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Bryde Christensen AB, Dyrloev K, Hoej M, Poulsen S, Reinholt N, Arnfred S. "The Depressed" and "People with Anxiety" therapists' discursive representations of patients with depression and anxiety in Danish Psychiatry. Health (London) 2024; 28:390-411. [PMID: 37191112 DOI: 10.1177/13634593231173802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Stigmatization within mental health care has previously been identified, and some diagnoses have been shown to be particularly exposed to negative attitudes and stigma. However, no previous studies have explored practitioners' discursive construction of patients with different diagnoses within a transdiagnostic group context. We performed discourse analysis on 12 interviews with Danish mental health practitioners, who had been conducting either transdiagnostic psychotherapy (The Unified Protocol) or standard group cognitive behavioral therapy (CBT) with patients treated for anxiety disorders or major depressive disorder. The purpose of this study was to identify how patients with anxiety and depression were represented by therapists. We identified a "training discourse," within which patients were evaluated through perceived motivation, responsibility, active participation, and progression. We argue that this training discourse can be related to a broader neoliberal order of discourse valuing efficiency and agency. The analysis indicated that patients with anxiety were sometimes "favorized" over patients with depression, and it is argued that the neoliberal order of discourse and pre-assumptions related to the diagnoses are contributing to this. The interviews indicate that multiple discourses were applied when describing patients, and ambivalence was often detectable. We discuss the findings of the analysis in relation to therapists' general critical attitudes toward the psychiatric system and in relation to broader societal tendencies.
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Affiliation(s)
- Anne Bryde Bryde Christensen
- Center for Eating and Feeding Disorders Research, Capital Region of Denmark & Mental Health Services Region Zealand, Denmark
| | | | - Michaela Hoej
- Capital Region of Denmark Mental Health Services, Denmark
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2
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Hovmand OR, Reinholt N, Bryde Christensen A, Bach B, Eskildsen A, Arendt M, Hvenegaard M, Poulsen S, Arnfred SM. Utility of the Work and Social Adjustment Scale (WSAS) in predicting long-term sick-leave in Danish patients with emotional disorders. Nord J Psychiatry 2024; 78:14-21. [PMID: 37988055 DOI: 10.1080/08039488.2023.2226123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/11/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The Work and Social Adjustment Scale (WSAS) is a self-administered measure designed to assess the level of inability to function socially as a consequence of a defined problem or disorder. METHODS A total of 230 patients with emotional disorders completed the Danish translation of the WSAS, measures of anxiety and depression, the Level of Personality Functioning Brief Form, the Personality Inventory for DSM-5 Short Form, and the World Health Organization Five-Item Well-Being Index (WHO-5). We conducted a confirmatory factor analysis of the previously suggested factor structure of the instrument. We furthermore evaluated the construct validity of the WSAS by means of its relationship with depression, anxiety, personality functioning, and overall well-being. Finally, we evaluated the utility of the WSAS to identify those on long-term sick-leave by conducting receiver operating characteristic (ROC) curves. RESULTS The instrument had a poor to average fit with the previously reported single-factor structure, but a better fit to a modified single-factor structure. Cronbach's alpha and McDonald's omega showed good internal scale reliability (α = .79, ωtotal = .85). WSAS was positively correlated with measures of anxiety (r = .33), depression (r = .44), and personality functioning (r = .23 and r = .20), and negatively correlated with WHO-5 wellbeing (r = -.57). The optimal cut-off point in the ROC-analyses was 23, which yielded a sensitivity of 74% and a specificity of 55% in the prediction of sick-leave status. DISCUSSION The Danish WSAS shows promising psychometric properties, but has limited external validity insofar as predicting long-term sick leave in psychiatric patients with emotional disorders.
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Affiliation(s)
- Oliver Rumle Hovmand
- Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
- Psychiatry South, Region Zealand Mental Health Services, Denmark
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark
| | | | - Bo Bach
- Neurocentre, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Denmark
| | - Mikkel Arendt
- Department of Affective Disorders, Aarhus University Hospital, Denmark
| | - Morten Hvenegaard
- Neurocentre, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Denmark
| | - Sidse M Arnfred
- Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
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Hovmand OR, Reinholt N, Christensen AB, Eskildsen A, Bach B, Arendt M, Poulsen S, Hvenegaard M, Arnfred SM. Affectivity in danish patients with emotional disorders: assessing the validity of the Positive and Negative Affect Schedule (PANAS). BMC Psychiatry 2023; 23:943. [PMID: 38093282 PMCID: PMC10720164 DOI: 10.1186/s12888-023-05450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The Positive and Negative Affect Schedule (PANAS) was designed to measure trait positive affect (PA) and trait negative affect (NA). METHODS The Danish PANAS was administered to outpatients with depression and anxiety disorders. Internal consistency was assessed using Cronbach's alpha and McDonald's omega and factorial structure was evaluated using confirmatory factor analysis (CFA). Convergent validity was evaluated by means of correlations with the negative affectivity and the detachment domain of the Personality Inventory for DSM-5 Short Form (PID-5-SF), the Hamilton Anxiety Rating Scale 6 (HARS-6) and the Hamilton Depression Rating Scale 6 (HDRS-6). RESULTS PANAS Scores of 256 patients were analyzed. Cronbach's alpha and McDonald's omega showed good internal consistency for both the PA score (alpha = .84 and omega = .89) and the NA score (alpha = .86 and omega = .90). CFA analysis confirmed a structure with two factors corresponding to the PA and NA factors. PA was negatively correlated with the detachment domain of PID-5 (r = -.47), HARS-6 (r = -.15) and HDRS-6 (r = -.37). NA was positively correlated with PID-5-SF negative affectivity domain (r = .43), HARS-6 (r = .51) and HDRS-6 (r = .52). DISCUSSION The Danish PANAS has promising internal consistency and construct validity, which are comparable to other studies of the instrument.
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Affiliation(s)
- Oliver Rumle Hovmand
- Psychiatric Research Unit, Region Zealand Mental Health Service, Faelledvej 6, 4200, Slagelse, Denmark.
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
- Psychiatry South, Region Zealand Mental Health Services, Copenhagen, Denmark.
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Faelledvej 6, 4200, Slagelse, Denmark
| | | | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Bach
- Psychiatric Research Unit, Region Zealand Mental Health Services, Copenhagen, Denmark
| | - Mikkel Arendt
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hvenegaard
- Neurocentre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sidse M Arnfred
- Psychiatric Research Unit, Region Zealand Mental Health Service, Faelledvej 6, 4200, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Region Zealand Mental Health Services, Copenhagen, Denmark
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Niemeijer M, Reinholt N, Poulsen S, Bach B, Christensen AB, Eskildsen A, Hvenegaard M, Arendt M, Arnfred S. Trait and symptom change in group cognitive behaviour therapy for anxiety and depression. Clin Psychol Psychother 2023; 30:1058-1070. [PMID: 37106559 DOI: 10.1002/cpp.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Personality traits underlying both anxiety disorders and depression are more malleable than previously presumed. This study examined associations between changes in personality traits (i.e. negative affectivity and detachment) and alleviation of anxiety and depression symptoms following cognitive behaviour therapy (CBT). We hypothesized that decreases in negative affectivity would predict alleviation of depression and anxiety symptoms and decreases in detachment would predict decreases in depression and, to a lesser degree, anxiety symptoms. Data (N = 156) were collected in a randomized controlled trial comparing transdiagnostic and diagnosis-specific group CBT for patients with major depressive disorder, social anxiety disorder, panic disorder or agoraphobia. We assessed personality traits using the Personality Inventory for DSM-5 (PID-5) and symptoms with the Hopkins Symptom Checklist 25-item scale (SCL). Prediction was based on regression analyses. We found that decreases in negative affectivity predicted lower levels of depression and anxiety symptoms while decreases in detachment only predicted lower levels of depression symptoms. The findings substantiate current efforts to explicate the dynamic interplay between personality traits and symptoms and support the existing focus on targeting negative affectivity and detachment in therapy for anxiety disorders and depression. The trial is registered at clinicaltrials.gov (ID NCT02954731).
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Affiliation(s)
- Miriam Niemeijer
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Psychotherapeutical Clinic, Psychiatric Center Copenhagen, Copenhagen Ø, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Bo Bach
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Center for Personality Disorder Research, Psychiatric Research Unit, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Hvenegaard
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
| | - Mikkel Arendt
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Hovmand OR, Reinholt N, Dichmann K, Borisov R, Arnfred S. Social phobia and evasiveness: trial protocol for a randomized controlled feasibility and superiority trial of the effect of Modified Collaborative Assessment vs. standard assessment on patients' readiness for psychotherapy (CO-ASSM-RCT). Pilot Feasibility Stud 2023; 9:102. [PMID: 37340450 DOI: 10.1186/s40814-023-01332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Evasive personality disorder (AvPD) and social phobia (SP) have substantial costs for patients and their families and great economic costs to the society. While psychotherapy can be an efficacious treatment, many patients drop out during treatment. Increased knowledge on how to decrease dropout from psychotherapy is warranted, including how to increase a patient's readiness for psychotherapy. METHODS We describe a randomized controlled feasibility and superiority trial of 42 individuals with a clinical diagnosis of either SP or AvPD, who are to initiate psychotherapeutic treatment in Danish outpatient mental health services. They will be randomized in a 1:1 ratio to either assessment-as-usual and receive no further assessment or to a Modified Collaborative Assessment (MCA) provided as a pre-treatment intervention before psychotherapy initiation. MCA will include a battery of psychological tests designed to thoroughly assess the patients' psychopathology. The tests are administered in collaboration with the patient, including detailed oral and written feedback. We hypothesize that the intervention is feasible regarding patient's acceptance and adherence. We further hypothesize that patients randomized to MCA will reach higher levels of readiness for psychotherapy as assessed with the University of Rhode Island Change Assessment Scale (URICA). DISCUSSION This protocol assesses the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the readiness for participation in psychotherapy of patients with SP and AvPD. Results from this feasibility study could guide the development of future large-scale trials of MCA and procedures for MCA treatment fidelity assessment. TRIAL REGISTRATION NCT2021001.
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Affiliation(s)
- Oliver Rumle Hovmand
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark.
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
| | - Kirstine Dichmann
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for Psychotherapy and Psychopathology, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
- Department of Forensic Psychiatry, Region Zealand Mental Health Service, Slagelse, Denmark
| | - Radoslav Borisov
- Psychiatry South, Region Zealand Mental Health Service, Ramsherred 1, 1. Sal, 4700, Naestved, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
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Á Steig DH, Reinholt N, Christensen AB, Hvenegaard Pedersen M, Arnfred SM. Patient-reported outcome measures in depression. Nord J Psychiatry 2023; 77:212-219. [PMID: 35848935 DOI: 10.1080/08039488.2022.2074136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM Patient-reported outcome measures (PROMs) are increasingly important as a mean for quality assurance. Feasible estimates of recovery can be achieved through the application of Jacobson plots, which is a simple demonstration of the outcome of each case, recommended for clinical use. We applied this approach with PROMs collected regarding group psychotherapy in a mental health service (MHS) setting. We hypothesized a recovery rate of above 50% of all cases, expecting a lower recovery rate amongst patients with severe depression. METHODS We made a secondary sub-sample analysis of data from patients with unipolar depression (N = 171) within a pragmatic, non-inferiority, randomized controlled clinical trial comparing two cognitive behavior therapy (CBT) group interventions. The treatment consisted of 14 2-hours weekly group CBT sessions. We collected depression PROMs with the Becks Depression Inventory-II and functional levels PROMs with the Work and Social Adjustment Scale at baseline, end-of-treatment, and at a 6-months follow-up. RESULTS At follow-up, 35% (N = 43/123) of cases with moderate or severe depression (BDI > 19) at baseline reached scores below the cut-off for moderate depression. Recovery rates in severe cases were significantly lower (26.5 vs 52.5%; p = 0.0004). We observed severe functional impairment in 36% of the patients at baseline (52/144) and observed no changes or worsening in scores at a 6-months follow-up in 44% of the patients (64/144). CONCLUSION We achieved satisfactory remission rates for patients with moderate depression. Patients with severe depression and patients with functional impairment reached recovery rates below the standard of comparable MHSs. Improved MHSs for these patients are needed.
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Affiliation(s)
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Morten Hvenegaard Pedersen
- Mental Health Centre, Ballerup, Mental Health Service Capital Region, Copenhagen University Hospital, Ballerup, Denmark
| | - Sidse Marie Arnfred
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
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Christensen AB, Rejaye Gryesten J, Kokholm J, Vislie K, Reinholt N, Dichmann K, Poulsen S, Arnfred S. The unified protocol: patient and therapist perspectives on the utility of the group manual. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2061340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jasmin Rejaye Gryesten
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Kokholm
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kitty Vislie
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine Dichmann
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bryde Christensen A, Pavlo AJ, Davidson L, Poulsen S, Reinholt N, Hvenegaard M, Simonsen E, Arnfred S. Does one treatment benefit all? Patients’ experiences of standardized group CBT for anxiety and depression. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Reinholt N, Hvenegaard M, Christensen AB, Eskildsen A, Hjorthøj C, Poulsen S, Arendt MB, Rosenberg NK, Gryesten JR, Aharoni RN, Alrø AJ, Christensen CW, Arnfred SM. Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:36-49. [PMID: 34111874 DOI: 10.1159/000516380] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. OBJECTIVE This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. METHODS In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. RESULTS At end-of-treatment, WHO-5 mean scores for patients in UP (n = 148) were non-inferior to those of patients in dCBT (n = 143; mean difference -2.94; 95% CI -8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. CONCLUSIONS This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.
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Affiliation(s)
- Nina Reinholt
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark.,Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Hvenegaard
- Competency Center for Rehabilitation and Recovery, Mental Health Center Ballerup, Ballerup, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark
| | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Berg Arendt
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jasmin Rejaye Gryesten
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark
| | - Ruth Nielsen Aharoni
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anja Johnsen Alrø
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sidse Marie Arnfred
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark.,Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Yan Z, Meng F, He M, Li Z. The efficacy of a transdiagnostic group cognitive behavioral intervention for Chinese elderly with emotional disorders: A one-year follow-up randomized clinical trial. Front Psychiatry 2022; 13:1027994. [PMID: 36506431 PMCID: PMC9732091 DOI: 10.3389/fpsyt.2022.1027994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND With the global aging, geriatric emotional disorders have received more and more attention. Psychotherapy is an effective approach for alleviating the symptoms associated with emotional disorder, but the number of experienced therapists is low. Studies should be conducted to explore a low-cost and efficient treatment method. Previous findings indicate that transdiagnostic cognitive behavior therapy is an effective approach for treatment of emotional disorders. Group therapy is appropriate for the elderly as they are characterized by high levels of loneliness. In this study, we compared and explored the effects of a transdiagnostic group cognitive behavioral intervention (TD-GCBT), a transdiagnostic individual cognitive behavioral intervention (TD-CBT), and treatment as usual (TAU) on treatment of emotional disorders among the elderly. METHOD A total of 120 elderly patients diagnosed with emotional disorders were randomly assigned to the TD-GCBT group (40), TD-CBT group (40), and TAU group (40). Changes in symptoms were assessed using HAMD, PHQ-9, HAMA, and GAD-7 scales at baseline, post-treatment (three months), six-month and twelve-months follow-up. The efficacies of the three intervention strategies were compared using linear mixed-effects models. Post-hoc and simple effect analyses were conducted to determine the differences among the three groups. RESULTS The HAMD, PHQ-9, HAMA, and GAD-7 scores revealed a significant effect from baseline to 12 months for time (p < 0.001), group (p < 0.001) and time × group interaction (p < 0.001) in TD-GCBT group compared with the TD-CBT group and TAU group. The effect of TD-GCBT (HAMD: Cohen's d (3th month, 6th month, 12th month) = 2.69, 3.98, 4.51; HAMA: Cohen's d = 2.84, 4.13, 5.20) and TD-CBT (HAMD: Cohen's d = 2.55, 2.87, 2.63; HAMA: Cohen's d = 2.43, 2.83, 2.78) group was better relative to that of the TAU group (HAMD: Cohen's d = 0.41, 1.13, 1.46; HAMA: Cohen's d = 0.64, 1.22, 1.57) (p < 0.001). The scores of the TD-GCBT group showed the most significant decrease compared with the other two groups. CONCLUSION The findings indicate that TD-GCBT method is effective for treatment of emotional disorders among the elderly. TD-GCBT is effective for alleviating depression and anxiety symptoms up to at least nine months after treatment. The results indicate that TD-GCBT is a cost-effective and resource-effective strategy and can be used an alternative therapy for treatment of mental disorders. CLINICAL TRIAL REGISTRATION [https://www.chictr.org.cn], identifier [ChiCTR1900021806].
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Affiliation(s)
- Zijun Yan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fanqiang Meng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meiling He
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhanjiang Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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11
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Raimondi G, Samela T, Lester D, Imperatori C, Carlucci L, Contardi A, Balsamo M, Innamorati M. Psychometric Properties of the Italian Mentalization Questionnaire: Assessing Structural Invariance and Construct Validity. J Pers Assess 2021; 104:628-636. [PMID: 34694942 DOI: 10.1080/00223891.2021.1991362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mentalization is an important interpersonal ability, necessary for adaptive interpersonal relationships and emotion regulation. Deficits in mentalization have been associated with poor psychological outcomes and have been observed in patients with Borderline Personality Disorder. The Mentalization Questionnaire (MZQ) has been developed as self-report measure of mentalization deficit. The aim of the study was to investigate the dimensionality of the MZQ in a nonclinical sample composed of Italian adults from the general population and to analyze its performance in categorizing individuals with higher risk of borderline symptoms. A non-clinical sample of 1,015 adults (709 women and 306 men) was administered the Italian versions of the MZQ, the Reflective Functioning Questionnaire (RFQ), and a measure of borderline psychopathology. A revised single-factor solution fitted the data well and demonstrated metric invariance across gender. The internal consistency (Ordinal α = 0.87) and stability (r = 0.84) were satisfactory. The MZQ was moderately associated with the RFQ dimensions. The ROC curve analysis showed that the MZQ was able to discriminate satisfactorily people with higher risk for borderline symptomatology from those with lower risk. The MZQ may, therefore, be considered a reliable and valid measure of mentalization for categorizing people at higher risk for borderline pathology.
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Affiliation(s)
- Giulia Raimondi
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Tonia Samela
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | | | - Leonardo Carlucci
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Anna Contardi
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Michela Balsamo
- Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
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Bryde Christensen A, Wahrén S, Reinholt N, Poulsen S, Hvenegaard M, Simonsen E, Arnfred S. "Despite the Differences, We Were All the Same". Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5324. [PMID: 34067758 PMCID: PMC8157163 DOI: 10.3390/ijerph18105324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The rationale for delivering CBT in groups is that patients can model themselves through each other due to their similarities in symptoms. However, there has recently been a shift towards transdiagnostic CBT protocols, in which patients with varied diagnoses participate in the same groups. This shift challenges the rationale of delivering CBT in groups, and it is therefore highly important to understand if and how group cohesion develops in mixed diagnoses CBT groups. The current study used a qualitative comparative framework to investigate the patients' experiences of group cohesion in diagnosis-specific versus transdiagnostic CBT groups. Twenty-three patients were interviewed with semi-structured interviews upon completion of the treatment. Participants had a primary diagnosis of MDD, panic disorder, agoraphobia or social anxiety disorder. A comparative thematic analysis was carried out. Three themes were found: the move from differences to similarities, the role of group cohesion in group CBT and factors helpful and hindering to group cohesion. Group cohesion developed across groups and was considered highly important in both diagnosis-specific and transdiagnostic CBT groups.
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Affiliation(s)
- Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Signe Wahrén
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Morten Hvenegaard
- Mental Health Services, Capital Region of Denmark, 2200 København N, Denmark;
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4200 Slagelse, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
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Who Is Seeking Help for Sleep? A Clinical Profile of Patients in a Sleep Psychology Clinic. Int J Behav Med 2021; 28:207-213. [PMID: 32405918 DOI: 10.1007/s12529-020-09882-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present study outlines a clinical profile of an ecologically valid population consulting for sleep difficulties at the Sleep Psychology Clinic of the Consultation service of the School of Psychology of Université Laval . METHOD Patients self-report to the sleep clinic. Following a phone screening interview, patients present to the clinic for a semi-structured clinical interview for sleep and psychopathology, which is conducted by psychologists and doctorate psychology students. A chart review of adult patients (56% female, Mage = 43.6 years) was conducted (between 2015 and 2018) to record diagnosed sleep, psychiatric, and medical conditions. RESULTS There was a high level of comorbidity with an average of 2.85 diagnoses (any diagnosis combined) per patient (SD = 1.76), with 27% of the patients having at least four diagnoses. Reviewing specific types of disorders, 58.5% of patients presented with at least one comorbid psychiatric disorder, 27.5% with one medical comorbidity, or 39.5% with another sleep disorder alongside their primary sleep concern. Insomnia was the main sleep disorder (76%). Anxiety (77.8%) and depression (53.8%) were the predominant psychiatric disorders, while fibromyalgia (10.9%), hypertension (10.9%), and head trauma (9.1%) were the main medical conditions. Of patients with five diagnoses and more, 77.8% were taking on average 3.2 different types of medications. The number of diagnoses predicted the use of prescribed hypnotics and the use of any type of medications. CONCLUSION This clinical profile emphasizes the reality of multiple morbidities, which may have implications for clinical decisions. Future research is required to evaluate transdiagnostic approaches for the sleep disorder patient with multiple morbidities.
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Rodie DJ, Fitzgibbon K, Perivolaris A, Crawford A, Geist R, Levinson A, Mitchell B, Oslin D, Sunderji N, Mulsant BH. The primary care assessment and research of a telephone intervention for neuropsychiatric conditions with education and resources study: Design, rationale, and sample of the PARTNERs randomized controlled trial. Contemp Clin Trials 2021; 103:106284. [PMID: 33476774 DOI: 10.1016/j.cct.2021.106284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
While most patients with depression, anxiety, or at-risk drinking receive care exclusively in primary care settings, primary care providers experience challenges in diagnosing and treating these common problems. Over the past two decades, the collaborative care model has addressed these challenges. However, this model has been adopted very slowly due to the high costs of care managers; inability to sustain their role in small practices; and the perceived lack of relevance of interventions focused on a specific psychiatric diagnosis. Thus, we designed an innovative randomized clinical trial (RCT), the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs). This RCT compared the outcomes of enhanced usual care and a novel model of collaborative care in primary care patients with depressive disorders, generalized anxiety, social phobia, panic disorder, at-risk drinking, or alcohol use disorders. These conditions were selected because they are present in almost a third of patients seen in primary care settings. Innovations included assigning the care manager role to trained lay providers supported by computer-based tools; providing all care management centrally by phone - i.e., the intervention was delivered without any face-to-face contact between the patient and the care team; and basing patient eligibility and treatment selection on a transdiagnostic approach using the same eligibility criteria and the same treatment algorithms regardless of the participants' specific psychiatric diagnosis. This paper describes the design of this RCT and discusses the rationale for its main design features.
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Affiliation(s)
- David J Rodie
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea Levinson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, United States of America
| | - Nadiya Sunderji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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López PL, Ciapponi A, Compte EJ, Comandé D, Murray S, Ailan D, Torrente FM. Transdiagnostic versus specific cognitive-behavioral treatments for adults with anxiety disorders. Hippokratia 2020. [DOI: 10.1002/14651858.cd013735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pablo Luis López
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT); CONICET, INECO Foundation, Favaloro University; Buenos Aires Argentina
| | - Agustín Ciapponi
- Argentine Cochrane Centre; Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET); Buenos Aires Argentina
| | | | - Daniel Comandé
- Argentine Cochrane Centre; Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET); Buenos Aires Argentina
| | - Stuart Murray
- Department of Psychiatry & Behavioral Sciences; University of Southern California; Los Angeles California USA
| | - Delfina Ailan
- Psychiatry and Cognitive Psychotherapy; Institute of Cognitive Neurology (INECO); Buenos Aires Argentina
| | - Fernando Manuel Torrente
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT); CONICET, INECO Foundation, Favaloro University; Buenos Aires Argentina
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Personalized Psychotherapy for Outpatients with Major Depression and Anxiety Disorders: Transdiagnostic Versus Diagnosis-Specific Group Cognitive Behavioural Therapy. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10116-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Background
Only about half of all patients with anxiety disorders or major depression respond to cognitive behaviour therapy (CBT), even though this is an evidence-based treatment. Personalized treatment offers an approach to increase the number of patients who respond to therapy. The aim of this study was to examine predictors and moderators of (differential) treatment outcomes in transdiagnostic versus diagnosis-specific group CBT.
Methods
A sample of 291 patients from three different mental health clinics in Denmark was randomized to either transdiagnostic or diagnosis-specific group CBT. The study outcome was the regression slope of the individual patient's repeated scores on the WHO-5 Well-being Index. Pre-treatment variables were identified as moderators or predictors through a two-step variable selection approach.
Results
While the two-step approach failed to identify any moderators, four predictors were found: level of positive affect, duration of disorder, the detachment personality trait, and the coping strategy of cognitive reappraisal. A prognostic index was constructed, but did not seem to be robust across treatment sites.
Conclusions
Our findings give insufficient evidence to support a recommendation of either transdiagnostic or diagnosis-specific CBT for a given patient or to predict the response to the applied group therapies.
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Bryde Christensen A, Svart N, Bokelund H, Reinholt N, Eskildsen A, Poulsen S, Hvenegaard M, Simonsen E, Arnfred S. Therapists' Perceptions of Individual Patient Characteristics that May Be Hindering to Group CBT for Anxiety and Depression. Psychiatry 2020; 83:344-357. [PMID: 33064967 DOI: 10.1080/00332747.2020.1800292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Individual patient characteristics are important in trying to understand why people respond differently to group CBT. Only a few studies have explored therapists' perceptions of within-patient attributes that may be hindering in group CBT in a mental health setting. Method: We explored the perception of individual patient characteristics and related obstacles in 12 psychotherapists in Danish Mental Health Services through semi-structured interviews. The interviews were analyzed using a descriptive qualitative framework. Results: The results revealed four distinct themes that the therapists pointed to as important for the outcome of a 14-week group CBT intervention for social phobia, panic disorder, agoraphobia and major depressive disorder. The four themes were Complexity & severity, External circumstances, Attitudes & coping and Cognitive ability & reflection level. The therapists explained how they perceived higher complexity and severity in the patients as an obstacle, they highlighted that a calm and stable outside environment aided therapeutic change, whilst stressors were hindering. They perceived active coping mechanisms, positive attitudes and high readiness to change as positive factors, whilst dependent and hostile coping mechanisms and negative attitudes were seen as obstacles. Finally, the therapists pointed to cognitive abilities and reflection level, explaining how it could be difficult to obtain good outcomes for patients who's cognitive abilities were debilitated due to psychopathological factors or for patients with a generally low reflection level. Conclusions: The results indicated that the therapists experience group CBT as an intervention that requires certain prerequisites of the patients, and that the four themes should be considered when deciding on treatment options for any given patient. The clinical utility and theoretical implications of the results are discussed.
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18
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The Neuroscience of Nonpharmacological Traditional Chinese Therapy (NTCT) for Major Depressive Disorder: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2183403. [PMID: 31223326 PMCID: PMC6541968 DOI: 10.1155/2019/2183403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/18/2019] [Accepted: 05/05/2019] [Indexed: 02/05/2023]
Abstract
Background Depression is a common disease affecting a large number of people across the world. Many researchers have focused on treatment for depression based on Western scientific approaches, but research based on traditional Chinese medicine (TCM) interventions, studying its clinical effectiveness and the underlying mechanisms involved, has been limited. The aim of this review is to conduct a pioneering systematic review with meta-analysis of existing studies that investigate the neuroscience basis of nonpharmacological traditional Chinese therapy (NTCT). Methods Both English (Pubmed, Embase, Scopus, SPORTDiscus, PsycINFO) and Chinese (China National Knowledge Infrastructure (CNKI)) databases were searched from inception to October 2018. The effects of NTCT on major depressive disorder, brain activity, and neurophysiological biomarker related outcomes were extracted. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. The effect size of each study was reported by the mean difference of change scores. Results Six of twelve eligible studies showed that there was a significant improvement in favor of acupuncture in depressive symptoms (SMD -0.69, 95% CI -1.09 to -0.28, p=0.002, I 2 = 73%, p< 0.0008). Based on the available evidence, NTCT including acupuncture, Qigong, and Tai Chi was found to possibly improve brain metabolites, brain activity, and immune and endocrine systems in patients with major depressive disorder. Conclusions Acupuncture could effectively relieve depressive syndromes. The clinical effects of acupuncture might be attributable to their influence on three proposed pathways, namely, the hypothalamic-pituitary-adrenal (HPA) axis, the locus coeruleus (LC)-immunity pathway, and the negative feedback loop of the hippocampus. Nevertheless, conclusions are limited due to the small number of studies included and the low-quality of the study designs. In the future, a cross-sectional study is needed to test the proposed plausible pathways. PROSPERO registration number is CRD42017080937.
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19
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Bonnín CM, Yatham LN, Michalak EE, Martínez-Arán A, Dhanoa T, Torres I, Santos-Pascual C, Valls E, Carvalho AF, Sánchez-Moreno J, Valentí M, Grande I, Hidalgo-Mazzei D, Vieta E, Reinares M. Psychometric properties of the well-being index (WHO-5) spanish version in a sample of euthymic patients with bipolar disorder. J Affect Disord 2018; 228:153-159. [PMID: 29248821 DOI: 10.1016/j.jad.2017.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/18/2017] [Accepted: 12/03/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The concept of well-being which focuses on positive emotions has received increased research attention. However, a consensus definition of this term is lacking. The Well-Being Index scale (WHO-5) is a generic, self-report scale that contains five Likert-type items to evaluate psychological well-being. This construct may provide a relevant outcome in bipolar disorder (BD) research and care beyond the rating of mood symptoms. Thus, in the current study, the psychometric properties of the WHO-5 Spanish version were assessed in a sample of euthymic patients with BD. METHODS Patients with BD- I and BD-II and healthy controls completed the Well-Being Index (WHO-5) together with an assessment of depressive (Hamilton Depression Rating Scale-17; HAM-D) and manic symptoms (Young Mania Rating Scale; YMRS); and a measure of psychosocial functioning (Functioning Assessment Short Test; FAST). Internal consistency reliability was measured through Cronbach's alpha. Test-retest reliability was calculated comparing the WHO-5 total score at baseline and after 10 days of the first administration. To assess the structure of the scale, a principal component analysis (PCA) was carried out. Correlations between the WHO-5, HAM-D, YMRS and FAST were calculated. Finally, a t-test for independent samples was applied to compare the WHO-5 total score in the patient and control groups. RESULTS A total of 104 patients with BD and 40 healthy controls were included in this study. A Chronbach's alpha of 0.83 indicated acceptable internal consistency. A paired sample t-test revealed no significant differences between WHO-5 total score at baseline and at follow-up (tn = - 0.72; df = 15; p = 0.48). The PCA provided a single factor solution that accounted for 59.74% of the variation in WHO-5. Test-retest reliability was high (r = 0.83; p < 0.001). Moderate negative correlations were observed between the WHO-5 total score, the FAST (r = - 0.46.; p < 0.001) and the HAM-D (r = - 0.68; p < 0.001), but not with the YMRS (r = - 0.07; p = 0.42). Finally, significant differences were found when comparing the WHO-5 total score between patient and healthy controls (t = 5.1; df = 147; p < 0.001). LIMITATIONS some limitations include the lack of a comparator scale to test for validity construct and the small sample size in the test-retest reliability CONCLUSIONS: The WHO-5 shows an acceptable reliability index and measures a unitary construct in a Spanish population of euthymic patients with BD.
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Affiliation(s)
- C M Bonnín
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - L N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - E E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Martínez-Arán
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - T Dhanoa
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - I Torres
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Santos-Pascual
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Valls
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A F Carvalho
- Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - J Sánchez-Moreno
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - I Grande
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - D Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - E Vieta
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - M Reinares
- Department of Psychiatry and Psychology, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Geronazzo-Alman L, Guffanti G, Eisenberg R, Fan B, Musa GJ, Wicks J, Bresnahan M, Duarte CS, Hoven C. Comorbidity classes and associated impairment, demographics and 9/11-exposures in 8,236 children and adolescents. J Psychiatr Res 2018; 96:171-177. [PMID: 29078153 DOI: 10.1016/j.jpsychires.2017.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/08/2017] [Accepted: 10/13/2017] [Indexed: 01/20/2023]
Abstract
The extensive comorbidity of psychiatric disorders in children and adolescents leads to clinical heterogeneity, and is an often-overlooked issue in etiopathogenic and treatment studies in developmental psychopathology. In a representative sample (N=8236) of New York City public school students assessed six months after 9/11, latent class analysis was applied to 48 symptoms across seven disorders: posttraumatic stress, agoraphobia, separation anxiety, panic disorder, generalized anxiety (GAD), major depression (MDD) and conduct disorder (CD). Our objective was to identify classes defined by homogenous symptom profiles, and to examine the association between class membership and gender, age, race, different types of exposure to 9/11, and impairment. Eight homogenous comorbidity patterns were identified, including four severe disturbance classes: a multimorbid internalizing class (INT), a class with a high probability of CD, MDD, and GAD symptoms (Distress/EXT), a non-comorbid externalizing class, and a non-comorbid MDD class. Demographic and 9/11-related exposures showed some degree of specificity in their association with severe symptom profiles. Impairment was particularly high in the INT and Distress/EXT classes. A better characterization of phenomic data, that takes comorbidity into account, is essential to understand etiopathogenic processes, and to move psychiatric research forward towards personalized medicine. The high probability of endorsing symptoms of multiple disorders in the INT and Distress/EXT classes supports the use of treatments focusing on multimorbidity. Clinical trials should evaluate the effectiveness of disorder-specific versus transdiagnostic interventions. The association between class membership and demographic and exposure variables suggests that interventions may be improved by considering specific predictors of class membership.
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Affiliation(s)
- Lupo Geronazzo-Alman
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States.
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School, 115 Mill Street Belmont, MA 02478, United States
| | - Ruth Eisenberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
| | - Bin Fan
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
| | - George J Musa
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
| | - Judith Wicks
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
| | - Michaeline Bresnahan
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
| | - Christina Hoven
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, United States
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Neudeck P, Brahm CI, Hamm AO. Transdiagnostische expositionsbasierte Behandlung von Angststörungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Neben störungsspezifischen Behandlungskonzepten werden in den letzten Jahren vermehrt transdiagnostische Behandlungsmanuale in der expositionsbasierten Behandlung von Ängsten und komorbiden Störungen eingesetzt. Die vorliegende narrative systematische Übersichtsarbeit beschreibt den Stand der Forschung zu transdiagnostischen Behandlungskonzepten in Hinsicht auf Angst- und komorbide Störungen. Methode: Die Literaturrecherche und die Datenanalyse wurden angelehnt an die PRISMA Guidelines vorgenommen. Die Ergebnisse von 17 Untersuchungen zu expositionsbasierten transdiagnostischen Behandlungskonzepten der letzten fünfzehn Jahre werden beschrieben. Ergebnisse: Die Resultate der referierten Studien zeigen, dass expositionsbasierte transdiagnostische Behandlungen die Symptome, sowohl der primären als auch der komorbiden Störungen, signifikant reduzieren. Expositionsbasierte transdiagnostische Konzepte sind effektiv zur Behandlungen von Angststörungen und komorbider Störungen. Sie stellen eine geeignete Alternative zu störungsspezifischen Behandlungen dar. Diskussion: Die Implikationen transdiagnostischer Konzepte für das praktische Vorgehen bei der individualisierten Diagnostik, der Vorbereitung und Durchführung von Expositionen werden erörtert. Schließlich werden Vorschläge für die Konzeptualisierung einer störungsübergreifenden Behandlung von Angststörungen, insbesondere solcher mit komorbider Symptomatik, vorgestellt.
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Affiliation(s)
| | | | - Alfons O. Hamm
- Institut für Psychologie, Ernst-Moritz-Arndt-Universität Greifswald
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