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Özer D, Dişsiz M. The effect of online group based acceptance and commitment therapy on psychotic symptoms and functioning levels of individuals with early psychosis. Schizophr Res 2024; 267:55-64. [PMID: 38518479 DOI: 10.1016/j.schres.2024.03.018] [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: 12/25/2023] [Revised: 02/24/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This study examined the effect of online group-based Acceptance and Commitment Therapy (ACT) applied to individuals with early psychosis on psychotic symptoms and functionality levels. METHODS This randomized controlled study population consisted of 77 individuals who had been diagnosed with schizophrenia and other psychotic disorders according to DSM-5 diagnostic criteria at most three years ago. The study sample consisted of 53 individuals who met the inclusion criteria and were assigned to the intervention (n = 26) and control (n = 27) groups by simple randomization method. The intervention group received an eight-session ACT program as online group therapy, while the control group received no application made by the researchers. Data were obtained using the "Positive and Negative Syndrome Scale (PANSS)" and the "Social Functioning Assessment Scale (SFAS)" at pre-test, post-test and 3-month follow-up. RESULTS While it was found that the post-test and 3-month follow-up test PANSS mean scores of the individuals in the intervention group were lower than the mean score of the individuals in the control group; it was determined that the mean score of SFAS was higher than the mean score of the individuals in the control group (p < 0.05). In addition, while no hospitalization was observed in the intervention group during the follow-up period, 14.8 % (n = 4) of the individuals in the control group were hospitalized. DISCUSSION It was found that online group-based ACT applied to individuals with early psychosis reduced psychotic symptoms and increased their functionality levels. It was also found that hospitalizations were less in the intervention group. CLINICALTRIALS gov ID: NCT05210816.
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Affiliation(s)
- Duygu Özer
- Bartın University, Faculty of Health Sciences, Department of Nursing, Bartın, Turkey.
| | - Melike Dişsiz
- University of Health Sciences, Hamidiye Nursing Faculty, Istanbul, Turkey
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2
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Morris EMJ, Johns LC, Gaudiano BA. Acceptance and commitment therapy for psychosis: Current status, lingering questions and future directions. Psychol Psychother 2024; 97:41-58. [PMID: 37357973 DOI: 10.1111/papt.12479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Acceptance and Commitment Therapy for psychosis (ACTp) is a contextual behavioural intervention that promotes psychological flexibility by fostering active acceptance, cognitive defusion, values construction and committed action to enhance well-being and recovery. Multiple studies have shown that ACTp is acceptable and efficacious, but questions remain as to its distinction from similar approaches and the conditions under which it would be implemented most effectively. METHODS We present the current evidence for processes and outcomes of ACTp and summarise the qualitative findings of experiences of service users in ACT programmes. We compare ACTp with other cognitive behavioural therapies and mindfulness-informed interventions for psychosis. RESULTS Acceptance and commitment therapy for psychosis is promising as a pragmatic, process-driven intervention model. Further efforts are needed to investigate psychological flexibility in the context of psychosis with observational, experimental and intervention studies that will inform model scope and treatment refinement. Additionally, implementation research is the necessary next step, including how support persons can be trained in ACTp. Lower intensity and technology-assisted approaches have the potential to reduce barriers to accessing ACTp and extend impact. CONCLUSIONS Over the last 20 years, ACTp has demonstrated meaningful effects in individual and group formats in a range of settings, targeting outcomes such as rehospitalisation, depression, psychotic symptom distress and impact. Future work should focus on how best to integrate ACTp with other current evidence-based interventions for psychosis.
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Affiliation(s)
- Eric M J Morris
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
- Northern Health, Melbourne, Victoria, Australia
| | - Louise C Johns
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Brandon A Gaudiano
- Department of Psychiatry & Human Behavior, Brown University & Butler Hospital, Providence, Rhode Island, USA
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3
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Sabé M, Kohler R, Perez N, Sauvain-Sabé M, Sentissi O, Jermann F, Prada P, Perroud N, Böge K. Mindfulness-based interventions for patients with schizophrenia spectrum disorders: A systematic review of the literature. Schizophr Res 2024; 264:191-203. [PMID: 38157679 DOI: 10.1016/j.schres.2023.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) have emerged as secular practices, including elements of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). While MBIs have been widely adopted for physical and mental illness, only a few available programs are explicitly adapted for psychosis. However, previous reviews have reported the vital heterogeneity regarding treatment program structure. Therefore, this review aims to compare the structure of different mindfulness protocols applied to patients with schizophrenia spectrum disorder (SSD). METHODS A systematic search was conducted up to March 2023 in PubMed, Embase and PsycInfo. Following our protocol (CRD 42023253356), we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. RESULTS We included 22 randomized controlled trials (RCTs) involving 1500 patients SSD. All programs varied in structure, session components, duration, and instructor experience. While MBSR-like programs focused on stress reactivity, MBCT-like programs addressed primary symptoms of psychosis and relapse prevention. Despite the heterogeneity of programs, some common mechanisms emerged, including attention training, emotion and stress regulation, decentering, self-compassion, and cognitive restructuring. CONCLUSIONS The critical heterogeneity found limits the interpretation of results. However, most recent trials present fewer risks of bias and more homogenous programs. Findings suggested potential benefits, such as reduced negative symptoms, increased well-being, and decreased hospitalization rates. For future studies, authors should align on more congruent MBIs programs for patients with SSD. Further research is needed to identify optimal mindfulness teaching approaches for patients with psychosis and investigate specific mechanisms of action, relevant processes, and optimal doses in varying settings.
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Affiliation(s)
- Michel Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Raoul Kohler
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Natacha Perez
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Mathilde Sauvain-Sabé
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Francoise Jermann
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Switzerland
| | - Paco Prada
- Consultation Liaison and Crisis Intervention, University Hospitals of Geneva, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Switzerland
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin; and Freie Universität Berlin; and Humboldt-Universität zu Berlin; and Berlin Institute of Health, Germany; German Center of Mental Health (DZPG), Germany
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Raugh IM, Strauss GP. Trait Mindfulness in Psychotic Disorders: Dimensions Predicting Symptoms, Cognition, and Functional Outcome. Behav Ther 2024; 55:55-67. [PMID: 38216237 PMCID: PMC10787159 DOI: 10.1016/j.beth.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Mindfulness-based treatments are efficacious for psychotic disorders (PD). However, which components of mindfulness (i.e., attentive monitoring and nonjudgmental acceptance) are most relevant treatment targets is unclear. Further, there is a dearth of literature examining clinical correlates of mindfulness in people with PD. The present study aimed to examine group differences and clinical correlates of mindfulness in people with PD. We hypothesized that PD would report lower monitoring and acceptance than CN and that mindfulness components would be associated with symptoms including dysfunctional beliefs, alexithymia, neurocognitive ability, positive symptoms, and mood symptoms. Groups included individuals with PD (n = 54) and nonpsychiatric controls (n = 55). Participants completed self-report measures of mindfulness and related constructs and clinical interviews of symptoms. Results of ANOVA models indicated that global mindfulness was lower in PD relative to CN, with greatest differences evident for acceptance in the affective psychosis group. Regression models found that greater monitoring was associated with improved neurocognitive performance, while acceptance was associated with lower defeatist beliefs, alexithymia, and depression/anxiety symptoms. Results highlight the importance of targeting acceptance in the psychosocial treatment of PDs, especially for those with mood symptoms.
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Tunç H, Morris PG, Kyranides MN, McArdle A, McConachie D, Williams J. The relationships between valued living and depression and anxiety: A systematic review, meta-analysis, and meta-regression. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Lavelle J, Storan D, Eswara Murthy V, De Dominicis N, Mulcahy HE, McHugh L. Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies. J Clin Med 2022; 11:2757. [PMID: 35628884 PMCID: PMC9145285 DOI: 10.3390/jcm11102757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.
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Affiliation(s)
- Joseph Lavelle
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
| | - Darragh Storan
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Varsha Eswara Murthy
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
| | - Noemi De Dominicis
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
| | - Hugh E. Mulcahy
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Louise McHugh
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
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Miller H, Lawson D, Power E, das Nair R, Sathananthan N, Wong D. How do people with acquired brain injury interpret the Valued Living Questionnaire? A cognitive interviewing study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Chernov NV, Moiseeva TV, Belyakova MA, Polyakova MD, Sozinova MV. Acceptance and Commitment Therapy for Patients with a First Psychotic Episode. CONSORTIUM PSYCHIATRICUM 2021; 2:30-39. [PMID: 39045446 PMCID: PMC11262069 DOI: 10.17816/cp97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/08/2021] [Indexed: 01/19/2023] Open
Abstract
The search for the most effective methods of therapy for mental disorders is a priority for modern psychiatry. An approach to the early diagnostics and rehabilitation of patients experiencing psychotic episodes for the first time is proposed in the present article. The proposed approach is based on the combination of drug therapy and acceptance and commitment therapy (ACT) characterized by the development of the patient's psychological flexibility, rather than controlling the disease symptoms. The article describes the main processes of the ACT model: acceptance, cognitive defusion, contact with the present moment, understanding of the inner world, awareness of significant values, and the regulation of purposeful behaviour for the implementation of these values. Recommendations for different stages of treatment were also developed by specialists of the First Psychotic Episode Clinic at the Mental Health Clinic No.1 named after N.A. Alexeev. The psychological rehabilitation of patients with the use of ACT in the case of psychotic disorders with both negative and positive symptoms was elaborated. The application of acceptance and commitment therapy in the early diagnostics and treatment of patients experiencing a first psychotic episode results in fewer readmissions and improved psychosocial functioning in both inpatient and outpatient care.
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Berman BM, Kurlancheek K. The Choice Point Model of Acceptance and Commitment Therapy With Inpatient Substance Use and Co-occurring Populations: A Pilot Study. Front Psychol 2021; 12:758356. [PMID: 34777161 PMCID: PMC8581629 DOI: 10.3389/fpsyg.2021.758356] [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] [Received: 08/13/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: Acceptance and Commitment Therapy (ACT) is an empirically supported treatment which aims to enhance self-acceptance and a commitment to core values. The present study examined the effectiveness of the Choice Point model of ACT in a residential substance use disorder (SUD) setting. Choice Point is a contemporary approach to ACT and targets transdiagnostic processes. Methods: This uncontrolled quasi-experimental design assessed 47 participants taking part in Choice Point for Substances (CHOPS) in order to investigate its influence on psychological inflexibility, values-based action, and self-compassion over time. The study additionally assessed for sleeper effects and associations between transdiagnostic processes and warning signs of relapse. Results: Findings demonstrated a decrease in psychological inflexibility and increases in values-based action and self-compassion over time. Gains were maintained at follow-up, and sleeper effects were observed for psychological inflexibility and mindfulness. Correlational analysis suggested that all transdiagnostic processes were related to warning signs of relapse at follow-up. Conclusion: These results provide preliminary evidence for the feasibility, acceptability, and effectiveness of CHOPS for SUD. Observed sleeper effects in psychological inflexibility and mindfulness indicate that CHOPS may provide longer-term benefits critical to a population where relapse is common. While encouraging, these findings should be interpreted with caution. Future research should utilize comparison groups when investigating CHOPS.
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Affiliation(s)
- Brian M Berman
- Retreat Behavioral Health, Department of Psychology, Ephrata, PA, United States
| | - Kris Kurlancheek
- Retreat Behavioral Health, Clinical Department, Ephrata, PA, United States
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10
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Hochard KD, Hulbert-Williams L, Ashcroft S, McLoughlin S. Acceptance and values clarification versus cognitive restructuring and relaxation: A randomized controlled trial of ultra-brief non-expert-delivered coaching interventions for social resilience. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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11
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Krzyzanowski D, Agid O, Goghari V, Remington G. Cognitive discrepancies, motivation and subjective well-being in people with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 26:100205. [PMID: 34258238 PMCID: PMC8259292 DOI: 10.1016/j.scog.2021.100205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/07/2023]
Abstract
Research indicates that people with schizophrenia often achieve similar levels of subjective well-being (SWB) compared to healthy controls despite prominent symptomatology and significant functional difficulties. Furthermore, compared to healthy controls, young-adult people with schizophrenia differ in the relative importance they place on values, or guiding life principles, associated with educational and occupational success (openness to change), suggesting that changing motivations may contribute to SWB and the apparent motivational deficits commonly reported in this population. The current study sought to better understand these relationships in middle-aged people with schizophrenia or schizoaffective disorder (n=29) versus a relatively healthy group of community controls (n=23). Participants completed measures of SWB and values. They also completed a cognitive battery and interviews concerned with mental and physical health. Patients reported similar levels of SWB compared to controls in the context of significant cognitive, social and vocational difficulties. Moreover, living consistently with values (valued living) predicted SWB in both groups. Lastly, internalized mental illness stigma was negatively associated with openness to change in the patient group. While encouraging from an emotional resiliency perspective, SWB and valued living in people with schizophrenia may hinder motivation towards treatment goals that could otherwise improve functional outcomes in this population. Patients with schizophrenia reported similar levels of SWB compared to community controls. Living consistently with values (i.e., valued living) predicted SWB in both groups. Internalized mental illness stigma was negatively associated with openness to change values in the patient group. Changing motivations may contribute to the apparent motivational deficits commonly reported in people with schizophrenia.
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Affiliation(s)
- Daniel Krzyzanowski
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
| | - Ofer Agid
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Department of Psychiatry, University of Toronto, 27 King's College Cir, Toronto ON M5S, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
| | - Vina Goghari
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
| | - Gary Remington
- University of Toronto Scarborough, Graduate Department of Psychological Clinical Science, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.,Department of Psychiatry, University of Toronto, 27 King's College Cir, Toronto ON M5S, Canada.,Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON M6J 1H1, Canada
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12
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Crego A, Yela JR, Gómez-Martínez MÁ, Riesco-Matías P, Petisco-Rodríguez C. Relationships between Mindfulness, Purpose in Life, Happiness, Anxiety, and Depression: Testing a Mediation Model in a Sample of Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:925. [PMID: 33494471 PMCID: PMC7908241 DOI: 10.3390/ijerph18030925] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
Mindfulness is connected to positive outcomes related to mental health and well-being. However, the psychological mechanisms that account for these relationships are largely unknown. A multiple-step multiple mediator structural equation modeling (SEM) model was tested with mindfulness as the independent variable; purpose in life and behavioral activation as serial mediators; and happiness, anxiety, and depression as outcome measures. Data were obtained from 1267 women. Higher mindfulness was associated with higher levels of happiness and lower anxiety and depression symptoms. The association of mindfulness with the outcome variables could be partially accounted for by purpose in life and behavioral activation. The SEM model explained large proportions of variance in happiness (50%), anxiety (34%), and depression (44%) symptoms. Mindfulness is associated with both a sense of purpose in life and engagement in activities, which are also connected with positive outcomes. Moreover, having purposes in life is linked to higher levels of behavioral activation.
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Affiliation(s)
- Antonio Crego
- Department of Psychology, Pontifical University of Salamanca, Calle de la Compañía 5, 37002 Salamanca, Spain; (J.R.Y.); (M.Á.G.-M.); (P.R.-M.)
| | - José Ramón Yela
- Department of Psychology, Pontifical University of Salamanca, Calle de la Compañía 5, 37002 Salamanca, Spain; (J.R.Y.); (M.Á.G.-M.); (P.R.-M.)
| | - María Ángeles Gómez-Martínez
- Department of Psychology, Pontifical University of Salamanca, Calle de la Compañía 5, 37002 Salamanca, Spain; (J.R.Y.); (M.Á.G.-M.); (P.R.-M.)
| | - Pablo Riesco-Matías
- Department of Psychology, Pontifical University of Salamanca, Calle de la Compañía 5, 37002 Salamanca, Spain; (J.R.Y.); (M.Á.G.-M.); (P.R.-M.)
| | - Cristina Petisco-Rodríguez
- Faculty of Education, Pontifical University of Salamanca, Calle Henry Collet 52-70, 37007 Salamanca, Spain;
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Østergaard T, Lundgren T, Zettle RD, Landrø NI, Haaland VØ. Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms. Front Psychol 2020; 11:528. [PMID: 32292369 PMCID: PMC7119364 DOI: 10.3389/fpsyg.2020.00528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/05/2020] [Indexed: 01/05/2023] Open
Abstract
Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.
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Affiliation(s)
- Tom Østergaard
- Department of Psychiatry, Sørlandet Hospital, Arendal, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Tobias Lundgren
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Robert D. Zettle
- Department of Psychology, Wichita State University, Wichita, KS, United States
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
- Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Vegard Øksendal Haaland
- Department of Psychiatry, Sørlandet Hospital, Arendal, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
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van Aubel E, Bakker JM, Batink T, Michielse S, Goossens L, Lange I, Schruers K, Lieverse R, Marcelis M, van Amelsvoort T, van Os J, Wichers M, Vaessen T, Reininghaus U, Myin-Germeys I. Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Behav Res Ther 2020; 128:103592. [PMID: 32146218 DOI: 10.1016/j.brat.2020.103592] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to 25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p = .027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p = .011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808.
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Affiliation(s)
- Evelyne van Aubel
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
| | - Jindra Myrthe Bakker
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Tim Batink
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; U-Center, Epen, Netherlands.
| | - Stijn Michielse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Liesbet Goossens
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Iris Lange
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Koen Schruers
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Health Psychology, Faculty of Psychology, University of Leuven, Leuven, Belgium.
| | - Ritsaert Lieverse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands.
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, England, United Kingdom; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry (UCP), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), the Netherlands.
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
| | - Ulrich Reininghaus
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Public Mental Health, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany; Center for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
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15
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Jansen JE, Gleeson J, Bendall S, Rice S, Alvarez-Jimenez M. Acceptance- and mindfulness-based interventions for persons with psychosis: A systematic review and meta-analysis. Schizophr Res 2020; 215:25-37. [PMID: 31780349 DOI: 10.1016/j.schres.2019.11.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acceptance- and mindfulness-based approaches have gained popularity in recent years. OBJECTIVE A systematic review and meta-analysis of the efficacy and safety of acceptance- and mindfulness-based therapies for persons with a psychotic or schizophrenia spectrum disorder. METHODS Following PRISMA guidelines, relevant databases were searched for published randomized controlled trials (RCTs) up to October 2018. Outcomes were severity of overall symptomatology, hospitalization, positive and negative symptoms, depression, anxiety, social functioning, quality of life, acceptance, mindfulness skills and safety of the interventions. RESULTS Sixteen studies comprising 1268 people with a schizophrenia spectrum disorder were included in the meta-analyses. Moderate to large effect sizes were found for overall symptomatology and hospitalization at endpoint (SMD .80, 95% CI -1.31, -0.29 and MD 4.38, -5.58, -3.17 respectively) and follow-up (SMD 1.10, -2.09, -0.10 and MD 7.18, -8.67, - 5.68 respectively). There were significant small effects on negative symptoms (SMD .24; -0.44, -0.03), small to moderate effects for depression (SMD .47; -0.80, -0.14), social functioning (SMD .43; -0.75, - 0.12) and mindfulness (SMD .51; -0.97, -0.05), moderate to large effects for acceptance (SMD .78; -1.44, -0.12), while no significant effects for positive symptoms (SMD .27; -0.65, 0.00), anxiety (SMD 2.11; -4.64, 0.42) or quality of life (SMD .43; -0.88, 0.02). Majority of studies (75%) had low risk of bias and sensitivity analyses supported the findings. CONCLUSION Acceptance- and mindfulness-based approaches appear to be effective and safe interventions for individuals with schizophrenia spectrum disorders and could be a useful extension of standard casemanagement and psychofarmacology.
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Affiliation(s)
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
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16
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Böge K, Karadza A, Fuchs LM, Ehlen F, Ta TMT, Thomas N, Bajbouj M, Hahn E. Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders-A Qualitative Approach. Front Psychiatry 2020; 11:600. [PMID: 32676042 PMCID: PMC7333646 DOI: 10.3389/fpsyt.2020.00600] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
In recent years, mindfulness-based interventions (MBI) have gained clinical relevance in the treatment of patients with schizophrenia spectrum disorders (SSDs). High symptom burden, long durations of hospitalization and high rehospitalization rates demonstrate the severity and cost-intensity of these disorders. MBIs have shown promising treatment outcomes in a small number of trials, primarily taking place in English-speaking countries. The current study aims to explore mechanisms and processes as well as adverse effects of MBIs on in-patients with SSDs in a German university hospital setting. A qualitative design based on inductive thematic analysis accompanied by quantitative assessments was chosen. A semi-structured interview guide was developed by psychiatrists and psychologists to assess patient experiences, perceptions, thoughts, and feelings during and after taking part in a MBI. Twenty-seven interviews were conducted between September 2017 and October 2018 with in-patients who are diagnosed with schizophrenia or schizoaffective disorder. Rater-based questionnaires, such as the Positive and Negative Syndrome Scale (PANSS), Montgomery Asberg Depression Rating Scale (MADRS), and Psychotic Symptom Rating Scales-Auditory Hallucination (PSYRATS-AH) were administered at baseline to collect clinical outcomes. Qualitative analysis revealed two domains: content and function. In the first domain related to content with the core elements "detachment and rumination", "presence and getting lost", "non-judgment and judgment", and effects with "emotions", "cognition", and "symptom changes". A second domain related to function was extracted, including the relevance of perception of context and transfer to everyday life. Overall, improvements concerning cognition, distress, and psychopathology were detected, while no adverse effects, such as increased psychotic symptoms, were revealed. As the first study of its kind, mechanisms, processes, and the safety of MBIs were explored and confirmed in a sample of German in-patients with SSDs. The results of this qualitative study are in line with recent findings on MBIs amongst patients with psychotic disorders from other countries. Results lay the ground for future research to focus on the systematic study of MBIs in large samples, its treatment processes, outcomes, and effectiveness for in-patients with SSDs.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Almira Karadza
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Lukas M Fuchs
- Institute of Sociology, Freie Universität Berlin, Berlin, Germany
| | - Felicitas Ehlen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychiatry, Jüdisches Krankenhaus, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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17
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Karimi-Dehkordi M, Spiers J, Clark AM. An evolutionary concept analysis of "patients' values". Nurs Outlook 2019; 67:523-539. [PMID: 31072646 DOI: 10.1016/j.outlook.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients' values are everywhere and nowhere in nursing: frequently invoked and associated with effective nursing care but seldom explicitly defined or subject to dedicated analysis. Clarification of the concept of patients' values is pivotal because respecting and supporting patients' values are widely recognized as crucial for ethical nursing care. Despite this and the pervasive employment of the term patients' values in theories, approaches, and clinical guidelines, the concept remains ambiguous. PURPOSE We sought to understand the key elements of the concept by investigating its use in theoretical and empirical literature. METHOD This study used Rodgers' evolutionary concept analysis approach. FINDINGS We found that values are core individual beliefs that function in hierarchical systems; however, in the context of disease, the priority assigned to values by the individual may change. This is important, given that values play a foundational role in health-related decisions, such as in the context of chronic diseases. DISCUSSION Values are influenced by both individual intrinsic needs and the social context, but importantly, are involved in guiding decision-making. The attributes of the values may vary according to the context of the disease, the type of disease, and the decision at hand.
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Affiliation(s)
| | - Jude Spiers
- University of Alberta, Faculty of Nursing, Edmonton, AB, Canada
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18
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Reilly ED, Ritzert TR, Scoglio AA, Mote J, Fukuda SD, Ahern ME, Kelly MM. A systematic review of values measures in acceptance and commitment therapy research. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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19
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The evidence base of Acceptance and Commitment Therapy (ACT) in psychosis: A systematic review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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A Comparison Between the Effectiveness of Acceptance and Commitment Treatment and Behavioral Activation Treatment for Depression on Symptoms Severity and Rumination Among Patients with Treatment-Resistant Depression. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.10742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Vilardaga R, Rizo J, Zeng E, Kientz JA, Ries R, Otis C, Hernandez K. User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness. JMIR Serious Games 2018; 6:e2. [PMID: 29339346 PMCID: PMC5790963 DOI: 10.2196/games.8881] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/10/2017] [Accepted: 11/25/2017] [Indexed: 01/14/2023] Open
Abstract
Background Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company. Results We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content.
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Affiliation(s)
- Roger Vilardaga
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Javier Rizo
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Emily Zeng
- Design Use Build, Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Design Use Build, Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Chad Otis
- Chad Otis Illustration & Design, Seattle, WA, United States
| | - Kayla Hernandez
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
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22
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Huang X, Huang X, Zhou Y, He H, Mei F, Sun B, Soares JC, Yang Zhang X. Association of serum BDNF levels with psychotic symptom in chronic patients with treatment-resistant depression in a Chinese Han population. Psychiatry Res 2017; 257:279-283. [PMID: 28783576 DOI: 10.1016/j.psychres.2017.07.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/06/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022]
Abstract
The neurotrophic hypothesis of depression is supported by consistent findings of lower serum BDNF levels in depressed patients. Increasing evidence shows different clinical characteristics of patients with psychotic major depression versus nonpsychotic major depression. However, the possible association between BDNF and psychotic symptoms in depression has not been investigated. We recruited 90 treatment-resistant depression (TRD) patients and 90 gender- and age-matched healthy control subjects and examined serum BDNF in both groups. Patients' depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HDRS-17), and psychopathological symptoms by the 18-item Brief Psychiatric Rating Scale (BPRS-18). Our results showed that BDNF levels were significantly lower in patients than controls. Correlation analysis revealed a significantly positive correlation between BDNF and the thought disturbance subscale of BPRS-18 (p < 0.05), and a trend toward a significantly positive correlation between BDNF and the BPRS-18 total score (p = 0.06). Stepwise multiple regression analyses confirmed BDNF as the influencing factor for the thought disturbance subscales of the BPRS-18. Our findings suggest that BDNF may be involved in the pathophysiology of TRD, and its associated psychotic symptoms, especially thought disturbance.
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Affiliation(s)
- Xingbing Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiong Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Yanling Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Hongbo He
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fang Mei
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Bin Sun
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiang Yang Zhang
- Psychiatry Research Center, Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
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23
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Gaudiano BA, Primack J, Miller IW. Investigating the Role of Acceptance, Mindfulness, and Values in Patients with Psychosis in the Context of Depression. JOURNAL OF PSYCHIATRIC INTENSIVE CARE 2016; 12:79-87. [PMID: 35392656 PMCID: PMC8985380 DOI: 10.20299/jpi.2016.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Emerging research suggests that interventions incorporating acceptance, mindfulness, and values clarification elements are efficacious when treating patients experiencing major depression with psychotic features. However, there is little research on how these psychological constructs relate to symptoms and functioning in this population to guide future intervention efforts. METHODS Patients with psychotic symptoms (hallucinations and/or delusions) occurring in the context of a major depressive episode (N = 29) were recruited primarily during a psychiatric hospitalization and assessed using a battery of self-report and interviewer-rated measures. RESULTS Psychological acceptance was correlated with hallucination severity, behavioral activation, and family functioning; mindfulness was correlated with depression severity and behavioral activation; and values-action consistency was correlated with family functioning. Significant associations between acceptance, mindfulness, and values remained in most cases in multivariate analyses after controlling for the presence of the other variables and accounted for large amounts of variance. CONCLUSIONS Although requiring future replication due to the sample size, findings support the conclusion that acceptance, mindfulness, and values appear to have meaningful and somewhat unique associations with important aspects of symptoms and functioning in individuals with psychotic depression. Potential treatment targets and mechanisms of psychosocial interventions are discussed.
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Affiliation(s)
| | - Jennifer Primack
- Butler Hospital
- Providence VA Medical Center, Providence, Rhode Island
| | - Ivan W Miller
- Butler Hospital
- Alpert Medical School of Brown University
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24
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Bürgy M. [Delusional depression : Diagnostics, phenomenology and therapy]. DER NERVENARZT 2016; 88:529-537. [PMID: 27357450 DOI: 10.1007/s00115-016-0149-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Depressive delusion is the key symptom of psychotic depression also known as major depressive disorder with psychotic features (ICD-10: F 32.3). Delusional topics are limited to guilt, impoverishment and hypochondria. Kurt Schneider described these as being the three primordial fears of human beings. Psychotic depression is distinguished by the particular severity and frequency of the episodes of illness as well as by increased suicidal tendencies. Although one in five patients with a major depression experiences psychotic symptoms, this condition is all too easily overlooked and the appropriate therapy is not initiated. Here we use case histories to illustrate some of the obstacles to diagnosis arising from the difficulty of identifying delusions hidden in a person's experience of depression, life history and personality. A targeted active exploration of these difficulties is significant taking into account the observable symptoms and not only the subjectively experienced symptoms. A phenomenological approach is chosen to explore the matter of depressive delusion and to investigate the interaction of delusion and affect and the special importance of anxiety for the genesis of delusion. In accordance with the current treatment recommendations and against this background, it is proposed that the pharmacological strategy should be supplemented by the use of benzodiazepines more often than has it has been in the past.
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Affiliation(s)
- M Bürgy
- Klinik für Spezielle Psychiatrie, Sozialpsychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Klinikum Stuttgart, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
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25
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Acceptance-based Behavior Therapy for Depression With Psychosis: Results From a Pilot Feasibility Randomized Controlled Trial. J Psychiatr Pract 2015; 21:320-33. [PMID: 26352221 PMCID: PMC4704101 DOI: 10.1097/pra.0000000000000092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acceptance-based depression and psychosis therapy (ADAPT), a mindfulness/acceptance-based behavioral activation treatment, showed clinically significant effects in the treatment of depression with psychosis in a previous open trial. The goal of the current study was to further test the feasibility of ADAPT to determine the utility of testing it in a future clinical trial, following a stage model of treatment development. Feasibility was determined by randomizing a small number of patients (N=13) with comorbid depression and psychosis to medication treatment as usual plus enhanced assessment and monitoring versus ADAPT for 4 months of outpatient treatment. Both conditions were deemed acceptable by patients. Differences in between-subjects effect sizes favored ADAPT posttreatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism). Thus ADAPT shows promise for improving outcomes compared with medications alone and requires testing in a fully powered randomized trial.
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27
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Dalrymple KL, Morgan TA, Lipschitz JM, Martinez JH, Tepe E, Zimmerman M. An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results. Behav Modif 2014; 38:516-48. [PMID: 24402463 PMCID: PMC4810445 DOI: 10.1177/0145445513518422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Depression and social anxiety disorder (SAD) are highly comorbid, resulting in greater severity and functional impairment compared with each disorder alone. Although recently transdiagnostic treatments have been developed, no known treatments have addressed this comorbidity pattern specifically. Preliminary support exists for acceptance-based approaches for depression and SAD separately, and they may be more efficacious for comorbid depression and anxiety compared with traditional cognitive-behavioral approaches. The aim of the current study was to develop and pilot test an integrated acceptance-based behavioral treatment for depression and comorbid SAD. Participants included 38 patients seeking pharmacotherapy at an outpatient psychiatry practice, who received 16 individual sessions of the therapy. Results showed significant improvement in symptoms, functioning, and processes from pre- to post-treatment, as well as high satisfaction with the treatment. These results support the preliminary acceptability, feasibility, and effectiveness of this treatment in a typical outpatient psychiatry practice, and suggest that further research on this treatment in larger randomized trials is warranted.
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Affiliation(s)
- Kristy L Dalrymple
- Rhode Island Hospital, Providence, USA Brown University, Providence, RI, USA
| | - Theresa A Morgan
- Rhode Island Hospital, Providence, USA Brown University, Providence, RI, USA
| | | | | | | | - Mark Zimmerman
- Rhode Island Hospital, Providence, USA Brown University, Providence, RI, USA
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28
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Khoury B, Lecomte T, Gaudiano BA, Paquin K. Mindfulness interventions for psychosis: a meta-analysis. Schizophr Res 2013; 150:176-84. [PMID: 23954146 DOI: 10.1016/j.schres.2013.07.055] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND An increasing number of mindfulness interventions are being used with individuals with psychosis or schizophrenia, but no known meta-analysis has investigated their effectiveness. OBJECTIVE To evaluate the efficacy of mindfulness interventions for psychosis or schizophrenia, we conducted an effect-size analysis of initial studies. DATA SOURCES A systematic review of studies published in journals or in dissertations in PubMED, PsycINFO or MedLine from the first available date until July 25, 2013. REVIEW METHODS A total of 13 studies (n=468) were included. RESULTS Effect-size estimates suggested that mindfulness interventions are moderately effective in pre-post analyses (n=12; Hedge's g=.52). When compared with a control group, we found a smaller effect size (n=7; Hedge's g=.41). The obtained results were maintained at follow-up when data were available (n=6; Hedge's g=.62 for pre-post analyses; results only approached significance for controlled analyses, n=3; Hedge's g=.55, p=.08). Results suggested higher effects on negative symptoms compared with positive ones. When combined together, mindfulness, acceptance, and compassion strongly moderated the clinical effect size. However, heterogeneity was significant among the trials, probably due to the diversity of interventions included and outcomes assessed. CONCLUSION Mindfulness interventions are moderately effective in treating negative symptoms and can be useful adjunct to pharmacotherapy; however, more research is warranted to identify the most effective elements of mindfulness interventions.
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Affiliation(s)
- Bassam Khoury
- Department of Psychology, Université de Montréal, Canada.
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Abstract
Psychotic depression is associated with significant morbidity and mortality but is underdiagnosed and undertreated. In recent years, there have been several studies that have increased our knowledge regarding the optimal treatment of patients with psychotic depression. The combination of an antidepressant and antipsychotic is significantly more effective than either antidepressant monotherapy or antipsychotic monotherapy for the acute treatment of psychotic depression. Most treatment guidelines recommend either the combination of an antidepressant with an antipsychotic or ECT for the treatment of an acute episode of unipolar psychotic depression. The optimal maintenance treatment after a person responds to either the antidepressant/antipsychotic combination or the ECT is unclear particularly as it pertains to length of time the patient needs to take the antipsychotic medication. Little is known regarding the optimal treatment of a patient with bipolar disorder who has an episode of psychotic depression or the clinical characteristics of responders to medication treatments vs ECT treatments.
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Affiliation(s)
- Anthony J. Rothschild
- *To whom correspondence should be addressed; 361 Plantation Street, Worcester, MA 01605, US; tel: (508) 856-1027, fax: (508) 856-4854, e-mail:
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