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Shafran R, Egan SJ, de Valle M, Davey E, Carlbring P, Creswell C, Wade TD. A guide for self-help guides: best practice implementation. Cogn Behav Ther 2024; 53:561-575. [PMID: 38900562 DOI: 10.1080/16506073.2024.2369637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
Guided self-help is an evidence-based intervention used globally. Self-help is a fundamental part of the stepped care model of mental health services that enables the efficient use of limited resources. Despite its importance, there is little information defining the role of the guide and the key competences required. In this context, the guide is defined as the person who facilitates and supports the use self-help materials. This article sets out the role of the guide in guided self-help. It considers practical issues such as the importance of engagement to motivate clients for early change, personalising the intervention, structuring sessions, how best to use routine outcome monitoring and supervision requirements. Key competences are proposed, including generic competences to build the relationship as well as specific competences such as being able to clearly convey the role of the guide to clients. Guides should be prepared for "self-help drift", a concept akin to therapist drift in more traditional therapies. Knowing how to identify mental health problems, use supervision and manage risk and comorbidity are all key requirements for guides. The paper concludes by calling for increased recognition and value of the role of the guide within mental health services.
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Affiliation(s)
- Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sarah J Egan
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Madelaine de Valle
- Flinders Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Emily Davey
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Tracey D Wade
- Flinders Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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Smárason O, Skarphedinsson G, Storch EA. Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents. Psychiatr Clin North Am 2024; 47:311-323. [PMID: 38724122 DOI: 10.1016/j.psc.2024.02.002] [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] [Indexed: 07/10/2024]
Abstract
Anxiety and depression are prevalent and impairing psychiatric problems for children and adolescents. In this review, the authors summarize information about their prevalence and impact, the most common assessment methods, the main components of cognitive behavioral therapy (CBT), and research on the effectiveness of CBT for these disorders. Future directions, including improving access to CBT through technology-based approaches and increasing personalization of treatment, are discussed.
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Affiliation(s)
- Orri Smárason
- Department of Child and Adolescent Psychiatry, Landspitali - The National University Hospital of Iceland, Dalbraut 12 105, Reykjavik.
| | | | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA
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Abdelaziz EM, Alsadaan N, Alqahtani M, Elsharkawy NB, Ouda MMA, Ramadan OME, Shaban M, Shokre ES. Effectiveness of Cognitive Behavioral Therapy (CBT) on Psychological Distress among Mothers of Children with Autism Spectrum Disorder: The Role of Problem-Solving Appraisal. Behav Sci (Basel) 2024; 14:46. [PMID: 38247698 PMCID: PMC10813282 DOI: 10.3390/bs14010046] [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: 11/18/2023] [Revised: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
Mothers of children with autism spectrum disorder (ASD) face considerable psychological distress. Cognitive behavioral therapy (CBT) has shown promise in reducing caregiver burden, but evidence in the Arab world is lacking. Problem-solving appraisal training may optimize CBT's benefits. This study evaluated a tailored CBT program emphasizing the role of problem-solving appraisal in managing distress through the process of CBT. Sixty mothers were randomly allocated in a 1:1 ratio to either the CBT intervention group or the control group. The CBT group received 3-month sessions incorporating problem-solving appraisal training within a CBT curriculum from October 2022 to April 2023. Problem-solving techniques are focused on equipping individuals with the skills to identify, approach, and effectively resolve problems, leading to a reduction in stress levels and an improved capacity to cope with difficult situations. All mothers completed assessments of socio-demographics such as age, level of education, marital status, occupation, and adequacy of family income, the Depression Anxiety Stress Scale (DASS-21) and the Problem-Solving Inventory (PSI) before and after the program. The CBT group showed significant pre-to-post reductions in depression, anxiety, stress, and general psychological distress compared to controls (all p < 0.05). They also exhibited significant improvements in problem-solving confidence, approach-avoidance style and personal control (all p < 0.05). The customized CBT program markedly improved psychological well-being for mothers of children with ASD in Egypt. Incorporating problem-solving techniques may optimize CBT's benefits cross-culturally. These findings have implications for the implementation of evidence-based support programs for families impacted by ASD worldwide.
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Affiliation(s)
- Enas Mahrous Abdelaziz
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (E.M.A.); (N.B.E.); (M.M.A.O.); (O.M.E.R.); (M.S.)
- Psychiatric Mental Health Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
| | - Nourah Alsadaan
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (E.M.A.); (N.B.E.); (M.M.A.O.); (O.M.E.R.); (M.S.)
| | - Mohammed Alqahtani
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al Hofuf 31982, Saudi Arabia;
| | - Nadia Bassuoni Elsharkawy
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (E.M.A.); (N.B.E.); (M.M.A.O.); (O.M.E.R.); (M.S.)
- Maternal and Newborn Health Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
| | - Marwa Mohamed Ahmed Ouda
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (E.M.A.); (N.B.E.); (M.M.A.O.); (O.M.E.R.); (M.S.)
- Pediatric Nursing Department, Faculty of Nursing, Damanhur University, Damanhur 22516, Egypt
| | - Osama Mohamed Elsayed Ramadan
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (E.M.A.); (N.B.E.); (M.M.A.O.); (O.M.E.R.); (M.S.)
- Pediatric Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
| | - Mostafa Shaban
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (E.M.A.); (N.B.E.); (M.M.A.O.); (O.M.E.R.); (M.S.)
- Geriatric Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
| | - Evon S. Shokre
- Psychiatric Mental Health Nursing Department, Faculty of Nursing, Fayum University, Fayum 63514, Egypt;
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Grasser LR, Erjo T, Goodwin MS, Naim R, German RE, White J, Cullins L, Tseng WL, Stoddard J, Brotman MA. Can peripheral psychophysiological markers predict response to exposure-based cognitive behavioral therapy in youth with severely impairing irritability? A study protocol. BMC Psychiatry 2023; 23:926. [PMID: 38082431 PMCID: PMC10712194 DOI: 10.1186/s12888-023-05421-4] [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: 10/10/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Irritability, an increased proneness to anger, is a primary reason youth present for psychiatric care. While initial evidence supports the efficacy of exposure-based cognitive behavioral therapy (CBT) for youth with clinically impairing irritability, treatment mechanisms remain unclear. Here, we propose to measure peripheral psychophysiological indicators of arousal-heart rate (HR)/electrodermal activity (EDA)-and regulation-heart rate variability (HRV)-during exposures to anger-inducing stimuli as potential predictors of treatment efficacy. The objective of this study is to evaluate whether in-situ biosensing data provides peripheral physiological indicators of in-session response to exposures. METHODS Blood volume pulse (BVP; from which HR and HRV canl be derived) and EDA will be collected ambulatorily using the Empatica EmbracePlus from 40 youth (all genders; ages 8-17) undergoing six in-person exposure treatment sessions, as part of a multiple-baseline trial of exposure-based CBT for clinically impairing irritability. Clinical ratings of irritability will be conducted at baseline, weekly throughout treatment, and at 3-month and 6-month follow-ups via the Clinical Global Impressions Scale (CGI) and the Affective Reactivity Index (ARI; clinician-, parent-, and child-report). Multilevel modeling will be used to assess within- and between-person changes in physiological arousal and regulation throughout exposure-based CBT and to determine whether individual differences are predictive of treatment response. DISCUSSION This study protocol leverages a wearable biosensor (Empatica) to continuously record HR/HRV (derived from BVP) and EDA during in-person exposure sessions for youth with clinically impairing irritability. Here, the goal is to identify changes in physiological arousal (EDA, HR) and regulation (HRV) over the course of treatment in tandem with changes in clinical symptoms. TRIAL REGISTRATION The participants in this study come from an overarching clinical trial (trial registration numbers: NCT02531893 first registered on 8/25/2015; last updated on 8/25/2023). The research project and all related materials were submitted and approved by the appropriate Institutional Review Board of the National Institute of Mental Health (NIMH).
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Affiliation(s)
- Lana Ruvolo Grasser
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Trinity Erjo
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Matthew S Goodwin
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ramaris E German
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jamell White
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Cullins
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Joel Stoddard
- Department of Psychiatry and Biomedical Informatics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Raudenska J, Gumančík J, Raudenský M, Pasqualucci A, Moka E, Varrassi G, Paladini A, Javurkova A. Cognitive-Behavioral Play Therapy and COVID-19 Pandemic Trauma in Preschool Children. Cureus 2023; 15:e44249. [PMID: 37772203 PMCID: PMC10524805 DOI: 10.7759/cureus.44249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Traumatic life events, such as the ongoing COVID-19 pandemic, can be a challenging health emergency, among others. The pandemic can also affect young preschoolers. They can experience negative emotions and behavioral and social difficulties. It can be hard for children to understand on their own what is going on, as well as for their families. This narrative review summarizes the role of psychotherapeutic approaches in working with trauma and aims to manage trauma, such as COVID-19, in preschool children. It focuses on the possibilities of applying cognitive-behavioral play therapy (CBPT) in preschool children who suffer from trauma during the COVID-19 pandemic period. The therapeutic approaches are tailored to specific development in preschoolers. Furthermore, the article provides insights into the relationship between negative emotions, thinking, and behavior, and COVID-19 as a threat, by describing a cognitive model in preschool-aged children. Finally, the article offers possible ways of applying play-based cognitive-behavioral therapy programs in preschool children who are victims of trauma.
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Affiliation(s)
- Jaroslava Raudenska
- Department of Nursing, Second Medical Faculty of Charles University, Prague, CZE
| | - Jiří Gumančík
- Department of Psychology, Faculty of Health and Life Sciences, University of Northumbria in Newcastle, Newcastle upon Tyne, GBR
| | | | - Alberto Pasqualucci
- Department of Anesthesia and Critical Care, University of Perugia, Perugia, ITA
| | - Eleni Moka
- Department of Anesthesiology, Creta InterClinic, Heraklion, GRC
| | | | - Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
| | - Alena Javurkova
- Department of Clinical Psychology, University Hospital Královské Vinohrady, Prague, CZE
- Department of Nursing, Second Medical Faculty of Charles University and Motol University Hospital, Prague, CZE
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