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Samson JA, Newkirk TR, Teicher MH. Practitioner Review: Neurobiological consequences of childhood maltreatment - clinical and therapeutic implications for practitioners. J Child Psychol Psychiatry 2024; 65:369-380. [PMID: 37609790 DOI: 10.1111/jcpp.13883] [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] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Childhood maltreatment is one of the most important preventable risk factors for a wide variety of psychiatric disorders. Further, when psychiatric disorders emerge in maltreated individuals they typically do so at younger ages, with greater severity, more psychiatric comorbid conditions, and poorer response to established treatments, resulting in a more pernicious course with an increased risk for suicide. Practitioners treating children, adolescents, and young adults with psychiatric disorders will likely encounter the highest prevalence of clients with early-onset maltreatment-associated psychiatric disorders. These may be some of their most challenging cases. METHOD In this report, we explore key validated alterations in brain structure, function, and connectivity associated with exposure to childhood maltreatment as potential mechanisms behind their patients' clinical presentations. RESULTS We then summarize key behavioral presentations likely associated with neurobiological alterations and propose a toolkit of established trauma and skills-based strategies that may help diminish symptoms and foster recovery. We also discuss how some of these alterations may serve as latent vulnerability factors for the possible development of future psychopathology. CONCLUSIONS Research on the neurobiological consequences of childhood adversity provides a vastly enriched biopsychosocial understanding of the developmental origins of health and pathology that will hopefully lead to fundamental advances in clinical psychology and psychiatry.
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Affiliation(s)
- Jacqueline A Samson
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | - Thatcher R Newkirk
- Department of Psychiatry, Geisel School of Medicine, Dartmouth Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
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Johnson LN, Fierstein R, Cahn SC, Hoch AL, Twardzik LN. Implementation of Radically Open Dialectical Behavior Therapy in a University or College Counseling Setting: A Case Study. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2023. [DOI: 10.1080/87568225.2023.2191879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
| | - Robin Fierstein
- Wellness Center, Rowan University, Glassboro, New Jersey, USA
| | - Stacey C. Cahn
- Wellness Center, Rowan University, Glassboro, New Jersey, USA
| | - Amy L. Hoch
- Wellness Center, Rowan University, Glassboro, New Jersey, USA
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Yalcin O, Lee C, Correia H. Factor Structure of the Young Schema Questionnaire (Long Form‐3). AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ozgur Yalcin
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
| | - Christopher Lee
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia,
| | - Helen Correia
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
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Gilbert K, Perino MT, Myers MJ, Sylvester CM. Overcontrol and neural response to errors in pediatric anxiety disorders. J Anxiety Disord 2020; 72:102224. [PMID: 32289747 PMCID: PMC7260107 DOI: 10.1016/j.janxdis.2020.102224] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/01/2023]
Abstract
Multiple risk factors that may contribute to the development and severity of pediatric anxiety disorders, one of which is dimensional overcontrol. Overcontrol is a constellation of characteristics including heightened performance monitoring, inflexibility, perfectionism and aversion to making mistakes. In this study, we examined overcontrol in children with anxiety disorders and tested whether the underlying dimension of overcontrol specifically explains altered brain response to errors in pediatric anxiety disorders. Parent-reported scores of child overcontrol were collected in a sample of children (ages 8-12 years) with (n = 35) and without (n = 34) anxiety disorders and the relationship of overcontrol and anxiety symptoms to neural responding to errors during functional magnetic resonance imaging (fMRI) was examined. Results indicated childhood overcontrol was elevated in pediatric anxiety disorders and was significantly associated with anxiety severity, even when controlling for comorbid depression and ADHD. Additionally, overcontrol was associated with reduced neural response to errors versus correct responses in the bilateral dorsal anterior cingulate cortex (dACC) and insula, even when controlling for anxiety symptoms. Overcontrol may serve as an underlying mechanism associated with clinical pediatric anxiety that demonstrates significant associations with aberrant neural error responding. Overcontrol may be an underlying mechanism contributing to pediatric anxiety that could be targeted for early intervention.
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Affiliation(s)
- Kirsten Gilbert
- Department of Psychiatry, Washington University in St. Louis, 4444 Forest Park, Suite 2100, St. Louis MO, 63108, USA.
| | - Michael T Perino
- Department of Psychiatry, Washington University in St. Louis, 4444 Forest Park, Suite 2100, St. Louis MO, 63108, USA
| | - Michael J Myers
- Department of Psychiatry, Washington University in St. Louis, 4444 Forest Park, Suite 2100, St. Louis MO, 63108, USA
| | - Chad M Sylvester
- Department of Psychiatry, Washington University in St. Louis, 4444 Forest Park, Suite 2100, St. Louis MO, 63108, USA
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Lynch TR, Hempel RJ, Whalley B, Byford S, Chamba R, Clarke P, Clarke S, Kingdon DG, O'Mahen H, Remington B, Rushbrook SC, Shearer J, Stanton M, Swales M, Watkins A, Russell IT. Refractory depression - mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms. Br J Psychiatry 2020; 216:204-212. [PMID: 31317843 PMCID: PMC7282863 DOI: 10.1192/bjp.2019.53] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression. AIMS To compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627). METHOD RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated. RESULTS After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94-9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI -2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI -2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group. CONCLUSIONS The RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
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Affiliation(s)
- Thomas R. Lynch
- Emeritus Professor of Clinical Psychology, Department of Psychology, University of Southampton, UK,Correspondence: Thomas R. Lynch, Department of Psychology, University of Southampton, Highfield Campus, SouthamptonSO17 1BJ, UK.
| | - Roelie J. Hempel
- Senior Research Fellow, Department of Psychology, University of Southampton, UK
| | - Ben Whalley
- Lecturer in Psychology, Cognition Institute, School of Psychology, Plymouth University, UK
| | - Sarah Byford
- Professor of Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Rampaul Chamba
- Patient and Public Representative, Member of Trial Management Committee responsible for Public & Patient Inclusion, UK
| | - Paul Clarke
- Professor of Social Statistics, Institute for Social and Economic Research, University of Essex, UK
| | - Susan Clarke
- Visiting Professor, Consultant Clinical Psychologist, Intensive Psychological Therapies Service, Dorset Healthcare University NHS Foundation Trust, UK
| | - David G. Kingdon
- Professor of Mental Health Care Delivery, Department of Medicine, University of Southampton, UK
| | - Heather O'Mahen
- Senior Lecturer in Clinical Psychology, Department of Psychology, College of Life and Environmental Sciences, University of Exeter, UK
| | - Bob Remington
- Emeritus Professor in Psychology, Department of Psychology, University of Southampton, UK
| | - Sophie C. Rushbrook
- Consultant Clinical Psychologist, Intensive Psychological Therapies Service, Dorset Healthcare University NHS Foundation Trust, UK
| | - James Shearer
- Lecturer in Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Maggie Stanton
- Consultant Clinical Psychologist, Psychological Services, Southern Health NHS Foundation Trust, UK
| | - Michaela Swales
- Consultant Clinical Psychologist and Reader in Clinical Psychology, School of Psychology, Bangor University, UK
| | - Alan Watkins
- Associate Professor of e-Trials Research, Medical School, Swansea University, UK
| | - Ian T. Russell
- Professor of Clinical Trials, Medical School, Swansea University, UK
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Cacabelos R. Pharmacogenomics of drugs used to treat brain disorders. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2020.1738217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ramon Cacabelos
- International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain
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Gilbert K, Hall K, Codd RT. Radically Open Dialectical Behavior Therapy: Social Signaling, Transdiagnostic Utility and Current Evidence. Psychol Res Behav Manag 2020; 13:19-28. [PMID: 32021506 PMCID: PMC6955577 DOI: 10.2147/prbm.s201848] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/24/2019] [Indexed: 12/17/2022] Open
Abstract
At the core of an overcontrolled personality and coping style is a tendency to have too much self-control, exhibiting as behavioral and cognitive inflexibility, high inhibition of emotion, high detail-focused processing and perfectionism, and a lack of social connectedness. Overcontrol underlies a wide variety of psychiatric illnesses and as such, an innovative transdiagnostic therapy called Radically Open Dialectical Behavior Therapy (RO DBT) has been developed to treat disorders characterized by overcontrol. RO DBT targets maladaptive social signaling in order to help individuals "rejoin the tribe," hypothesizing that increasing social connectedness by means of targeting social signaling is the central mechanism of change in treatment. Because RO DBT is used for individuals with an overcontrolled personality style, rather than individual disordered symptoms, it can be used transdiagnostically across a range of comorbid disorders, including treatment-resistant depression and anxiety, anorexia nervosa, and personality disorders such as obsessive-compulsive personality disorder. The current article introduces this novel treatment approach and discusses its emphasis on social signaling and its transdiagnostic nature. We then provide the first review of existing literature testing the efficacy of RO DBT across clinical populations, discuss issues related to assessment of overcontrol, and speculate on future directions for this novel therapy.
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Affiliation(s)
- Kirsten Gilbert
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Karyn Hall
- Dialectical Behavior Therapies Center, Houston, TX, USA
| | - R Trent Codd
- Cognitive-Behavioral Therapy Center of Western North Carolina, Asheville, NC, USA
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8
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Shearer J, Lynch TR, Chamba R, Clarke S, Hempel RJ, Kingdon DG, O'Mahen H, Remington B, Rushbrook SC, Russell IT, Stanton M, Swales M, Watkins A, Whalley B, Byford S. Refractory depression - cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial. BJPsych Open 2019; 5:e64. [PMID: 31352916 PMCID: PMC6669879 DOI: 10.1192/bjo.2019.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Refractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.AimsTo estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627). METHOD We undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in quality-adjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life. RESULTS The additional cost of RO DBT plus TAU compared with TAU alone was £7048 and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of £220 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of £30 000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared with TAU at the NICE £30 000 threshold. CONCLUSIONS In its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.Declaration of interestR.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from the National Institute for Health Research (NIHR). T.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd, and a grant outside the submitted work from the Medical Research Council. He was co-director of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two directors of Radically Open Ltd. H.O'M. reports personal fees outside the submitted work from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.R. provides RO DBT supervision through her company S C Rushbrook Ltd. I.R. reports grants outside the submitted work from NIHR and Health & Care Research Wales. M. Stanton reports personal fees outside the submitted work from British Isles DBT Training, Stanton Psychological Services Ltd and Taylor & Francis. M. Swales reports personal fees outside the submitted work from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor & Francis. B.W. was co-director of Radically Open Ltd between November 2014 and February 2015.
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Affiliation(s)
- James Shearer
- Lecturer in Health Economics,Institute of Psychiatry, Psychology & Neuroscience, King's College London,UK
| | - Thomas R Lynch
- Emeritus Professor of Clinical Psychology,University of Southampton,UK
| | - Rampaul Chamba
- Patient and Public Representative,Member of Trial Management Committee responsible for Public & Patient Inclusion,West Midlands,UK
| | - Susan Clarke
- Visiting Professor, Intensive Psychological Therapies Service,Dorset Healthcare University NHS Foundation Trust,UK
| | - Roelie J Hempel
- Senior Research Fellow,University of Southampton; andRadically Open Ltd,London,UK
| | - David G Kingdon
- Professor of Mental Health Care Delivery, Department of Medicine,University of Southampton,UK
| | - Heather O'Mahen
- Senior Lecturer in Clinical Psychology, Department of Psychology,University of Exeter,UK
| | - Bob Remington
- Emeritus Professor in Psychology,University of Southampton,UK
| | - Sophie C Rushbrook
- Consultant Clinical Psychologist, Intensive Psychological Therapies Service,Dorset Healthcare University NHS Foundation Trust,UK
| | - Ian T Russell
- Professor of Clinical Trials, Medical School,University of Swansea,UK
| | - Maggie Stanton
- Consultant Clinical Psychologist, Psychological Services,Southern Health NHS Foundation Trust,UK
| | - Michaela Swales
- Consultant Clinical Psychologist and Reader in Clinical Psychology, School of Psychology,University of Bangor,UK
| | - Alan Watkins
- Associate Professor of e-Trials Research, Medical School,University of Swansea,UK
| | - Ben Whalley
- Lecturer in Psychology, Cognition Institute, School of Psychology,University of Plymouth,UK
| | - Sarah Byford
- Professor of Health Economics,Institute of Psychiatry, Psychology & Neuroscience, King's College London,UK
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Sackeim HA, Aaronson ST, Bunker MT, Conway CR, Demitrack MA, George MS, Prudic J, Thase ME, Rush AJ. The assessment of resistance to antidepressant treatment: Rationale for the Antidepressant Treatment History Form: Short Form (ATHF-SF). J Psychiatr Res 2019; 113:125-136. [PMID: 30974339 DOI: 10.1016/j.jpsychires.2019.03.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/11/2019] [Accepted: 03/21/2019] [Indexed: 12/26/2022]
Abstract
There is considerable diversity in how treatment-resistant depression (TRD) is defined. However, every definition incorporates the concept that patients with TRD have not benefited sufficiently from one or more adequate trials of antidepressant treatment. This review examines the issues fundamental to the systematic evaluation of antidepressant treatment adequacy and resistance. These issues include the domains of interventions deemed effective in treatment of major depressive episodes (e.g., pharmacotherapy, brain stimulation, and psychotherapy), the subgroups of patients for whom distinct adequacy criteria are needed (e.g., bipolar vs. unipolar depression, psychotic vs. nonpsychotic depression), whether trials should be rated dichotomously as adequate or inadequate or on a potency continuum, whether combination and augmentation strategies require specific consideration, and the criteria used to evaluate the adequacy of treatment delivery (e.g., dose, duration), trial adherence, and clinical outcome. This review also presents the Antidepressant Treatment History Form: Short-Form (ATHF-SF), a completely revised version of an earlier instrument, and details how these fundamental issues were addressed in the ATHF-SF.
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Affiliation(s)
- Harold A Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA.
| | - Scott T Aaronson
- Sheppard Pratt Health System and Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | | | - Charles R Conway
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | | | - Mark S George
- Departments of Psychiatry, Neurology, and Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Joan Prudic
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
| | - Michael E Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - A John Rush
- Duke-NUS Medical School, Singapore; Duke University, Durham, NC, USA; Texas Tech University, Permian Basin, TX, USA
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10
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Zhao X, Li Y, Tian Q, Zhu B, Zhao Z. Repetitive transcranial magnetic stimulation increases serum brain-derived neurotrophic factor and decreases interleukin-1β and tumor necrosis factor-α in elderly patients with refractory depression. J Int Med Res 2019; 47:1848-1855. [PMID: 30616482 PMCID: PMC6567781 DOI: 10.1177/0300060518817417] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on serum levels of brain-derived neurotrophic factor (BDNF), interleukin (IL)-1β, and tumor necrosis factor (TNF)-α in elderly patients with refractory depression. Methods A total of 58 elderly patients diagnosed with refractory depression between January 2015 and December 2016 were divided randomly into two groups: 29 patients who received rTMS and 29 controls without rTMS. Thirty healthy individuals were also enrolled and all received rTMS. Serum levels of BDNF, IL-1β, and TNF-α were measured before the study (0 days), and at 48 hours and 1, 2, 3, and 4 weeks after the first TMS treatment. Results BDNF levels gradually increased with treatment duration in the rTMS group and were significantly higher compared with the control group. In contrast, IL-1β and TNF-α levels gradually decreased and were significantly lower than in the control group. None of the serum factors were affected by rTMS in the healthy individuals. BDNF levels were negatively correlated and IL-1β and TNF-α levels were positively correlated with Hamilton Depression Rating Scale-24 scores. Conclusion These results suggest that rTMS may increase BDNF and decrease IL-1β and TNF-α serum levels in elderly patients with refractory depression.
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Affiliation(s)
- Xiangxiang Zhao
- 1 Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China.,2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yanpeng Li
- 2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qing Tian
- 2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bingqian Zhu
- 3 School of Nursing, Shanghai Jiaotong University, Shanghai, China
| | - Zhongxin Zhao
- 2 Department of Neurology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Psychometric properties of the Swedish version of the Ego Resilience scale (ER) and a new shortened version of the Ego Undercontrol Scale (EUC). CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0069-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractThe Ego Resilience scale (ER) and The Ego Undercontrol scale (EUC) are designed to assess personality types based on how people inhibit or express their emotional impulses. The study aim was to evaluate the psychometric properties of the Swedish version of both scales. Two community samples were recruited through convenience sampling and were informed about the study either while attending an undergraduate class at University or through advertisement on the Internet. For the two samples respectively, 483 and 197 individuals aged 18–70 completed the self-rating questionnaires via a website. In the first sample, factor structure, internal consistency, test-retest reliability and construct validity of the ER and the EUC were evaluated and a shorter version of the EUC (EUC-13) was developed based on the outcome. In the second sample, factor structure and psychometric properties of the EUC-13 were analyzed. Exploratory and confirmatory factor analysis supported both the original version of the ER and the EUC-13. Both instruments showed satisfactory levels of internal consistency for all subscales but Socially restrained behavior from the EUC-13, good test-retest reliability, as well as satisfactory preliminary evidence of validity. Further validation studies are recommended, such as investigating the scales in clinical settings.
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12
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Bourke JD, Plant C, Wooldridge S. Interpersonal Psychotherapy With Expressive Art for Depression in a Psycho-Oncology Context. Clin Case Stud 2018. [DOI: 10.1177/1534650118796340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The following case outlines the use of interpersonal psychotherapy (IPT) with integrated expressive art practices over 10 sessions in treatment of AF, a 62-year-old Caucasian female presenting with depression as a psycho-oncology outpatient. AF’s presentation was in the context of a history of diagnosis and treatment of melanoma, several family losses to cancer, long-standing dysthymia and recurrent major depressive episodes, and relocation from interstate following marriage separation. IPT was delivered to address AF’s identified core problem area of interpersonal sensitivities, while expressive art exercises played a role of creative self-reflection and exploration. At the conclusion of therapy, AF demonstrated not only elimination of clinical symptoms of depression and anxiety but also growth as a newly resilient and enlivened individual. Theoretical, research, and intervention implications for treatment of depression in broad and specific to psycho-oncology contexts are discussed.
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Affiliation(s)
- Jesse D. Bourke
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Camille Plant
- The University of Newcastle, Callaghan, New South Wales, Australia
- Calvary Mater Newcastle Hospital, Waratah, New South Wales, Australia
| | - Sophia Wooldridge
- The University of Newcastle, Callaghan, New South Wales, Australia
- Calvary Mater Newcastle Hospital, Waratah, New South Wales, Australia
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Ijaz S, Davies P, Williams CJ, Kessler D, Lewis G, Wiles N. Psychological therapies for treatment-resistant depression in adults. Cochrane Database Syst Rev 2018; 5:CD010558. [PMID: 29761488 PMCID: PMC6494651 DOI: 10.1002/14651858.cd010558.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antidepressants are a first-line treatment for adults with moderate to severe major depression. However, many people prescribed antidepressants for depression don't respond fully to such medication, and little evidence is available to inform the most appropriate 'next step' treatment for such patients, who may be referred to as having treatment-resistant depression (TRD). National Institute for Health and Care Excellence (NICE) guidance suggests that the 'next step' for those who do not respond to antidepressants may include a change in the dose or type of antidepressant medication, the addition of another medication, or the start of psychotherapy. Different types of psychotherapies may be used for TRD; evidence on these treatments is available but has not been collated to date.Along with the sister review of pharmacological therapies for TRD, this review summarises available evidence for the effectiveness of psychotherapies for adults (18 to 74 years) with TRD with the goal of establishing the best 'next step' for this group. OBJECTIVES To assess the effectiveness of psychotherapies for adults with TRD. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (until May 2016), along with CENTRAL, MEDLINE, Embase, and PsycINFO via OVID (until 16 May 2017). We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov to identify unpublished and ongoing studies. There were no date or language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with participants aged 18 to 74 years diagnosed with unipolar depression that had not responded to minimum four weeks of antidepressant treatment at a recommended dose. We excluded studies of drug intolerance. Acceptable diagnoses of unipolar depression were based onthe Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) or earlier versions, International Classification of Diseases (ICD)-10, Feighner criteria, or Research Diagnostic Criteria. We included the following comparisons.1. Any psychological therapy versus antidepressant treatment alone, or another psychological therapy.2. Any psychological therapy given in addition to antidepressant medication versus antidepressant treatment alone, or a psychological therapy alone.Primary outcomes required were change in depressive symptoms and number of dropouts from study or treatment (as a measure of acceptability). DATA COLLECTION AND ANALYSIS We extracted data, assessed risk of bias in duplicate, and resolved disagreements through discussion or consultation with a third person. We conducted random-effects meta-analyses when appropriate. We summarised continuous outcomes using mean differences (MDs) or standardised mean differences (SMDs), and dichotomous outcomes using risk ratios (RRs). MAIN RESULTS We included six trials (n = 698; most participants were women approximately 40 years of age). All studies evaluated psychotherapy plus usual care (with antidepressants) versus usual care (with antidepressants). Three studies addressed the addition of cognitive-behavioural therapy (CBT) to usual care (n = 522), and one each evaluated intensive short-term dynamic psychotherapy (ISTDP) (n = 60), interpersonal therapy (IPT) (n = 34), or group dialectical behavioural therapy (DBT) (n = 19) as the intervention. Most studies were small (except one trial of CBT was large), and all studies were at high risk of detection bias for the main outcome of self-reported depressive symptoms.A random-effects meta-analysis of five trials (n = 575) showed that psychotherapy given in addition to usual care (vs usual care alone) produced improvement in self-reported depressive symptoms (MD -4.07 points, 95% confidence interval (CI) -7.07 to -1.07 on the Beck Depression Inventory (BDI) scale) over the short term (up to six months). Effects were similar when data from all six studies were combined for self-reported depressive symptoms (SMD -0.40, 95% CI -0.65 to -0.14; n = 635). The quality of this evidence was moderate. Similar moderate-quality evidence of benefit was seen on the Patient Health Questionnaire-9 Scale (PHQ-9) from two studies (MD -4.66, 95% CI 8.72 to -0.59; n = 482) and on the Hamilton Depression Rating Scale (HAMD) from four studies (MD -3.28, 95% CI -5.71 to -0.85; n = 193).High-quality evidence shows no differential dropout (a measure of acceptability) between intervention and comparator groups over the short term (RR 0.85, 95% CI 0.58 to 1.24; six studies; n = 698).Moderate-quality evidence for remission from six studies (RR 1.92, 95% CI 1.46 to 2.52; n = 635) and low-quality evidence for response from four studies (RR 1.80, 95% CI 1.2 to 2.7; n = 556) indicate that psychotherapy was beneficial as an adjunct to usual care over the short term.With the addition of CBT, low-quality evidence suggests lower depression scores on the BDI scale over the medium term (12 months) (RR -3.40, 95% CI -7.21 to 0.40; two studies; n = 475) and over the long term (46 months) (RR -1.90, 95% CI -3.22 to -0.58; one study; n = 248). Moderate-quality evidence for adjunctive CBT suggests no difference in acceptability (dropout) over the medium term (RR 0.98, 95% CI 0.66 to 1.47; two studies; n = 549) and lower dropout over long term (RR 0.80, 95% CI 0.66 to 0.97; one study; n = 248).Two studies reported serious adverse events (one suicide, two hospitalisations, and two exacerbations of depression) in 4.2% of the total sample, which occurred only in the usual care group (no events in the intervention group).An economic analysis (conducted as part of an included study) from the UK healthcare perspective (National Health Service (NHS)) revealed that adjunctive CBT was cost-effective over nearly four years. AUTHORS' CONCLUSIONS Moderate-quality evidence shows that psychotherapy added to usual care (with antidepressants) is beneficial for depressive symptoms and for response and remission rates over the short term for patients with TRD. Medium- and long-term effects seem similarly beneficial, although most evidence was derived from a single large trial. Psychotherapy added to usual care seems as acceptable as usual care alone.Further evidence is needed on the effectiveness of different types of psychotherapies for patients with TRD. No evidence currently shows whether switching to a psychotherapy is more beneficial for this patient group than continuing an antidepressant medication regimen. Addressing this evidence gap is an important goal for researchers.
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Affiliation(s)
- Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of BristolNIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustLewins Mead, Whitefriars BuildingBristolUKBS1 2NT
| | - Philippa Davies
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
| | - Catherine J Williams
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - David Kessler
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Glyn Lewis
- UCLUCL Division of Psychiatry67‐73 Riding House StLondonUKW1W 7EJ
| | - Nicola Wiles
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
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Abstract
This article conceptualizes Anorexia Nervosa (AN) as a prototypical overcontrolled disorder, characterized by low receptivity and openness, low flexible control, pervasive inhibited emotional expressiveness, low emotional awareness, and low social connectedness and intimacy with others. As a result, individuals with AN often report high levels of emotional loneliness. A new evidence-based treatment, Radically Open Dialectical Behavior Therapy (RO-DBT), and its underlying neuroregulatory theory, offer a novel way of understanding how self-starvation and social signaling deficits are used as maladaptive regulation strategies to reduce negative affect. RO-DBT proposes that rather than trying to be 'emotionally regulated' or achieving equanimity, long-term psychological well-being is achieved by increasing social connectedness. RO-DBT skills, including body posture, gestures, and facial expressions, activate brain regions that increase social safety responses that function to automatically enhance the open-minded and flexible social-signaling, which are crucial for establishing long-term intimate bonds with others and becoming part of a "tribe."
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Affiliation(s)
- Roelie Hempel
- a School of Psychology , University of Southhampton , Southampton , UK
| | - Emily Vanderbleek
- b Department of Psychology , University of Notre Dame , Notre Dame , UK
| | - Thomas R Lynch
- a School of Psychology , University of Southhampton , Southampton , UK
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15
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Resilients, overcontrollers and undercontrollers: A systematic review of the utility of a personality typology method in understanding adult mental health problems. Clin Psychol Rev 2017; 57:75-92. [DOI: 10.1016/j.cpr.2017.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/18/2022]
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16
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French LRM, Turner KM, Dawson S, Moran P. Psychological treatment of depression and anxiety in patients with co-morbid personality disorder: A scoping study of trial evidence. Personal Ment Health 2017; 11:101-117. [PMID: 28488378 DOI: 10.1002/pmh.1372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 11/06/2022]
Abstract
It is unclear what the best psychological treatment is for depression and anxiety in people with co-morbid personality disorder. Trials of different psychological treatment options for this patient group have been conducted, but this evidence has not previously been systematically reviewed or critically appraised. We set out to conduct a scoping review in order to describe which psychological therapies appear most effective in treating depression and/or anxiety in patients with co-morbid personality disorder. PsycINFO, Cochrane library trials, Medline and Embase databases were searched for studies involving randomized, controlled, experimental, parallel-arm comparisons, examining any well-defined, psychotherapeutic intervention for adults, in an outpatient setting, with a clearly defined diagnosis of depression and/or anxiety, and co-morbid personality disorder. A total of 1662 papers were identified. Fifteen met criteria for inclusion and were reviewed. There was weak evidence to support the use of cognitive behavioural therapy as a psychological treatment for depression in patients with co-morbid personality disorder. However, the literature is characterized by considerable methodological heterogeneity, and further research is needed before there is sufficient evidence to indicate which psychological treatment would be most effective in treating anxiety and/or depression in this patient group. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- L R M French
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - K M Turner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.,The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S Dawson
- Cochrane Trials Search Co-ordinator (CCDAN), Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - P Moran
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.,The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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17
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Hughes-Morley A, Young B, Hempel RJ, Russell IT, Waheed W, Bower P. What can we learn from trial decliners about improving recruitment? Qualitative study. Trials 2016; 17:494. [PMID: 27733181 PMCID: PMC5062905 DOI: 10.1186/s13063-016-1626-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Trials increasingly experience problems in recruiting participants. Understanding the causes of poor recruitment is critical to developing solutions. We interviewed people who had declined a trial of an innovative psychological therapy for depression (REFRAMED) about their response to the trial invitation, in order to understand their decision and identify ways to improve recruitment. Methods Of 214 people who declined the trial, 35 (16 %) gave permission to be contacted about a qualitative study to explore their decision. Analysis of transcripts of semi-structured interviews was informed by grounded theory. Results We interviewed 20 informants: 14 women and six men, aged 18 to 77 years. Many interviewees had prior experience of research participation and positive views of the trial. Interviewees’ decision making resembled a four-stage sequential process; in each stage they either decided not to participate in the trial or progressed to the next stage. In stage 1, interviewees assessed the invitation in the context of their experiences and attitudes; we term those who opted out at this stage ‘prior decliners’ as they had an established position of declining trials. In stage 2, interviewees assessed their own eligibility; those who judged themselves ineligible and opted out at this stage are termed ‘self-excluders’. In stage 3, interviewees assessed their need for the trial therapy and potential to benefit; we term those who decided they did not need the trial therapy and opted out at this stage ‘treatment decliners’. In stage 4, interviewees deliberated the benefits and costs of trial participation; those who opted out after judging that disadvantages outweighed advantages are termed ‘trial decliners’. Across all stages, most individuals declined because they judged themselves ineligible or not in need of the trial therapy. While ‘prior decliners’ are unlikely to respond to any trial recruitment initiative, the factors leading others to decline are amenable to amelioration as they do not arise from a rejection of trials or a personal stance. Conclusions To improve recruitment in similar trials, the most successful interventions are likely to address patients’ assessments of their eligibility and their potential to benefit from the trial treatment, rather than reducing trial burden. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN85784627. Registration date 10 August 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1626-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adwoa Hughes-Morley
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK. .,York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Department of Psychology, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Roelie J Hempel
- School of Psychology, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ian T Russell
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Williamson Building, Manchester, M13 9PT, UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Williamson Building, Manchester, M13 9PT, UK
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