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Svensén S, Bolstad I, Ødbehr LS, Larsson G. Beyond medications: a multifaceted approach to alleviating comorbid anxiety and depression in clinical settings. Front Psychol 2024; 15:1456282. [PMID: 39286566 PMCID: PMC11402800 DOI: 10.3389/fpsyg.2024.1456282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/19/2024] [Indexed: 09/19/2024] Open
Abstract
Background Comorbid anxiety and depression are common and can make the problems more complex and sometimes resistant to pharmacological treatment. In existing research, the diagnoses are often studied separately, and physical activity, healthy nutrition, psychoeducation, and social support have shown good effects. The aim of the present study was to explore the longitudinal effects of a comprehensive treatment on patients with comorbid anxiety and depression in a clinical context. Method Eighty inpatients (15 men and 65 women) in age range 23-65 years receiving psychiatric treatment in Norwegian clinic participated in the longitudinal study. Treatment was person-centered and was most frequently given for anxiety and depression, e.g., pharmacological treatment and psychotherapy, individually and in groups. In combination with this, physical activity, healthy nutrition, psychoeducation and social support in contacts with authorities and relatives were also a part of treatment. Depression and anxiety were assessed using the Beck Anxiety Inventory and Beck Depression Inventory at three points in time: baseline, at the end of treatment, and 3 months after treatment. The answers were categorized and combined into four groups according to severity of anxiety and depression to measure effects on comorbidity. Mann Whitney U test, Chi-square, Friedmans test, and McNemar test were used to analyze the data. Result The results showed a significant increase of frequencies in the group with mild anxiety and depression 3 months past treatment compared to baseline. Conclusion Through the comprehensive, person-centered treatment more patients had low levels of both anxiety and depression 3 months after treatment. We suggest that clinics working with comorbid depression and anxiety patients should add physical activity, nutrition advice, social support, and psychoeducation to the traditional treatment regimes. More research concerning comorbid anxiety and depression are urgent to further expand the treatment possibilities.
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Affiliation(s)
- Sofia Svensén
- Inland Norway University of Applied Sciences, Elverum, Norway
- Swedish Defence University, Karlstad, Sweden
| | | | | | - Gerry Larsson
- Inland Norway University of Applied Sciences, Elverum, Norway
- Swedish Defence University, Karlstad, Sweden
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Rodriguez N, Gonzales-Pacheco DM, Byham-Gray LD, Rothpletz-Puglia P. Trauma-Informed Care Training for Dietetic Interns Improves Attitudes Toward Women Who Have Experienced Trauma. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:869-876. [PMID: 37921798 DOI: 10.1016/j.jneb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To assess change in attitudes toward women who have experienced trauma and to describe interns' reflections regarding the provision of universal trauma precautions and the training sessions. METHODS Dietetic interns participated in 3 2-hour trauma-informed care (TIC) training sessions. A multiple-methods design was used, incorporating a presurvey and postsurvey to assess change in attitudes and thematic analysis to assess self-reflections. RESULTS The attitudes of the interns improved across all statements. Two components measuring attitudes about sympathetic feelings toward mothers with underlying trauma and substance use disorder during pregnancy and retaining custody of their children reached statistical significance (P < 0.05). Four themes were identified in the self-reflections: TIC training was informative, valuable, and warranted, and interns felt comfortable discussing TIC. CONCLUSIONS AND IMPLICATIONS Students positively assessed the TIC training and changed their attitudes. Trauma-informed care can be effectively incorporated within dietetics education to support students in developing therapeutic relationships in their future nutrition care standards.
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Affiliation(s)
- Nancy Rodriguez
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ
| | - Diana M Gonzales-Pacheco
- Department of Individual, Family, and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, NM
| | - Laura D Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ
| | - Pamela Rothpletz-Puglia
- Department of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Newark, NJ.
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Roer GE, Lien L, Bolstad I, Aaseth JO, Abebe DS. The impact of PTSD on risk of cardiometabolic diseases: a national patient cohort study in Norway. BMC Psychiatry 2023; 23:349. [PMID: 37210523 PMCID: PMC10200052 DOI: 10.1186/s12888-023-04866-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 05/13/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with cardiometabolic diseases, concurrent anxiety, alcohol use disorder and depression. The relationship between PTSD and cardiometabolic diseases are still unclear, and less is known about the effects of socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression. The study, therefore, aims to examine the risk of developing cardiometabolic diseases including type 2 diabetes mellitus over time in PTSD patients, and to what extent socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression attenuate associations between PTSD and risk of developing cardiometabolic diseases. METHOD A retrospective, register-based cohort study with 6-years follow-up of adult (> 18 years) PTSD patients (N = 7 852) compared with the general population (N = 4 041 366), was performed. Data were acquired from the Norwegian Patient Registry and Statistic Norway. Cox proportional regression models were applied to estimate hazard ratios (HRs) (99% confidence intervals) of cardiometabolic diseases among PTSD patients. RESULTS Significantly (p < 0.001) higher age and gender adjusted HRs were disclosed for all cardiometabolic diseases among PTSD patients compared to the population without PTSD, with a variation in HR from 3.5 (99% CI 3.1-3.9) for hypertensive diseases to HR = 6.5 (5.7-7.5) for obesity. When adjusted for socioeconomic status and comorbid mental disorders, reductions were observed, especially for comorbid depression, for which the adjustment resulted in HR reduction of about 48.6% for hypertensive diseases and 67.7% for obesity. CONCLUSIONS PTSD was associated with increased risk of developing cardiometabolic diseases, though attenuated by socioeconomic status and comorbid mental disorders. Health care professionals should be attentive towards the burden and increased risk that low socioeconomic status and comorbid mental disorders may represent for PTSD patients' cardiometabolic health.
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Affiliation(s)
- Grethe Emilie Roer
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway.
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130, Oslo, Norway.
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, NO-2418, Elverum, Norway
| | - Ingeborg Bolstad
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, NO-2418, Elverum, Norway
| | - Jan O Aaseth
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, NO-2418, Elverum, Norway
- Research Department, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway
| | - Dawit Shawel Abebe
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O. Box 104, NO-2381, Brumunddal, Norway
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130, Oslo, Norway
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Brewerton TD. The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines. Front Psychiatry 2023; 14:1149433. [PMID: 37252137 PMCID: PMC10213703 DOI: 10.3389/fpsyt.2023.1149433] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a "silo effect," in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.
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Wu YY, Chou WH. Smartphone addiction, gender and interpersonal attachment: A cross-sectional analytical survey in Taiwan. Digit Health 2023; 9:20552076231177134. [PMID: 37256009 PMCID: PMC10226168 DOI: 10.1177/20552076231177134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
Overview Smartphone use has dramatically increased worldwide, contributing to a profound change in interpersonal interactions. They have become the primary medium of human interaction, and smartphone addiction, consequently, has become a modern-day reality. Recent research on smartphone addiction has provided diverse explanations regarding the correlation between gender and addiction. Therefore, this study aims to analyse the correlation and variance among smartphone addiction, gender and interpersonal attachment. Methods The participants included Taiwanese citizens and the questionnaires were randomly distributed; 1190 valid questionnaires (534 males, 656 females) were collected. Descriptive statistics were computed to observe the average value and standard deviation between interpersonal attachment and gender. Next, Spearman's ρ was conducted to interpret the correlation among smartphone addiction, gender and interpersonal attachment. Finally, the participants were divided into three groups based on their pre-determined level of smartphone addiction: high, moderate and low addictions. The Analysis of variance (ANOVA) was performed based on interpersonal attachment as the independent variable to determine any statistically significant difference among the three levels. Results There are four patterns of interpersonal attachment: secure, avoidant, dismissing and anxious attachments. The correlation analysis revealed a significant positive correlation between interpersonal attachment and smartphone addiction (p > 0.000), while revealing no relationship between gender and smartphone addiction or gender and interpersonal attachment. Additionally, the ANOVA indicated the difference was statistically significant in the groups of high and moderate addictions; no statistical significance was identified in the group of low addiction (p < 0.204). Conclusion This study revealed that there was no correlation between gender and smartphone addiction, but rather, a positive correlation between smartphone addiction and interpersonal attachment. This positive correlation suggests both high and moderate addiction groups display insecurity in their interpersonal attachment. Therefore, to lower the prevalence of unhealthy smartphone addiction, maintaining healthy interpersonal relationships is suggested.
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Affiliation(s)
- Yi-Ying Wu
- Graduate School of Design, National Yunlin University of Science and
Technology, Douliou
| | - Wen-Huei Chou
- Department of Digital Media Design, National Yunlin University of Science and
Technology, Douliou
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Hoover LV, Yu HP, Duval ER, Gearhardt AN. Childhood trauma and food addiction: The role of emotion regulation difficulties and gender differences. Appetite 2022; 177:106137. [PMID: 35738482 DOI: 10.1016/j.appet.2022.106137] [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: 03/18/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Childhood trauma has been associated with substance use disorders (SUDs), but less research has investigated its association with food addiction (i.e., compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). Existing research on childhood trauma and food addiction has focused primarily on women from restricted samples. Further, emotion dysregulation difficulties are implicated in both childhood trauma and food addiction, but research has not explored whether it may play a mediating role. METHOD Thus, the current study utilizes a sample of 310 participants recruited from Amazon Mechanical Turk (mean age = 41.3 years old, 47.4% men, 78.7% white) to investigate the mediating role of emotion dysregulation in the association between childhood trauma and food addiction. We also conducted exploratory analyses to investigate for gender differences in these associations. Gender-stratified correlational matrixes were conducted to investigate association between childhood trauma, food addiction, and emotional dysregulation. Moderated mediation models and multilevel regressions were also conducted to identify the role of gender in the association between childhood trauma, food addiction, and emotion dysregulation. RESULTS Emotion dysregulation was found to partially mediate the associations between food addiction and childhood trauma and gender was found to moderate associations between childhood trauma and emotion dysregulation, as well as childhood trauma and food addiction. Both moderating pathways were significantly stronger for men compared to women. DISCUSSION Results suggests that emotion dysregulation may be one important mediator in the association between childhood trauma and food addiction, particularly for men. The identification of other potential mechanisms contributing to the association between childhood trauma and food addiction and the use of longitudinal measurement strategies will be important in future research.
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Affiliation(s)
- Lindzey V Hoover
- Department of Psychology, University of Michigan, Ann Arbor, USA.
| | - Hayley P Yu
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Elizabeth R Duval
- Department of Psychology, University of Michigan, Ann Arbor, USA; Department of Psychiatry, University of Michigan, Ann Arbor, USA
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Brinchmann BS, Lyngmo S, Herholdt-Lomholdt SM, Blix BH. Multiple perspectives and dialogue in understanding experiences of living with eating disorders: Two narratives-four unpackings. J Eat Disord 2022; 10:24. [PMID: 35168660 PMCID: PMC8848953 DOI: 10.1186/s40337-022-00554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This is a response to Conti et al.'s article, "Listening in the dark: why we need stories of people living with severe and enduring anorexia nervosa" (published in JED, 2016), and its call for relational metaphors and a relational approach to supplement the traditional medical/psychological diagnostic language used to describe the life experiences and complex emotions of people affected by an eating disorder. METHODS Four authors with different backgrounds unpack two narratives, 'The Prima Donna with the Green Dress' and 'Breaking down the Wall', both narrated during fieldwork in multifamily therapy. The narratives are unpacked from the perspective of a therapist within multifamily therapy, a researcher who conducted the fieldwork, a researcher based in phenomenology and a researcher based in narrative inquiry. The authors enter into dialogue with the narratives, and with each other. RESULTS The four authors focus on different elements within the narratives and understand them differently. One, focuses on strength and pride, and art expression as a different form of language for people living with an eating disorder. Another, on the experience of isolation, boundaries, and balancing openness and closedness. A third, sees the narratives as expressing a wish to see and be seen, and the fourth focuses on the absence of, and longing for, a shared space to explore. CONCLUSION The aim is not to reach a correct or shared interpretation of the narratives but to explore how different perspectives may contribute to different insights, not only about one family in particular but about, more generally, the experiences of people living with an eating disorder. Our work shows the significance of engaging with multiple perspectives and dialogue as supplements to the traditional medical/psychiatric diagnostic language in both clinical practice and research.
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Affiliation(s)
- Berit Støre Brinchmann
- The Faculty of Nursing and Health Sciences, Nord University, 8026, Bodø, Norway. .,Regional Centre for Eating Disorders, Nordland Hospital, 8076, Bodø, Norway.
| | - Siri Lyngmo
- Regional Centre for Eating Disorders, Nordland Hospital, 8076, Bodø, Norway
| | | | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
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