After intervention, the scores of toughness, strength, and optimism in the two groups were all improved, and the scores of mental resilience in the observation group were higher than those in the control group, with statistical significance
. Before intervention, there was no significant difference in the quality of life scores between the observation group and the control group
. After intervention, the quality of life score of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant
. The combined application of acceptance and commitment therapy and music relaxation therapy can help college students to improve their mental state, improve their mental resilience, enhance their evaluation of life quality, improve their sense of self-identity, and reduce the probability of the occurrence of unhealthy emotions such as depression.
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Capel LK, Zurita Ona P, Moller C, Twohig MP. An Open Trial of Acceptance and Commitment Therapy With Exposure and Response Prevention in an Intensive Outpatient Setting for Adults With OCD. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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50
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Carvalho T, Pinto-Gouveia J, Cunha M, da Motta C. Experiential avoidance, uncompassionate self-responding, and peritraumatic depersonalization/derealization: A novel mediation model for war-related PTSD symptomatology. J Clin Psychol 2022; 78:1074-1092. [PMID: 34993963 DOI: 10.1002/jclp.23303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/29/2021] [Accepted: 12/20/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore a novel model for war-related posttraumatic stress disorder (PTSD) symptomatology including emotion regulation processes, namely experiential avoidance (EA) and uncompassionate self-responding (USR), mediating the impact of childhood threat memories, combat exposure distress, combat and noncombat threats, and peritraumatic depersonalization/derealization (PDD) on PTSD symptomatology. METHOD A sample of 650 male Portuguese Overseas War veterans filled self-report instruments. RESULTS The model explained 59% of the variance of PTSD symptomatology. Both EA and USR mediated the effects of noncombat threats and PDD on PTSD. Additionally, EA mediated combat exposure distress and USR mediated childhood threat memories. Combat exposure distress, combat and noncombat threats, and PDD showed direct effects on PTSD symptomatology. CONCLUSION The findings help to better understand the relationship between predictive factors of war-related PTSD in clinical and research settings, providing novel insights on the effects of combat exposure distress, and the different effects of combat and noncombat-related threats on PTSD.
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Affiliation(s)
- Teresa Carvalho
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Instituto Superior Miguel Torga, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Marina Cunha
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Carolina da Motta
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,School of Psychology and Life Sciences, Lusófona University, Lisbon, Portugal.,Digital Human-Environment Interaction Lab (HEI-Lab), Lisboa, Portugal
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