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Burns JW, Jensen MP, Thorn BE, Lillis TA, Carmody J, Gerhart J, Keefe F. Cognitive Therapy, Mindfulness-Based Stress Reduction, and Behavior Therapy for the Treatment of Chronic Pain: Predictors and Moderators of Treatment Response. J Pain 2024:S1526-5900(24)00011-7. [PMID: 38199593 DOI: 10.1016/j.jpain.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Psychosocial interventions for people with chronic pain produce significant improvements in outcomes, but these effects on average are modest with much variability in the benefits conferred on individuals. To enhance the magnitude of treatment effects, characteristics of people that might predict the degree to which they respond more or less well could be identified. People with chronic low back pain (N = 521) participated in a randomized controlled trial which compared cognitive therapy, mindfulness-based stress reduction, behavior therapy and treatment as usual. Hypotheses regarding predictors and/or moderators were based on the Limit, Activate, and Enhance model; developed to predict and explain moderators/predictors of psychosocial pain treatments. Results were: 1) low levels of cognitive/behavioral function at pre-treatment predicted favorable pre- to post-treatment outcomes; 2) favorable expectations of benefit from treatment and sound working alliances predicted favorable pre- to post-treatment outcomes; 3) women benefited more than men. These effects emerged without regard to treatment condition. Of note, high levels of cognitive/behavioral function at pre-treatment predicted favorable outcomes only for people in the treatment as usual condition. Analyses identified a set of psychosocial variables that may act as treatment predictors across cognitive therapy, mindfulness-based stress reduction and behavior therapy, as hypothesized by the Limit, Activate, and Enhance model if these 3 treatments operate via similar mechanisms. Findings point toward people who may and who may not benefit fully from the 3 psychosocial treatments studied here, and so may guide future research on matching people to these kinds of psychosocial approaches or to other (eg, forced-based interventions) non-psychosocial approaches. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT02133976. PERSPECTIVE: This article examines potential predictors/moderators of response to psychosocial treatments for chronic pain. Results could guide efforts to match people to the most effective treatment type or kind.
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Affiliation(s)
- John W Burns
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | | | - Teresa A Lillis
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - James Carmody
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School
| | - James Gerhart
- Department of Psychology Central Michigan University
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
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Tyler J, Gallagher T, Wheaton MG, Hamlett GE, Rosenfield B, Rosenfield D, Simpson HB, Foa EB. Predictors of clinical worsening during a discontinuation trial of serotonin reuptake inhibitors for obsessive compulsive disorder. J Anxiety Disord 2024; 101:102805. [PMID: 38113781 DOI: 10.1016/j.janxdis.2023.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To explore predictors and moderators of clinical worsening during a double-blind trial in which patients with obsessive-compulsive disorder (OCD) were randomized to either continue or discontinue their Serotonin Reuptake Inhibitor (SRI) medication after achieving wellness from the addition of exposure and response prevention (EX/RP) therapy. METHOD The data came from a double-blind discontinuation trial that included N = 101 participants, 35 of whom were removed from the study due to clinical worsening. We first used LASSO logistic regression to identify which of the 34 potential baseline variables of interest (including demographics, diagnoses, other relevant clinical constructs, and specific genotypes), might moderate or predict this clinical worsening. Then logistic regression was used to examine which of these identified variables were significantly related to later clinical worsening. We verified the validity of our final prediction model using k-fold cross-validation. RESULTS There was one significant predictor of clinical worsening: In both groups, those with more past diagnoses had a greater likelihood of clinical worsening (p = .015). There were several moderators. Rates of clinical worsening were higher in the Discontinuation group compared to the Continuation group for participants who were taking a shorter half-life SRI (p = .044), were female (p = .022), had higher baseline levels of maladaptive metacognitions (p < .001), had fewer sleep problems at baseline (p = .001), and/or had more years of education (p < .001). CONCLUSIONS Our results identified several factors that may predict the development of clinical worsening in OCD patients discontinuing SRI medication following successful EX/RP treatment.
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Affiliation(s)
- Jeremy Tyler
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Thea Gallagher
- New York University, Department of Psychiatry, New York, NY 10016, USA
| | - Michael G Wheaton
- Barnard College, Columbia University, New York, NY 10027, USA; New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | | | - Helen B Simpson
- New York State Psychiatric Institute, New York, NY 10032, USA; Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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de Boer K, Johnson C, Wade TD, Radunz M, Fernando AN, Babb J, Stafrace S, Sharp G. A systematic review and meta-analysis of intensive treatment options for adults with eating disorders. Clin Psychol Rev 2023; 106:102354. [PMID: 37926059 DOI: 10.1016/j.cpr.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Eating disorders (EDs) are complex conditions with one of the highest mortality rates among psychiatric illnesses. While outpatient evidence-based treatments for EDs in adults exist, there is often utilisation of more intensive interventions as part of treatment. However, a comprehensive analysis of the impacts of intensive treatment (inpatient, residential and day program) on physical and psychosocial outcomes is lacking. Thus, the current systematic review and meta-analysis aimed to investigate the effectiveness of intensive treatments in adults with EDs for the outcomes of body mass index (BMI), disordered eating, depression, and quality of life, as well as a moderation analysis investigating a range of clinical characteristics. Overall, 62 studies were included in the meta-analysis. The results revealed that intensive treatment in adults yielded significant improvements in BMI (for underweight patients), disordered eating, depression, and quality of life. Treatment setting, length of stay and geographical region of the study all served as moderators for disordered eating and depression. Nevertheless, given the high heterogeneity in the meta- and moderation analyses, these results should be interpreted with caution. Future high-quality research is needed to determine the most beneficial elements of intensive treatment (compared to outpatient) in adults with EDs.
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Affiliation(s)
- Kathleen de Boer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Catherine Johnson
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Marcela Radunz
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | | | - Jennifer Babb
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Simon Stafrace
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia; Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia.
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Yap A, Johanesen P, Walsh C. Moderators uncertainty tolerance (UT) in healthcare: a systematic review. Adv Health Sci Educ Theory Pract 2023; 28:1409-1440. [PMID: 37097482 DOI: 10.1007/s10459-023-10215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 02/04/2023] [Indexed: 06/19/2023]
Abstract
Uncertainty tolerance (UT) is integral to healthcare. Providers' responses to medical uncertainty has ramifications on the healthcare system, the healthcare provider and the patient. Understanding healthcare providers' UT, is important for improving patient-care outcomes. Understanding whether and to what extent it is possible to modulate individuals' perceptions and responses to medical uncertainty, can provide insights into mechanisms for support for training and education. The objectives of this review were to further characterize moderators of healthcare UT and explore moderator influences on the perceptions and responses to uncertainty experienced by healthcare professionals. Framework analysis of qualitative primary literature was conducted on 17 articles, focusing on the impacts of UT on healthcare providers. Three domains of moderators were identified and characterized relating to the healthcare provider's personal attributes, patient-derived uncertainty and the healthcare system. These domains were further categorized into themes and subthemes. Results suggest these moderators influence perceptions and responses to healthcare uncertainty across a spectrum ranging from positive to negative to uncertain. In this way, UT could be a state-based construct within healthcare settings and is contextually determined. Our findings further characterize the integrative model of uncertainty tolerance (IMUT) (Hillen Social Science and Medicine 180, 62-75, 2017) and provide evidence for the relationship between moderators and their influences on cognitive, emotional and behavioral responses to uncertainty. These findings provide a foundation for understanding the complex nature of the UT construct, add to theory development, and provide groundwork for future research exploring appropriate support for training and education in healthcare fields.
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Affiliation(s)
- Ana Yap
- Department of Microbiology, Biomedical Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia.
| | - Priscilla Johanesen
- Department of Microbiology, Biomedical Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Chris Walsh
- Victoria University, Victoria University (VU) Online, Melbourne, VIC, Australia
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Jensen MP, Ehde DM, Hakimian S, Pettet MW, Day MA, Ciol MA. Who Benefits the Most From Different Psychological Chronic Pain Treatments? An Exploratory Analysis of Treatment Moderators. J Pain 2023; 24:2024-2039. [PMID: 37353183 PMCID: PMC10615716 DOI: 10.1016/j.jpain.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
Different psychological chronic pain treatments benefit some individuals more than others. Understanding the factors that are associated with treatment response-especially when those factors differ between treatments-may inform more effective patient-treatment matching. This study aimed to identify variables that moderate treatment response to 4 psychological pain interventions in a sample of adults with low back pain or chronic pain associated with multiple sclerosis, spinal cord injury, acquired amputation, or muscular dystrophy (N = 173). The current study presents the results from secondary exploratory analyses using data from a randomized controlled clinical trial which compared the effects of 4 sessions of cognitive therapy (CT), hypnosis focused on pain reduction (HYP), hypnosis focused on changing pain-related cognitions and beliefs (HYP-CT), and a pain education control condition (ED). The analyses tested the effects of 7 potential treatment moderators. Measures of primary (pain intensity) and secondary (pain interference, depression severity) outcome domains were administered before and after the pain treatments, and potential moderators (catastrophizing, hypnotizability, and electroencephalogram (EEG)-assessed oscillation power across five bandwidths) were assessed at pre-treatment. Moderator effects were tested fitting regression analyses to pre- to post-treatment changes in the three outcome variables. The study findings, while preliminary, support the premise that pre-treatment measures of hypnotizability and EEG brain activity predict who is more (or less) likely to respond to different psychological pain treatments. If additional research replicates the findings, it may be possible to better match patients to their more individually suitable treatment, ultimately improving pain treatment outcomes. PERSPECTIVE: Pre-treatment measures of hypnotizability and EEG-assessed brain activity predicted who was more (or less) likely to respond to different psychological pain treatments. If these findings are replicated in future studies, they could inform the development of patient-treatment matching algorithms.
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Affiliation(s)
- Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Dawn M. Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Shahin Hakimian
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Mark W. Pettet
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Melissa A. Day
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Marcia A. Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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Nöhles VB, Bermpohl F, Falkai P, Reif-Leonhard C, Jessen F, Adli M, Otte C, Meyer-Lindenberg A, Bauer M, Rubarth K, Anghelescu IG, Rujescu D, Correll CU. Patient characteristics, validity of clinical diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D): design, procedures and outcomes. BMC Psychiatry 2023; 23:744. [PMID: 37828493 PMCID: PMC10571442 DOI: 10.1186/s12888-023-05230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Suicidality, ranging from passive suicidal thoughts to suicide attempt, is common in major depressive disorder (MDD). However, relatively little is known about patient, illness and treatment characteristics in those with co-occurring MDD and suicidality, including the timing of and factors associated with the offset, continuation or reemergence of suicidality. Here, we present the background, rationale, design and hypotheses of the Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study, an investigator-initiated, observational study, funded by Janssen-Cilag GmbH. METHODS/RESULTS OASIS-D is an eight-site, six-month, cohort study of patients aged 18-75 hospitalized with MDD. Divided into three sub-studies and patient populations (PPs), OASIS-D will (i) systematically characterize approximately 4500 consecutively hospitalized patients with any form of unipolar depressive episode (PP1), (ii) evaluate the validity of the clinical diagnosis of moderate or severe unipolar depressive episode with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and present suicidality (at least passive suicidal thoughts) present ≥ 48 h after admission with the Sheehan-Suicide Tracking Scale (S-STS), assessing also predictors of the diagnostic concordance/discordance of MDD in around 500 inpatients (PP2), and (iii) characterize and prospectively follow for 6 months 315 inpatients with a research-verified moderate or severe unipolar depressive episode and at least passive suicidal thoughts ≥ 48 h after admission, evaluating treatment and illness/response patterns at baseline, hospital discharge, 3 and 6 months. Exploratory objectives will describe the association between the number of days with suicidality and utilization of outpatient and inpatient care services, and structured assessments of factors influencing the risk of self-injurious behavior without suicidal intent, and of continuous, intermittent or remitted suicidality during the 6-month observation period. CONCLUSION Despite their frequency and clinical relevance, relatively little is known about patient and treatment characteristics of individuals with MDD and suicidality, including factors moderating and mediating the outcome of both MDD and suicidality. Results of the OASIS-D study are hoped to improve the understanding of the frequency, correlates and 6-month naturalistic treatment and outcome trajectories of different levels of suicidality in hospitalized adults with MDD and suicidality. TRIAL REGISTRATION NCT04404309 [ClinicalTrials.gov].
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Affiliation(s)
- Viktor B Nöhles
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus St. Hedwig Hospital, Berlin, Germany
| | - Peter Falkai
- Clinic for Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Berlin, Germany
- Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kerstin Rubarth
- Institute of Medical Informatics, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ion-George Anghelescu
- Clinic for Psychiatry, Psychosomatics and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Kuo KM. Antecedents predicting digital contact tracing acceptance: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2023; 23:212. [PMID: 37821864 PMCID: PMC10568897 DOI: 10.1186/s12911-023-02313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
An awareness of antecedents of acceptance of digital contact tracing (DCT) can enable healthcare authorities to design appropriate strategies for fighting COVID-19 or other infectious diseases that may emerge in the future. However, mixed results about these antecedents are frequently reported. Most prior DCT acceptance review studies lack statistical synthesis of their results. This study aims to undertake a systematic review and meta-analysis of antecedents of DCT acceptance and investigate potential moderators of these antecedents. By searching multiple databases and filtering studies by using both inclusion and exclusion criteria, 76 and 25 studies were included for systematic review and meta-analysis, respectively. Random-effects models were chosen to estimate meta-analysis results since Q, I 2, and H index signified some degree of heterogeneity. Fail-safe N was used to assess publication bias. Most DCT acceptance studies have focused on DCT related factors. Included antecedents are all significant predictors of DCT acceptance except for privacy concerns and fear of COVID-19. Subgroup analysis showed that individualism/collectivism moderate the relationships between norms/privacy concerns and intention to use DCT. Based on the results, the mean effect size of antecedents of DCT acceptance and the potential moderators may be more clearly identified. Appropriate strategies for boosting the DCT acceptance rate can be proposed accordingly.
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Affiliation(s)
- Kuang-Ming Kuo
- Department of Business Management, National United University, No.1, 360301, Lienda, Miaoli, Taiwan, Republic of China.
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Patel ML, Rodriguez Espinosa P, King AC. Moderators of a Diet and Physical Activity Intervention: who Responds Best to Sequential vs. Simultaneous Approaches. Int J Behav Med 2023:10.1007/s12529-023-10223-9. [PMID: 37816943 DOI: 10.1007/s12529-023-10223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Given that low physical activity levels and poor dietary intake are co-occurring risk factors for chronic disease, there is a need for interventions that target both health behaviors, either sequentially or simultaneously. Little is known about participant characteristics that are associated with better or worse response to sequential and simultaneous interventions. METHOD The 12-month Counseling Advice for Lifestyle Management (CALM) randomized trial (N = 150; Mage = 55.3 years) targeted these two behaviors either via a sequential approach - dietary advice first then exercise advice added ("Diet-First") or exercise advice first then dietary advice added ("Exercise-First") - or via a simultaneous approach. The objective was to examine demographic, clinical, and psychosocial moderators of intervention effects on 12-month change in (1) moderate-to-vigorous physical activity (MVPA), (2) fruit/vegetable intake, (3) caloric intake from saturated fat, and (4) weight. Hierarchical regressions first compared Diet-First to Exercise-First, followed by comparisons of these arms combined ("sequential") to the simultaneous arm. RESULTS Older age, higher baseline BMI, and lower social support were associated with higher MVPA in Exercise-First vs. Diet-First, while lower tangible support was associated with higher fruit/vegetable intake in Exercise-First but not in Diet-First. Poor sleep was associated with higher levels of MVPA in the sequential arm than in the simultaneous arm. Lower vitality was associated with greater weight loss in the sequential arm than in the simultaneous arm, while the opposite was true for those who were not married. CONCLUSION Identifying moderators of treatment response can allow the behavioral medicine field to enhance intervention efficacy by matching participant subgroups to their best-fitting interventions. TRIAL REGISTRATION NCT00131105.
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Affiliation(s)
- Michele L Patel
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
| | | | - Abby C King
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Carpallo-González M, Muñoz-Navarro R, González-Blanch C, Cano-Vindel A. Symptoms of emotional disorders and sociodemographic factors as moderators of dropout in psychological treatment: A meta-review. Int J Clin Health Psychol 2023; 23:100379. [PMID: 36922928 PMCID: PMC10009192 DOI: 10.1016/j.ijchp.2023.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/08/2023] [Indexed: 03/07/2023] Open
Abstract
Objective Dropout from psychological treatment is an important problem that substantially limits treatment effectiveness. A better understanding of this phenomenon, could help to minimize it. Therefore, we performed a systematic review of meta-analyses (MA) on dropout from psychological treatments to (1) determine the estimated overall dropout rate (DR) and (2) to examine potential predictors of dropout, including clinical symptoms (anxiety and depression) and sociodemographic factors. Method A literature search of the PubMed PsycINFO, Embase, Scopus and Google Scholar databases was conducted. We identified 196 MAs on dropout from psychological treatment carried out primarily in adult patients or mixed samples (adults and children) between 1990 and 2022. Of these, 12 met all inclusion criteria. Two forest plots were created to visualize the DR and the relationship between DR and the disorder. Results The DR ranged from 15.9% to 46.8% and was significantly moderated by symptoms of emotional disorders. The highest DR were observed in younger, unmarried patients, and those with lower educational and income levels. Conclusions DR in patients undergoing psychological treatment is highly heterogeneous, but higher in individuals presenting symptoms of anxiety and/or depression, especially the latter. Given that high DR undermine the effectiveness of psychological interventions, it is clear that greater efforts are needed to reduce dropout, particularly among individuals with symptoms of emotional disorders.
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Affiliation(s)
| | | | - César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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Wergeland GJH, Haaland ÅT, Fjermestad KW, Öst LG, Gjestad R, Bjaastad JF, Hoffart A, Husabo E, Raknes S, Haugland BSM. Predictors of school-based cognitive behavior therapy outcome for youth with anxiety. Behav Res Ther 2023; 169:104400. [PMID: 37690362 DOI: 10.1016/j.brat.2023.104400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.
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Affiliation(s)
- Gro Janne H Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Åshild T Haaland
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Elisabeth Husabo
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway
| | | | - Bente S M Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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Haller K, Becker P, Niemeyer H, Boettcher J. Who benefits from guided internet-based interventions? A systematic review of predictors and moderators of treatment outcome. Internet Interv 2023; 33:100635. [PMID: 37449052 PMCID: PMC10336165 DOI: 10.1016/j.invent.2023.100635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
To our knowledge, no systematic review has been conducted on predictors or moderators of treatment outcome across diagnoses in guided internet-based interventions (IBIs) for adults. To identify who benefits from this specific format and therein inform future research on improving patient-treatment fit, we aimed to aggregate results of relevant studies. 2100 articles, identified by searching the databases PsycInfo, Ovid Medline, and Pubmed and through snowballing, were screened in April/May 2021 and October 2022. Risk of bias and intra- and interrater reliability were assessed. Variables were grouped by predictor category, then synthesized using vote counting based on direction of effect. N = 60 articles were included in the review. Grouping resulted in 88 predictors/moderators, of which adherence, baseline symptoms, education, age, and gender were most frequently assessed. Better adherence, treatment credibility, and working alliance emerged as conclusive predictors/moderators for better outcome, whereas higher baseline scores predicted more reliable change but higher post-treatment symptoms. Results of all other predictors/moderators were inconclusive or lacked data. Our review highlights that it is currently difficult to predict, across diagnoses, who will benefit from guided IBIs. Further rigorous research is needed to identify predictors and moderators based on a sufficient number of studies. PROSPERO registration: CRD42021242305.
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Affiliation(s)
- Katrin Haller
- Clinical Psychological Interventions, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Pauline Becker
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Helen Niemeyer
- Clinical Psychological Interventions, Freie Universität Berlin, Berlin, Germany
| | - Johanna Boettcher
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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12
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Loukas A, Li X, Wilkinson AV, Marti CN. Longitudinal Examination of ENDS Use Among Young Adult College Students: Associations with Depressive Symptoms and Sensation Seeking. Prev Sci 2023; 24:1068-1077. [PMID: 37428392 DOI: 10.1007/s11121-023-01572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
The present study examined (1) intraindividual changes in the frequency of electronic nicotine delivery systems (ENDS) use across young adulthood, 18 to 30 years old, and (2) if depressive symptoms and sensation-seeking tendencies, independently and in interaction with one another, were associated with these changes. Data were from a longitudinal study of students recruited from 24 Texas colleges and followed across six waves from fall 2015 to spring 2019. Participants (n = 1298; 36.3% non-Hispanic white, 56.3% women) were 18 to 26 years old in fall 2015 and all reported past 30-day ENDS use on at least one wave. We used growth curve modeling for an accelerated longitudinal design to examine if ENDS use frequency changed with increasing age and if depressive symptoms and sensation seeking, independently and in interaction with one another, were associated with these changes. Results showed that ENDS use frequency increased with increasing age. Depressive symptoms and sensation seeking were not independently associated with more frequent ENDS use or an accelerated increase in ENDS use frequency across increasing age. However, a significant two-way interaction indicated that young adults with elevated depressive symptoms used ENDS more frequently, but only when they had higher levels of sensation seeking. Findings indicate that young adults with depressive symptoms are a heterogeneous population and that those with high levels of sensation-seeking tendencies are at elevated risk for more frequent ENDS use. Interventions for young adults high in both sensation-seeking and depressive symptoms may help prevent and decrease ENDS use.
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Affiliation(s)
- Alexandra Loukas
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto, Austin, TX, 78712, USA.
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Anna V Wilkinson
- Department of Epidemiology, Human Genetics and Environmental Science, UTHealth Houston School of Public Health, Houston, USA
| | - C Nathan Marti
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto, Austin, TX, 78712, USA
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13
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Lao U, Li Y, Bai W, Wang Y, Li Y, Xie Y, Huang X, Zhu H, Zou X. Adaptation and Feasibility of the Mandarin Version of PEERS ® for Autistic Adolescents. J Autism Dev Disord 2023:10.1007/s10803-023-06056-w. [PMID: 37480435 DOI: 10.1007/s10803-023-06056-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The Program for the Education and Enrichment of Relational Skills (PEERS®) is a group-based social skills training program for adolescents on the autism spectrum. Although the program has been shown to be effective in improving social skills in autistic adolescents, evidence of its effectiveness from the Mandarin-speaking Chinese population is sparse. The present study used a non-randomized, pre- and post-intervention research design to investigate the feasibility and cultural validity of the program, as well as examine the moderators of intervention outcomes. METHODS Thirty-three autistic adolescents with intelligence quotient above 70 (Mage = 13.57, SDage = 1.43; Male: Female 25:8) and their parents received 14 concurrent 90-minute sessions. Adolescents' autistic traits, challenging behaviors, emotional functioning, socio-cognitive process, social environment factors (school support), and caregivers' well-being were evaluated. RESULTS The findings suggest that with minor adjustments, the Mandarin version of PEERS® was generally acceptable and feasible for autistic adolescents and their parents. PEERS® may improve the social skills knowledge, reciprocal communication abilities, and emotional well-being of autistic adolescents. Also, participants with a higher level of school support, and parents with lower perceived subjective well-being at baseline may gain more benefits from PEERS®. The cultural adaptation and acceptability of the Mandarin Version of PEERS® were discussed. CONCLUSION This feasibility study (Chinese Clinical Trial Registry: ChiCTR2200061417, 2022-06-23, retrospectively registered) provides a basis for further randomized control trials of the Mandarin version of PEERS®.
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Affiliation(s)
- Uchong Lao
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China
| | - Yan Li
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China
| | - Wuxia Bai
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China
| | - Yu Wang
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China
| | - Yongmei Li
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China
| | - Yixiang Xie
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China
| | - Xiaoqian Huang
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China
| | - Huilin Zhu
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China.
| | - Xiaobing Zou
- Child Development and Behavior Center, The Third Affiliated Hospital, Sun Yat-Sen University, 2693 Kai Chuang Avenue, Huangpu District, Guangzhou, 510530, China.
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García-Fernández G, Krotter A, González-Roz A, García-Pérez Á, Secades-Villa R. Effectiveness of including weight management in smoking cessation treatments: A meta-analysis of behavioral interventions. Addict Behav 2023; 140:107606. [PMID: 36642013 DOI: 10.1016/j.addbeh.2023.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The potential of weight gain after smoking cessation reduces the incentive to quit. This meta-analysis examines the efficacy of behavioral interventions for smoking cessation that also address post-cessation weight gain. METHODS Medline, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials on behavioral treatments targeting both health outcomes. Six separate meta-analyses were undertaken to assess treatment efficacy on smoking abstinence and weight outcomes at end of treatment (EOT), short-term, and long-term follow-up. Individual and treatment moderators were examined as well as methodological quality and publication bias of studies. RESULTS A total of 28 studies were included in the meta-analysis. There was a statistically significant positive impact of treatments addressing both targets on smoking outcomes at EOT (RR = 1.279, 95% CI: 1.096, 1.492, p = .002), but not at follow-ups. Age impacted on EOT abstinence rates Q (1) = 4.960, p = .026) while increasing the number of sessions significantly improved EOT abstinence rates (p = .020). There was no statistically significant impact of these treatments on weight at EOT (Hedges' g = -0.015, 95% CI: -.164, 0.135, p = .849) or follow-ups (short term: Hedges' g = 0.055, 95% CI: -0.060, 0.170, p = .347; long term: Hedges' g = -0.320, 95% CI: -.965, 0.325, p = .331). There were minimal impacts of publication bias, mostly related to sample size, meaning studies including small sample sizes revealed larger effect sizes on abstinence at EOT. DISCUSSION Addressing post-cessation weight management in treatments for smoking cessation significantly enhances tobacco abstinence at EOT though it was not found to have a lasting impact after treatment.
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Affiliation(s)
- Gloria García-Fernández
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain.
| | - Andrea Krotter
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Alba González-Roz
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Ángel García-Pérez
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Roberto Secades-Villa
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
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15
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Dale R, Limburg K, Schmid-Mühlbauer G, Probst T, Lahmann C. Somatic symptom distress and gender moderate the effect of integrative group psychotherapy for functional vertigo on vertigo handicap: A moderation analysis of a randomised controlled trial. J Psychosom Res 2023; 167:111175. [PMID: 36753945 DOI: 10.1016/j.jpsychores.2023.111175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Psychotherapeutic treatments for functional vertigo have shown promising results in recent years but it is still to be determined for whom these treatments work best. The aim of this study was to run a moderation analysis to identify which baseline factors may moderate the success of integrative psychotherapeutic group treatment (IPGT) as compared to a self-help group (SHG) active control. METHODS Data from 159 patients included in a 16-week randomised controlled trial were analysed. The outcome was vertigo-related handicap at post-treatment and gender, age, baseline somatisation, depression and anxiety were taken as putative moderators. RESULTS We found that baseline somatic symptoms (i.e. PHQ-15 score, p = 0.04, ∆R2 = 0.02) and gender (p = 0.04, ∆R2 = 0.02) significantly moderated the effect of treatment type on post-treatment vertigo handicap. Patients with higher PHQ-15 scores at baseline and women reduced their vertigo handicap more in IPGT as compared to in the control condition. CONCLUSION A possible explanation for this result is that somatic symptom distress is the central aetiopathogenetic factor of functional vertigo, while depressiveness and anxiety are rather epiphenomena in the sense of comorbidity. Although the results are not entirely consistent, according to some studies, female gender seems to be a favourable predictor of better therapy outcome. Given the high impairment and healthcare costs in those with vertigo/dizziness and psychiatric comorbidity, it is important to effectively treat these patients as early as possible. This study provides a prescriptive tool for practitioners, allowing for more patient-tailored treatment decisions.
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Affiliation(s)
- Rachel Dale
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Austria.
| | - Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany.
| | | | - Thomas Probst
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems, Austria.
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, 79104 Freiburg, Germany.
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16
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Peris-Baquero Ó, Moreno-Pérez JD, Navarro-Haro MV, Díaz-García A, Osma J. Emotion dysregulation and neuroticism as moderators of group Unified Protocol effectiveness outcomes for treating emotional disorders. J Affect Disord 2023; 331:313-321. [PMID: 36977435 DOI: 10.1016/j.jad.2023.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The personality dimension neuroticism and difficulties in emotional regulation (ER) are two variables closely related to the onset, course, and maintenance of emotional disorders (EDs). The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a treatment specifically designed to address neuroticism by training in adaptive ER skills and has been shown to be effective in reducing difficulties in ER. However, the specific impact of these variables on treatment outcomes is not entirely clear. The aim of the present study was to explore the moderating role of neuroticism and difficulties in ER regarding the evolution of depressive and anxiety symptoms and quality of life. METHODS This secondary study included 140 participants diagnosed with EDs, who received the UP in group format as part of an RCT being conducted in different Spanish Public Mental Health Units. RESULTS The results of this study found that high scores in neuroticism and difficulties in ER were associated with greater severity of depression and anxiety symptomatology, and with poorer quality of life. In addition, difficulties in ER moderated the efficacy of UP regarding anxiety symptoms, and quality of life. No moderating effects were found for depression (p > 0.5). LIMITATIONS We only evaluated two moderators that may influence UP effectivenes; other key moderators should be analyzed in future. CONCLUSIONS The identification of specific moderators affecting transdiagnostic interventions outcomes will allow the development of personalized interventions and provide useful information to improve the psychopathology and well-being of people with EDs.
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Affiliation(s)
- Ó Peris-Baquero
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | | | - M V Navarro-Haro
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - A Díaz-García
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - J Osma
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
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17
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Wienicke FJ, Beutel ME, Zwerenz R, Brähler E, Fonagy P, Luyten P, Constantinou M, Barber JP, McCarthy KS, Solomonov N, Cooper PJ, De Pascalis L, Johansson R, Andersson G, Lemma A, Town JM, Abbass AA, Ajilchi B, Connolly Gibbons MB, López-Rodríguez J, Villamil-Salcedo V, Maina G, Rosso G, Twisk JWR, Burk WJ, Spijker J, Cuijpers P, Driessen E. Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data. Clin Psychol Rev 2023; 101:102269. [PMID: 36958077 DOI: 10.1016/j.cpr.2023.102269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/04/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examined the efficacy and moderators of STPP for depression compared to control conditions. METHODS PubMed, PsycInfo, Embase, and Cochrane Library were searched September 1st, 2022, to identify randomized trials comparing STPP to control conditions for adults with depression. IPD were requested and analyzed using mixed-effects models. RESULTS IPD were obtained from 11 of the 13 (84.6%) studies identified (n = 771/837, 92.1%; mean age = 40.8, SD = 13.3; 79.3% female). STPP resulted in significantly lower depressive symptom levels than control conditions at post-treatment (d = -0.62, 95%CI [-0.76, -0.47], p < .001). At post-treatment, STPP was more efficacious for participants with longer rather than shorter current depressive episode durations. CONCLUSIONS These results support the evidence base of STPP for depression and indicate episode duration as an effect modifier. This moderator finding, however, is observational and requires prospective validation in future large-scale trials.
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Affiliation(s)
- Frederik J Wienicke
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Patrick Luyten
- Department of Clinical, Educational and Health Psychology, University College London, London, UK; Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Matthew Constantinou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jacques P Barber
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA
| | - Kevin S McCarthy
- Department of Psychology, Chestnut Hill College, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Peter J Cooper
- School of Psychology and Clinical Language Science, University of Reading, Reading, UK
| | - Leonardo De Pascalis
- Department of Psychological Science, University of Liverpool, Liverpool, UK; Department of Psychology, University of Bologna, Bologna, Italy
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Alessandra Lemma
- Anna Freud National Center for Children and Families, London, UK
| | - Joel M Town
- Center for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Allan A Abbass
- Center for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bita Ajilchi
- Department of Psychology, Faculty of Human Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mary Beth Connolly Gibbons
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Giuseppe Maina
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Gianluca Rosso
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - William J Burk
- Department of Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Jan Spijker
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands
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Röver C, Friede T. Using the bayesmeta R package for Bayesian random-effects meta-regression. Comput Methods Programs Biomed 2023; 229:107303. [PMID: 36566650 DOI: 10.1016/j.cmpb.2022.107303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Random-effects meta-analysis within a hierarchical normal modeling framework is commonly implemented in a wide range of evidence synthesis applications. More general problems may even be tackled when considering meta-regression approaches that in addition allow for the inclusion of study-level covariables. METHODS We describe the Bayesian meta-regression implementation provided in the bayesmetaR package including the choice of priors, and we illustrate its practical use. RESULTS A wide range of example applications are given, such as binary and continuous covariables, subgroup analysis, indirect comparisons, and model selection. Example R code is provided. CONCLUSIONS The bayesmeta package provides a flexible implementation. Due to the avoidance of MCMC methods, computations are fast and reproducible, facilitating quick sensitivity checks or large-scale simulation studies.
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Affiliation(s)
- Christian Röver
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany.
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
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Henriksson A, Strandberg E, Stenling A, Mazzoni AS, Sjövall K, Börjeson S, Raastad T, Demmelmaier I, Berntsen S, Nordin K. Does inflammation markers or treatment type moderate exercise intensity effects on changes in muscle strength in cancer survivors participating in a 6-month combined resistance- and endurance exercise program? Results from the Phys-Can trial. BMC Sports Sci Med Rehabil 2023; 15:8. [PMID: 36658635 PMCID: PMC9854232 DOI: 10.1186/s13102-023-00617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Resistance exercise has a beneficial impact on physical function for patients receiving oncological treatment. However, there is an inter-individual variation in the response to exercise and the tolerability to high-intensity exercise. Identifying potential moderating factors, such as inflammation and treatment type, for changes in muscle strength is important to improve the effectiveness of exercise programs. Therefore, we aimed to investigate if inflammation and type of oncological treatment moderate the effects of exercise intensity (high vs. low-moderate) on muscular strength changes in patients with breast (BRCA) or prostate cancer (PRCA). METHODS Participants with BRCA (n = 286) and PRCA (n = 65) from the Physical training and Cancer study (Phys-Can) were included in the present study. Participants performed a combined resistance- and endurance exercise program during six months, at either high or low-moderate intensity. Separate regression models were estimated for each cancer type, with and without interaction terms. Moderators included in the models were treatment type (i.e., neo/adjuvant chemotherapy-yes/no for BRCA, adjuvant androgen deprivation therapy (ADT)-yes/no for PRCA)), and inflammation (interleukin 6 (IL6) and tumor necrosis factor-alpha (TNFα)) at follow-up. RESULTS For BRCA, neither IL6 (b = 2.469, 95% CI [- 7.614, 12.552]) nor TNFα (b = 0.036, 95% CI [- 6.345, 6.418]) levels moderated the effect of exercise intensity on muscle strength change. The same was observed for chemotherapy treatment (b = 4.893, 95% CI [- 2.938, 12.724]). Similarly, for PRCA, the effect of exercise intensity on muscle strength change was not moderated by IL6 (b = - 1.423, 95% CI [- 17.894, 15.048]) and TNFα (b = - 1.905, 95% CI [- 8.542, 4.732]) levels, nor by ADT (b = - 0.180, 95% CI [- 11.201, 10.841]). CONCLUSIONS The effect of exercise intensity on muscle strength is not moderated by TNFα, IL6, neo/adjuvant chemotherapy, or ADT, and therefore cannot explain any intra-variation of training response regarding exercise intensity (e.g., strength gain) for BRCA or PRCA in this setting. TRIAL REGISTRATION ClinicalTrials.gov NCT02473003.
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Affiliation(s)
- Anna Henriksson
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Emelie Strandberg
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Stenling
- grid.23048.3d0000 0004 0417 6230Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway ,grid.12650.300000 0001 1034 3451Department of Psychology, Umeå University, Umeå, Sweden
| | - Anne-Sophie Mazzoni
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Sjövall
- grid.16982.340000 0001 0697 1236Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Sussanne Börjeson
- grid.5640.70000 0001 2162 9922Department of Oncology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Truls Raastad
- grid.23048.3d0000 0004 0417 6230Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway ,grid.412285.80000 0000 8567 2092Department of Physical Performance, Norwegian School of Sport Science, Oslo, Norway
| | - Ingrid Demmelmaier
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden ,grid.23048.3d0000 0004 0417 6230Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Sveinung Berntsen
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden ,grid.23048.3d0000 0004 0417 6230Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Karin Nordin
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Tudor K, Maloney S, Raja A, Baer R, Blakemore SJ, Byford S, Crane C, Dalgleish T, De Wilde K, Ford T, Greenberg M, Hinze V, Lord L, Radley L, Opaleye ES, Taylor L, Ukoumunne OC, Viner R, Kuyken W, Montero-Marin J. Universal Mindfulness Training in Schools for Adolescents: a Scoping Review and Conceptual Model of Moderators, Mediators, and Implementation Factors. Prev Sci 2022; 23:934-953. [PMID: 35267177 PMCID: PMC9343282 DOI: 10.1007/s11121-022-01361-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 02/02/2023]
Abstract
There is evidence that universal school-based mindfulness training (SBMT) can have positive effects for young people. However, it is unknown who benefits most from such training, how training exerts effects, and how implementation impacts effects. This study aimed to provide an overview of the evidence on the mediators, moderators, and implementation factors of SBMT, and propose a conceptual model that can be used both to summarize the evidence and provide a framework for future research. A scoping review was performed, and six databases and grey literature were searched. Inclusion and exclusion criteria were applied to select relevant material. Quantitative and qualitative information was extracted from eligible articles and reported in accordance with PRISMA-ScR guidelines. The search produced 5479 articles, of which 31 were eligible and included in the review. Eleven studies assessed moderators of SBMT on pupil outcomes, with mixed findings for all variables tested. Five studies examined the mediating effect of specific variables on pupil outcomes, with evidence that increases in mindfulness skills and decreases in cognitive reactivity and self-criticism post-intervention are related to better pupil outcomes at follow-up. Twenty-five studies assessed implementation factors. We discuss key methodological shortcomings of included studies and integrate our findings with existing implementation frameworks to propose a conceptual model. Widespread interest in universal SBMT has led to increased research over recent years, exploring who SBMT works for and how it might work, but the current evidence is limited. We make recommendations for future research and provide a conceptual model to guide theory-led developments.
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Affiliation(s)
- Kate Tudor
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Anam Raja
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Baer
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Sarah Byford
- Health Service and Population Research, King's College London, London, UK
| | | | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mark Greenberg
- Human Development and Family Studies, Penn State University, State College, USA
| | - Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Liz Lord
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lucy Radley
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Laura Taylor
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Russell Viner
- Institute of Child Health, University College London, London, UK
| | | | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, UK
- Teaching, Reseach & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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21
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Gorrell S, Byrne CE, Trojanowski PJ, Fischer S, Le Grange D. A scoping review of non-specific predictors, moderators, and mediators of family-based treatment for adolescent anorexia and bulimia nervosa: a summary of the current research findings. Eat Weight Disord 2022; 27:1971-1990. [PMID: 35092554 PMCID: PMC9872820 DOI: 10.1007/s40519-022-01367-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/13/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE This scoping review presents an up-to-date synthesis of the current evidence base for non-specific predictors, moderators, and mediators of family-based treatment (FBT) for adolescent anorexia and bulimia nervosa. METHODS We identify ways in which end-of-treatment outcomes have been shown to differ based upon baseline clinical features and person-specific factors and explore psychological mechanisms that may explain differences in treatment response. We draw from this evidence base to outline recommendations for clinical practice, as well as directions for future clinical eating disorder research. RESULTS Noted findings from review include that early response in weight gain and parental criticism may be particularly influential in treatment for anorexia nervosa. Further, for adolescents with either anorexia or bulimia nervosa, eating-related obsessionality may be a key intervention target to improve outcomes. CONCLUSION In addition to highlighting a need for attention to specific patient- and caregiver-level factors that impact treatment response, recommendations for research and clinical practice include testing whether certain targeted treatments (e.g., exposure-based approaches) may be suitable within the context of FBT for eating disorders. LEVEL OF EVIDENCE Level I: Evidence obtained from: at least one properly designed randomized controlled trials; experimental studies.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA
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22
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Goldstein LH, Robinson EJ, Chalder T, Stone J, Reuber M, Medford N, Carson A, Moore M, Landau S. Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res 2022; 158:110921. [PMID: 35617911 DOI: 10.1016/j.jpsychores.2022.110921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). METHODS We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. RESULTS Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. CONCLUSION Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.
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Affiliation(s)
- L H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, UK; Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK.
| | - T Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK.
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - A Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK.
| | - S Landau
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, UK.
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23
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Pradhan S, Chiu S, Burton C, Forsyth J, Corp N, Paskins Z, van der Windt DA, Babatunde OO. Overall Effects and Moderators of Rehabilitation in Patients With Wrist Fracture: A Systematic Review. Phys Ther 2022; 102:6566429. [PMID: 35421234 DOI: 10.1093/ptj/pzac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/05/2021] [Accepted: 04/05/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Wrist fractures constitute the most frequently occurring upper limb fracture. Many individuals report persistent pain and functional limitations up to 18 months following wrist fracture. Identifying which individuals are likely to gain the greatest benefit from rehabilitative treatment is an important research priority. This systematic review aimed to summarize effectiveness of rehabilitation after wrist fracture for pain and functional outcomes and identify potential effect moderators of rehabilitation. METHODS A comprehensive search of 7 databases (including MEDLINE, EMBASE, and the Physiotherapy Evidence Database) was performed for randomized controlled trials involving adults >50 years of age who sustained wrist fracture and had received 1 or more conservative treatments (eg, exercise/manual therapy, lifestyle, diet, or other advice). Study selection, data extraction, and risk-of-bias assessment were conducted independently by 2 reviewers. Results of included trials were summarized in a narrative synthesis. RESULTS A total of 3225 titles were screened, and 21 studies satisfying all eligibility criteria were reviewed. Over one-half of the included studies (n = 12) comprised physical therapist and/or occupational therapist interventions. Rehabilitative exercise/manual therapy was generally found to improve function and reduce pain up to 1 year after wrist fracture. However, effects were small, and home exercises were found to be comparable with physical therapist-led exercise therapy. Evidence for the effects of other nonexercised therapy (including electrotherapy, whirlpool) was equivocal and limited to the short term (<3 months). Only 2 studies explored potential moderators, and they did not show evidence of moderation by age, sex, or patient attitude of the effects of rehabilitation. CONCLUSION Effectiveness of current rehabilitation protocols after wrist fracture is limited, and evidence for effect moderators is lacking. Currently available trials are not large enough to produce data on subgroup effects with sufficient precision. To aid clinical practice and optimize effects of rehabilitation after wrist fracture, potential moderators need to be investigated in large trials or meta-analyses using individual participant data. IMPACT Many patients report persistent pain and functional limitations up to 18 months following wrist fracture. Effectiveness of current rehabilitation protocols after wrist fracture is limited and may be due to insufficient targeting of specific rehabilitation to individuals who are likely to benefit most. However, evidence for effect moderators is lacking within the currently available literature. To aid clinical practice and optimize effects of rehabilitation, investigating potential moderators of rehabilitation in individuals with wrist fracture via large trials or meta-analysis of individual participant data is research and policy imperative.
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Affiliation(s)
- Sara Pradhan
- University Hospital North Midlands NHS Trust, Newcastle Rd, Stoke-on-Trent, UK
| | - Sarah Chiu
- School of Medicine, Keele University, Staffordshire, Keele, UK
| | - Claire Burton
- School of Medicine, Keele University, Staffordshire, Keele, UK
| | - Jacky Forsyth
- Staffordshire University, Leek Road, Stoke-on-Trent UK
| | - Nadia Corp
- School of Medicine, Keele University, Staffordshire, Keele, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Staffordshire, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
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24
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Hennemann S, Witthöft M, Kleinstäuber M, Böhme K, Baumeister H, Ebert DD, Probst T. Somatosensory amplification moderates the efficacy of internet-delivered CBT for somatic symptom distress in emerging adults: Exploratory analysis of a randomized controlled trial. J Psychosom Res 2022; 155:110761. [PMID: 35182889 DOI: 10.1016/j.jpsychores.2022.110761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While studies mainly provide positive evidence for the efficacy of internet-delivered cognitive-behavioral therapy (ICBT) for various persistent somatic symptoms, it remains largely unclear for whom these interventions work or not. This exploratory analysis aimed to identify moderators for the outcome between ICBT for somatic symptom distres and a waitlist control group (WL) in a vulnerable target group of emerging adults. METHODS Based on data from a randomized controlled trial on 156 university students with varying degrees of somatic symptom distress who were allocated to either an eight-week, therapist guided ICBT (iSOMA) or to the WL, we examined pretreatment demographic characteristics, health-related variables (e.g., somatic symptom duration), mental distress (e.g., depression, anxiety) and cognitive-emotional factors (emotional reactivity, somatosensory amplification) as candidate moderators of the outcome, somatic symptom distress (assessed by the Patient Health Questionnaire, PHQ-15) from pre- to posttreatment. RESULTS Somatosensory amplification (assessed by the Somatosensory Amplification Scale, SSAS) moderated the outcome in favor of iSOMA (B = -0.17, SE = 0.08, p = 0.031), i.e., higher pretreatment somatosensory amplification was associated with better outcome in the active compared to the control intervention. No significant moderation effects were found among demographic characteristics, health-related variables, or mental distress. CONCLUSION Our findings suggest that an internet-delivered CBT for somatic symptom distress should be preferred over no active treatment particularly in individuals with moderate to high levels of somatosensory amplification, which as a next step should be tested against further treatments and in clinical populations. TRIAL REGISTRATION German Clinical Trials Register (DRKS00014375).
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Affiliation(s)
- Severin Hennemann
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Michael Witthöft
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Maria Kleinstäuber
- Utah State University, Emma Eccles Jones College of Education and Human Services, Department of Psychology, Logan (Utah), USA
| | - Katja Böhme
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Harald Baumeister
- Ulm University, Department of Clinical Psychology and Psychotherapy, Ulm, Germany
| | - David Daniel Ebert
- Technical University of Munich, Department of Sport and Health Sciences, München, Germany
| | - Thomas Probst
- Danube University Krems, Department for Psychotherapy and Biopsychosocial Health, Krems, Austria
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25
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Hoorelbeke K, Vervaeke J, Siegle GJ, Baeken C, Koster EH. Individual differences associated with treatment adherence and transfer effects following gamified web-based cognitive control training for repetitive negative thinking. Internet Interv 2022; 27:100507. [PMID: 35242588 PMCID: PMC8859013 DOI: 10.1016/j.invent.2022.100507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/27/2022] Open
Abstract
Recent research suggests beneficial effects of cognitive control training (CCT) on repetitive negative thinking (RNT), a key risk factor for internalizing symptomatology. However, relatively little is known regarding predictors of adherence to internet-delivered CCT as well as moderators of treatment effects for this intervention. Answering these questions could improve efficiency of clinical implementation of CCT as an eHealth intervention. The current pre-registered single-arm trial set-out to address these questions using a web-based gamified CCT procedure based on the adaptive Paced Auditory Serial Addition Task. Participants (N = 382) entered the internet-based study, where we observed considerable drop-out during the assessment phase and the first training sessions. Emotional stability and resilience emerged as predictors for deciding not to commence the intervention. Drop-out throughout the course of CCT was explained by age, emotion regulation-, and personality factors. We used latent profile analysis, a probabilistic modeling approach, to identify clusters of participants (User Profiles) based on indicators of baseline cognitive- and emotional functioning, training progress, and user experience. We obtained three User Profiles, reflecting low-, moderate-, and high-risk status. Effortful control, emotion regulation, internalizing symptomatology, resilience, and emotional stability played a central role in these User Profiles. Interestingly, User Profile predicted training related cognitive gains, as well as effects of CCT on anxiety- and stress symptoms, and reappraisal. Our findings suggest that CCT is most effective for the moderate- and high-risk groups. In addition, the high-risk group would likely benefit from a more intensive training procedure or repeated administration of the training procedure over time to foster long-term retention of training related gains.
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Affiliation(s)
- Kristof Hoorelbeke
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium,Corresponding author at: Henri-Dunantlaan 2, 9000 Ghent, Belgium.
| | - Jasmien Vervaeke
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium,Imec-Mict-Ghent University, Ghent, Belgium
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chris Baeken
- Department of Head and Skin (UZGent), Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium,Department of Psychiatry (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium,Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - Ernst H.W. Koster
- Psychopathology and Affective Neuroscience (PAN) lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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26
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Smith GC, Hancock GR, Hayslip B. Predictors and moderators of treatment efficacy in reducing custodial grandmothers' psychological distress. Aging Ment Health 2022; 26:250-262. [PMID: 33393377 PMCID: PMC8846565 DOI: 10.1080/13607863.2020.1857688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is increasingly recommended that hypothesis-generating studies be conducted after initial RCTs in order to identify moderators of differential treatment efficacy on individual outcomes. Such analyses are important because they help clarify the best inclusion and exclusion criteria or choice of stratification for maximizing power in subsequent RCTs, reduce the chances of discarding interventions that may appear to lack efficacy when only average treatment effects are taken into consideration, and facilitate the matching of individual clients to treatment alternatives. We identified predictors and moderators of treatment-related change in psychological distress among custodial grandmothers (n = 343) assigned within a prior RCT to behavior parent training (BPT), cognitive behavior therapy (CBT), or information only control (IOC) conditions. Latent change scores in psychological distress were estimated for each grandmother across pre-test to post-test and pre-test to six months, as indicated by self-reported and clinical ratings of depression and anxiety symptoms. These estimates served as outcomes in classification and regression tree analyses conducted separately within the CBT and BPT conditions to identify predictors of treatment efficacy. Matched groups based upon identified predictors were then formed across all RCT conditions, and Predictor × RCT Condition interactions were computed to test for moderation of differential treatment efficacy. Grandmother age was the only predictor and moderator of BPT efficacy at both measurement points, whereas multifaceted predictors and moderators emerged for CBT which varied by time since treatment.
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Affiliation(s)
- Gregory C. Smith
- School of Lifespan Development and Educational Sciences, Kent State University, Kent, OH, USA
| | - Gregory R. Hancock
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Bert Hayslip
- Department of Psychology, University of North Texas, Denton, Denton, TX, USA
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27
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Helander M, Enebrink P, Hellner C, Ahlen J. Parent Management Training Combined with Group-CBT Compared to Parent Management Training Only for Oppositional Defiant Disorder Symptoms: 2-Year Follow-Up of a Randomized Controlled Trial. Child Psychiatry Hum Dev 2022. [PMID: 35089501 DOI: 10.1007/s10578-021-01306-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
Parent management training (PMT) is recommended treatment for children with oppositional defiant disorder (ODD) and child-directed cognitive behavior therapy (CBT) is also recommended for school-aged children. The current study examined 2-year follow-up effects of parent management training (PMT) combined with the CBT based group intervention Coping Power Program (CPP) compared to PMT only. Results showed long-term effectiveness of both PMT and PMT combined with CPP in reduced disruptive behavior problems and harsh parenting strategies, and increased emotion regulation- and social communication skills. The earlier reported increase in emotion regulation- and social communication skills in the PMT with CPP condition during treatment remained stable while the PMT condition showed continued improvement during the follow-up period. To conclude, PMT with CPP did generally not provide significant benefits at the 2-year follow-up compared to PMT, apart from an improvement earlier in time regarding emotion regulation- and social communication skills.Trial registration number ISRCTN10834473, date of registration: 23/12/2015.
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28
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Pinto BM, Dunsiger SI, Kindred MM, Mitchell S. Peer mentoring for physical activity adoption and maintenance among breast cancer survivors: moderators of physical activity outcomes. J Cancer Surviv 2022:10.1007/s11764-021-01162-z. [PMID: 34994945 DOI: 10.1007/s11764-021-01162-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We aimed to identify the moderators of maintenance strategies' effects to assist cancer care organizations that offer peer mentoring physical activity programs. METHODS A total of 161 inactive breast cancer survivors participated in a 12-month study and were randomized to one of three conditions at baseline. American Cancer Society's Reach to Recovery coaches delivered weekly calls to participants for the first 3 months. During Months 4-9, participants self-monitored PA and received feedback (Reach Plus) or additionally received monthly calls from coaches (Reach Plus Phone) or weekly text/email messages (Reach Plus Message). Moderate-to-vigorous PA (MVPA) was assessed using self-report and accelerometry at baseline, 3, 6, 9, and 12 months. We examined baseline demographics, cancer-specific, and social cognitive variables as potential moderators of MVPA. Using Latent Class Models, we identified three participant profiles. The profile was used as a moderator in longitudinal mixed-effects models of MVPA. RESULTS Profile 1 (44%) were married, White, in preparation, with higher income and higher social support. Profile 2 (41%) were older, office employees, African American, with higher PA self-efficacy. Profile 3 (15%) were diagnosed with stage 1 cancer, in contemplation, with higher MVPA and lower social support. At follow-ups, among those with Profile 1, Reach Plus participants had higher MVPA than other groups (f2 [Formula: see text].10). Among those with Profile 2, Reach Plus Message participants had higher mean MVPA than other groups (f2 [Formula: see text].11). Among those with Profile 3, Reach Plus Phone participants had higher MVPA than other groups, f2 [Formula: see text].11 (all ps < .05). CONCLUSIONS Organizations can choose PA maintenance strategies that are most effective for survivors with specific profiles. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors with specific profiles increase PA when receiving certain PA maintenance programs. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02694640 (Feb. 26, 2016).
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Affiliation(s)
- Bernardine M Pinto
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29209, USA.
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29
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Czysz AH, Mason BL, Li Q, Chin-Fatt C, Minhajuddin A, Carmody T, Trivedi MH. Comparison of inflammatory markers as moderators of depression outcomes: A CO-MED study. J Affect Disord 2021; 295:1066-1071. [PMID: 34706415 DOI: 10.1016/j.jad.2021.08.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/30/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prior work suggests some individual immunomarkers may be useful moderators of treatment response between antidepressant medications. The relative moderating effect of individual immunomarkers remains unclear. It is also unknown whether combinations of immunomarkers have a superior moderating effect compared to any individual immunomarker. METHODS Baseline immunomarker levels were assayed using multiplex from a subset of participants in the CO-MED trial (n = 143). Individual and combinations of 19 immunomarkers were modeled as moderators between the three treatment arms (escitalopram monotherapy, escitalopram-bupropion and venlafaxine-mirtazapine) across a variety of depression outcomes. RESULTS Only IL-13 demonstrated a consistent moderating effect across all depression outcome measures. High IL-13 (>20 pg/ml) was associated with higher remission rates to bupropion-escitalopram (67%) versus escitalopram (24%) whereas low IL-13 was associated higher remission rates to escitalopram (59%) versus bupropion-escitalopram (38%). A similar, but weaker moderating effect was observed with venlafaxine-mirtazapine versus escitalopram. The addition of multiple immunomarkers did not consistently improve predictive modeling. LIMITATIONS This is a secondary analysis of a single clinical trial with a relatively small sample size per treatment arm. The testing of specific individual and combinations of biomarkers was data-driven. CONCLUSIONS Among 19 immunomarkers, Il-13 was the best single moderator of treatment outcome. Combinations of immunomarkers were not meaningfully superior to Il-13.
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Affiliation(s)
- Andrew H Czysz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Brittany L Mason
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Qiwei Li
- Department of Mathematical Sciences, University of Texas Dallas, Richardson, TX, United States of America
| | - Cherise Chin-Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Abu Minhajuddin
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Thomas Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
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Ghaffari M, Morowatisharifabad MA, Jadgal MS, Mehrabi Y, Alizadeh S. The effectiveness of intervention based on the transactional model on improving coping efforts and stress moderators in hemodialysis patients in Tehran: a randomized controlled trial. BMC Nephrol 2021; 22:377. [PMID: 34763652 PMCID: PMC8588589 DOI: 10.1186/s12882-021-02592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Present study was conducted to determine the effect of training on coping efforts and stress moderators, based on transactional model of Lazarus and Folkman, in hemodialysis patients. METHODS This is a randomized controlled clinical trial on 116 hemodialysis patients referred to dialysis centers in Tehran from May to August 2018. The patients were assigned to two experimental and control groups using a simple randomization method. The intervention included 6 training sessions in the form of coping efforts and moderators of transactional model. Data were collected before and 3 months after the intervention. Data were analyzed using SPSS 16. RESULTS After 3 months training intervention, there was significant increase in the intervention group in the mean scores of coping efforts (P < 0.001), moderators and subscales of emotional regulation from 51.18 ± 20.42 to 64.87 ± 13.18 (P < 0.001), dispositional coping style from 45.56 ± 19.45 to 55.84 ± 18.03 and social support from 49.61 ± 20.14 to 55.55 ± 17.35 (P < 0.005). CONCLUSION The training based on transactional model was successful in the increase of social support, dispositional coping style and emotional regulation in hemodialysis patients. Therefore, Nurses and healthcare providers can use this program to help hemodialysis patients to increase their adaptation to the illness and reduce stress. TRIAL REGISTRATION IRCT registration number: IRCT20180524039814N1 ; Registration date: 13-08-2018; Registration timing: retrospectively registered: Last update: 13-08-2018.
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Affiliation(s)
- Mohtasham Ghaffari
- Environmental and Occupational Hazards Control Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Saeed Jadgal
- Tropical and communicable diseases research center, Iranshahr University of Medical Sciences and health services, Iranshahr, Iran.,Department of Public Health, School of Nursing and Midwifery, Iranshahr University of Medical Sciences and Health Services, Iranshahr, Iran
| | - Yadollah Mehrabi
- School of public health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Alizadeh
- Health Department, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
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Reins JA, Buntrock C, Zimmermann J, Grund S, Harrer M, Lehr D, Baumeister H, Weisel K, Domhardt M, Imamura K, Kawakami N, Spek V, Nobis S, Snoek F, Cuijpers P, Klein JP, Moritz S, Ebert DD. Efficacy and Moderators of Internet-Based Interventions in Adults with Subthreshold Depression: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials. Psychother Psychosom 2021; 90:94-106. [PMID: 32544912 DOI: 10.1159/000507819] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. OBJECTIVE We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. METHODS Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. RESULTS Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. CONCLUSIONS Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.
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Affiliation(s)
- Jo Annika Reins
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Simon Grund
- Leibniz Institute for Science and Mathematics Education, University of Kiel, Kiel, Germany
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Kiona Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Kotaro Imamura
- Department of Mental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Viola Spek
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Stephanie Nobis
- Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Frank Snoek
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Daniel Ebert
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,
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Kosterman R, Epstein M, Bailey JA, Furlong M, Hawkins JD. The role of electronic cigarette use for quitting or reducing combustible cigarette use in the 30s: Longitudinal changes and moderated relationships. Drug Alcohol Depend 2021; 227:108940. [PMID: 34358769 PMCID: PMC8464509 DOI: 10.1016/j.drugalcdep.2021.108940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evidence for use of electronic cigarettes (e-cigs) as a potential aid in quitting or reducing combustible cigarette (c-cig) use is mixed. This study examined the extent to which e-cig initiation among smokers in their 30 s predicted quitting or reducing smoking or nicotine dependence symptoms by age 39, and whether the role of e-cigs in quitting differed by prospectively assessed moderators. METHODS Data were from the Seattle Social Development Project (SSDP), a panel study of 808 diverse participants with high retention. A subsample of 221 smokers at age 33 was selected for analysis. Self-reports of c-cig use and dependence were assessed longitudinally at ages 33 and 39. Sixteen potential moderators were examined, including social demographics, smoking attitudes and desire to quit, other health behaviors and status, and adolescent and early adult assessments of smoking history. RESULTS The use of e-cigs was consistently associated with a lower likelihood of quitting c-cigs by age 39, after accounting for frequency of prior c-cig use at age 33. This negative association persisted across all moderators examined, although it was nonsignificant among those with a definite desire to cut down. Among those who did not quit smoking, e-cig use had no association with decreases in either quantity of c-cigs used or dependence symptoms. CONCLUSIONS Results indicate that e-cigarette use was not helpful for quitting or reducing combustible cigarette use in the 30 s. Rather, across extensive tests of moderation, e-cig initiation consistently predicted less quitting during this important age period for successful cessation.
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Affiliation(s)
- Rick Kosterman
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave NE, Suite 401, Seattle, WA, 98115, USA.
| | - Marina Epstein
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave NE, Suite 401, Seattle, WA, 98115, USA.
| | - Jennifer A. Bailey
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave NE, Suite 401, Seattle, WA 98115, USA
| | - Madeline Furlong
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave NE, Suite 401, Seattle, WA, 98115, USA.
| | - J. David Hawkins
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave NE, Suite 401, Seattle, WA 98115, USA
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Eliasson ET, McNamee L, Swanson L, Lawrie SM, Schwannauer M. Unpacking stigma: Meta-analyses of correlates and moderators of personal stigma in psychosis. Clin Psychol Rev 2021; 89:102077. [PMID: 34563943 DOI: 10.1016/j.cpr.2021.102077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/18/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
Personal stigma entails perceived, experienced and internalised stigmatisation. Mental Health stigma has been widely researched across a range of countries and a meta-analysis of their associations and moderators in psychosis is timely. Meta-analyses were conducted examining the correlates and moderators of personal stigma in terms of: (1) demographic variables (2) illness related variables (3) symptoms/negative outcomes, and (4) aspects of wellbeing. Associations were obtained from a total of 216 records. Several demographic factors including age, economic status, employment, and rural residence had small associations with aspects of personal stigma (r's = 0.12 to -0.13). Personal stigma aspects were inversely related to medication adherence (r's = -0.20, -0.21), and positively associated with insight and number of hospitalisations (r's = 0.09-0.19). Most symptoms were positively associated with personal stigma (r's = 0.10-0.43), whereas inverse relations with wellbeing variables were identified (r's = -0.13 to -0.54). Moderator effects emerged including that of cultural setting and sex, age and education level, highlighting the role of cultural and demographic factors in shaping personal stigma aspects in psychosis. The present study also highlights the importance of recognizing the negative effect of actual stigma and discrimination experiences; particularly its detrimental impact on self-image and its complex role in shaping the internalisation of societal stigma.
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González-Blanch C, Birulés I, Pousa E, Barrigon ML, López-Carrilero R, Lorente-Rovira E, Ayesa-Arriola R, Setien-Suero E, Barajas A, Grasa EM, Ruiz-Delgado I, González-Higueras F, Cid J, Ochoa S. Moderators of cognitive insight outcome in metacognitive training for first-episode psychosis. J Psychiatr Res 2021; 141:104-110. [PMID: 34186271 DOI: 10.1016/j.jpsychires.2021.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/29/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
Metacognitive training (MCT) is a promising treatment for improving cognitive insight associated with delusional beliefs in individuals with psychotic disorders. The aim of this study was to examine potential moderators of cognitive insight in individuals with first-episode psychosis (FEP) who received either MCT or psychoeducation. The present study was based on data from a randomized control trial comparing MCT to psychoeducation. Baseline sociodemographic and clinical characteristics in a sample of 122 patients with FEP were examined as potential moderators of the self-reflectiveness and self-certainty dimensions of cognitive insight using the SPSS PROCESS macro. The only variable that moderated self-reflectiveness at the post-treatment evaluation was age of onset (b = -0.27, p = .025). The effect of MCT in reducing self-certainty was stronger in women (b = -3.26, p = .018) and in individuals with average or above average baseline self-esteem (b = -0.30, p = .007). Overall, our findings support the generalization of MCT to a variety of sociodemographic and clinical profiles. While some patient profiles may require targeted interventions such as MCT to improve cognitive insight, others may do equally as well with less demanding interventions such as a psychoeducational group.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla, Santander, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; MERITT, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Spain
| | - Esther Pousa
- Salut Mental Parc Taulí. Sabadell (Barcelona), Hospital Universitari, UAB Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - María Luisa Barrigon
- Department of Psychiatry, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain; Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; MERITT, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Esther Lorente-Rovira
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Psychiatry Service, Hospital Clinico Universitario, Valencia, Spain
| | - Rosa Ayesa-Arriola
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Esther Setien-Suero
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Ana Barajas
- Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain; Serra Húnter Programme, Government of Catalonia, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Eva M Grasa
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | | | - Jordi Cid
- Mental Health & Addiction Research Group, IdiBGi, Institut D'Assistencia Sanitàri, Girona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; MERITT, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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Vousoura E, Gergov V, Tulbure BT, Camilleri N, Saliba A, Garcia-Lopez L, Podina IR, Prevendar T, Löffler-Stastka H, Chiarenza GA, Debbané M, Markovska-Simoska S, Milic B, Torres S, Ulberg R, Poulsen S. Predictors and moderators of outcome of psychotherapeutic interventions for mental disorders in adolescents and young adults: protocol for systematic reviews. Syst Rev 2021; 10:239. [PMID: 34462006 PMCID: PMC8404358 DOI: 10.1186/s13643-021-01788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic review aims to address this critical gap within the literature on non-specific predictors and moderators of the outcomes of psychotherapeutic interventions among adolescents and young adults with mental disorders. METHODS The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. PubMed and PsycINFO databases will be searched for randomized controlled and quasi-experimental/naturalistic clinical trials. Risk of bias of all included studies will be assessed by the Mixed Methods Appraisal Tool. The quality of predictor and moderator variables will be also assessed. A narrative synthesis will be conducted for all included studies. DISCUSSION This systematic review will strengthen the evidence base on effective mental health interventions for young people, being the first to explore predictors and moderators of outcome of psychotherapeutic interventions for a wide range of mental disorders in young people. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020166756 .
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Affiliation(s)
- Eleni Vousoura
- Department of Psychology, American College of Greece - Deree, 6 Gravias Street GR-153 42 Aghia Paraskevi, Athens, Greece.
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Vera Gergov
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Nigel Camilleri
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | - Andrea Saliba
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | | | - Ioana R Podina
- Laboratory of Cognitive Clinical Sciences, Department of Psychology, University of Bucharest, Bucharest, Romania
| | | | | | | | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | - Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Megalakaki O, Kokou-Kpolou CK. Effects of biopsychosocial factors on the association between loneliness and mental health risks during the COVID-19 lockdown. Curr Psychol 2021;:1-12. [PMID: 34456535 DOI: 10.1007/s12144-021-02246-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
Previous data suggest that loneliness is a hallmark of the mental health issues triggered by the SARS-CoV-2 pandemic. The purpose of the present study was to examine the impact of loneliness on mental health and behavioural outcomes, as well as the moderating and mediating effects of biopsychosocial variables on these relationships. The data were collected during France’s first national COVID-19 lockdown and included 556 participants (Mage = 30.06 years, range = 18–87) who completed well-known validated measures assessing symptom-levels of anxiety, depression, and insomnia. They also indicated their level of worry about the COVID-19 crisis, and provided sociodemographic and health status data. Responses were submitted to hierarchical linear regression and mediation analyses. In terms of prevalence of loneliness, 18.9% of participants reported severe loneliness. High levels of loneliness were significantly associated with the three mental health and behavioural outcomes. The loneliness – anxiety relationship was moderated by employment and working arrangements. The loneliness – insomnia relationship was moderated by living conditions, history of medical or psychological problems, and COVID-19-related worry. Further findings supported the indirect effects of COVID-related worry on pathways from loneliness to the three mental health and behavioural health outcomes. The mediation models accounted for 28.9%, 33.7%, and 15.0% of the variance in anxiety, depression, and insomnia. The present evidence-based findings revealed that loneliness and worry were major contributing factors of mental health and behavioural concerns during the COVID-19 lockdown. They could inform treatment recommendations for tackling prolonged-self isolation and loneliness in specific vulnerable groups.
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Chung G, Ansong D, Brevard KC, Chen DG. Identifying treatment moderators of a trauma-informed parenting intervention with children in foster care: Using model-based recursive partitioning. Child Abuse Negl 2021; 117:105065. [PMID: 33853021 DOI: 10.1016/j.chiabu.2021.105065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/01/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Trauma-informed parenting interventions have been used in child welfare to help caregivers respond to children in trauma-informed ways that can mitigate the effects of maltreatment and build strong caregiver-child relationships. Existing studies support their effectiveness with children and youth involved in the child welfare system. However, to further advance the effectiveness of evidenced-based intervention for child welfare populations, one key step is to identify subgroups of individuals who have different intervention responses or outcomes. OBJECTIVE To identify pre-treatment moderators that can distinguish subgroups of caregivers and children who benefit differently from an intervention. PARTICIPANTS AND SETTING 414 children in foster care (age 3 or younger) and their caregivers (birth, adoptive, kin, and nonkin) were randomly assigned to receive a trauma-informed parenting intervention in the Illinois Birth through Three Title IV-E waiver demonstration or foster care services as usual. METHODS Model-based Recursive Partitioning (MOB) was used to identify treatment moderators and moderator interactions. MOB fits a parametric model and uses a data-driven method to find subgroups for which the specified parametric model has different parameters. Two parametric models (logistic and linear regression) were used in accordance with two outcomes: reunification (binary) and caregiver-child attachment (continuous). We examined 21 potential pre-treatment moderators in both models. RESULTS For the reunification outcome, the MOB produced the following three treatment moderators, which identified subgroups of participants who responded differently to the intervention: (a) caregivers' relationship with the child (kin vs. non-kin/permanent caregivers), (b) caregiver-child attachment, and (c) case history of physical abuse. For the attachment outcome, caregivers' age was found to be a treatment moderator. Future developments of trauma-informed interventions should consider these moderators.
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Affiliation(s)
- Gerard Chung
- School of Social Work, University of North Carolina at Chapel Hill, USA.
| | - David Ansong
- School of Social Work, University of North Carolina at Chapel Hill, USA
| | - Kanisha C Brevard
- School of Social Work, University of North Carolina at Chapel Hill, USA
| | - Ding-Geng Chen
- School of Social Work, University of North Carolina at Chapel Hill, USA
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Beatty L, Kemp E, Turner J, Butow P, Milne D, Yates P, Lambert S, Wootten A, Koczwara B. Moderators of intervention efficacy for Finding My Way: A web-based psychosocial intervention for cancer-related distress. Support Care Cancer 2021; 29:7669-7678. [PMID: 34142280 DOI: 10.1007/s00520-021-06291-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The present analysis explores whether demographic, psychosocial, or intervention adherence factors moderated treatment efficacy of Finding My Way (FMW), an efficacious self-directed web-based psychosocial program for newly diagnosed curatively treated cancer patients. METHODS Participants (n = 191) completed a 6-module intervention (n = 94) or attention-control (n = 97) program. Outcome measures were completed at baseline (T0), post-program (T1), 3-month (T2), and 6-month (T3) follow ups. Age, gender, social support, information processing style (monitoring vs blunting), emotion-regulation difficulties, and intervention adherence were examined as potential moderators. RESULTS Age moderated emotional functioning and general distress at T3 with significant intervention benefits only observed in younger participants; age moderated cognitive functioning at T1, with intervention benefits only found in older participants. Gender moderated helplessness/hopelessness, emotional functioning, and cognitive avoidance at T1 with men benefitting more from receiving the intervention vs control. Monitoring information-processing style moderated cancer distress and anxious preoccupation at T3: higher monitors benefitted more from receiving the intervention vs control. Program adherence moderated global QOL, emotional functioning and social functioning at T2 and T3; cognitive avoidance (T1), anxious preoccupation (T2) and role function (T3), with those who completed more of the program benefitting more if they received the intervention than control. Emotion dysregulation and social support each moderated role function at T2, with those more dysregulated and less socially supported benefitting more if they received the intervention than control. CONCLUSIONS For select outcomes, FMW is more effective for patients with specific characteristics; these findings can inform future tailoring and targeting of online programs for cancer-distress.
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Affiliation(s)
- Lisa Beatty
- Flinders University, Adelaide, Australia.
- Flinders Medical Centre, Adelaide, Australia.
| | - Emma Kemp
- Flinders University, Adelaide, Australia
- Flinders Medical Centre, Adelaide, Australia
| | - Jane Turner
- University of Queensland, Brisbane, Australia
| | | | - Donna Milne
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Patsy Yates
- Queensland University of Technology, Brisbane, Australia
| | | | | | - Bogda Koczwara
- Flinders University, Adelaide, Australia
- Flinders Medical Centre, Adelaide, Australia
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Spirito A, Nestor B, Massing-Schaffer M, Esposito-Smythers C, Stout R, Frazier E, Gomez J, Graves H, Yen S, Hunt J, Wolff J. Predictors and moderators of marijuana and heavy alcohol use outcomes in adolescents treated for co-occurring substance use and psychiatric disorders in a randomized controlled trial. J Subst Abuse Treat 2021;:108536. [PMID: 34238628 DOI: 10.1016/j.jsat.2021.108536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/15/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The current study identifies predictors and moderators of substance use outcomes for 111 adolescents with co-occurring substance use and psychiatric disorders who participated in a randomized controlled trial that compared the effectiveness of two home-based treatments: an integrated cognitive behavioral therapy (I-CBT) protocol, in which masters-level clinic staff received intensive training and ongoing supervision in the use of this protocol versus a treatment-as-usual (TAU) comparison condition in which therapists received a continuing education-style CBT workshop in the same protocol. METHOD The study conducted exploratory predictor and moderator analyses of marijuana and heavy alcohol use outcomes using candidate variables across four domains of psychological characteristics: adolescent substance use, adolescent psychiatric symptoms, parent, and family. RESULTS Regardless of treatment condition, low parental monitoring at baseline, as assessed by a videotaped interaction task, but not self-report, predicted greater percentage of marijuana use and heavy alcohol use days over the 6-month follow-up period. If parents entered treatment with low levels of parental monitoring, adolescents in the I-CBT condition reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU over the 6-month follow-up period. Greater adolescent aggression and parental emotion dysregulation at baseline also predicted greater percentage of marijuana use days over the 6-month follow-up period for the sample as a whole. Adolescents in the I-CBT condition who reported low positive urgency at baseline reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU care over the 6-month follow-up period. CONCLUSION The article discusses implications for clinical decision-making, improving treatment effectiveness, and tailoring interventions for adolescents with co-occurring substance use and psychiatric disorders.
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Phillips KA, Greenberg JL, Hoeppner SS, Weingarden H, O’Keefe S, Keshaviah A, Schoenfeld DA, Wilhelm S. Predictors and moderators of symptom change during cognitive-behavioral therapy or supportive psychotherapy for body dysmorphic disorder. J Affect Disord 2021; 287:34-40. [PMID: 33773357 PMCID: PMC8276884 DOI: 10.1016/j.jad.2021.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research on predictors of treatment outcome in body dysmorphic disorder, a common and severe disorder, is very limited, and no prior studies have examined moderators of outcome. Because treatment is often but not always efficacious, it is important to identify who is more likely to benefit. We examined predictors and moderators of improvement with therapist-delivered cognitive-behavioral therapy versus supportive psychotherapy in the only study of these treatments for body dysmorphic disorder. This report presents secondary analyses from a study whose primary findings have previously been published (Wilhelm et al., 2019). METHODS Participants (N=120) with DSM-IV body dysmorphic disorder were randomized to therapist-delivered weekly cognitive-behavioral therapy or supportive therapy for 24 weeks. Using reliable and valid measures, we tested baseline body dysmorphic disorder severity, insight/delusionality, and depression severity as predictors and moderators of overall and treatment modality-specific symptom change. We explored additional variables as predictors and moderators of outcome. RESULTS Greater treatment credibility (p=0.02) and presence of obsessive-compulsive personality disorder (p=0.03) predicted greater improvement. Serotonin-reuptake inhibitor treatment at baseline (unchanged during the study) (p=0.01) predicted less improvement. No other variables predicted or moderated outcome (all p>0.05). LIMITATIONS The study was not powered a priori to detect predictor or moderation effects, which limited our ability to detect them unless they were strong. CONCLUSIONS Because greater treatment credibility predicted better outcomes, fostering credibility during therapy may maximize gains. Improvement was not impeded by more severe body dysmorphic disorder, depressive symptoms, or poorer insight. No variables moderated treatment-specific improvement.
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Affiliation(s)
- Katharine A. Phillips
- Rhode Island Hospital,Alpert Medical School of Brown University,New York-Presbyterian Hospital,Weill Cornell Medical College, Cornell University
| | | | | | | | | | - Aparna Keshaviah
- Massachusetts General Hospital,Harvard Medical School,Mathematica Policy Research
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Li C, Chen X, Bi X. Wearable activity trackers for promoting physical activity: A systematic meta-analytic review. Int J Med Inform 2021; 152:104487. [PMID: 34020170 DOI: 10.1016/j.ijmedinf.2021.104487] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/01/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Although wearable activity trackers hold a promise of nudging people toward a more active lifestyle, current research reveals inconsistent findings regarding the effectiveness of them. The objectives of this paper are two-fold: (1) to synthesize evidence on the effects of wearable activity trackers for improving physical activities, and (2) to identify potential moderators of effect size. METHODS A systematic meta-analytic review was conducted. Forty-eight eligible papers based on forty-four distinct trials were identified through a systematic literature search process. Two authors independently extracted information from each study based on predefined data fields. Random-effects meta-analysis, subgroup analysis, and meta-regression analysis were employed. RESULTS First, interventions with wearable activity trackers significantly increased daily steps and weekly moderate-to-vigorous physical activity but had no impact on light physical activity or sedentary behavior. Second, daily steps and weekly moderate-to-vigorous physical activity were associated with participants' characteristics (i.e., gender, age, medical condition, and baseline physical activity level) and intervention features (i.e., sensors, modes of expert support, and intervention duration). The identified factors explained 53 % of the total variance for weekly moderate-to-vigorous physical activity. CONCLUSIONS The use of wearable activity trackers effectively improves conscious exercise behavior, including daily steps and weekly moderate-to-vigorous physical activity, but not effective for modifying habitual behavior, such as light physical activity and sedentary behavior. We also explicitly show that the extent to which the interventions with wearable activity trackers help users is contingent on the type of users and the design and delivery of interventions. Future studies are called to validate the findings and to offer theoretical explanations.
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Affiliation(s)
- Caining Li
- School of Management, Jilin University, Changchun, China
| | - Xiaoyu Chen
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore.
| | - Xinhua Bi
- School of Management, Jilin University, Changchun, China.
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Nelson TD, Johnson AB, Ramsdell EL, Brock RL. Individual differences in the effects of child sleep problems on early executive functioning. Adv Child Dev Behav 2021; 60:179-195. [PMID: 33641793 DOI: 10.1016/bs.acdb.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep is a critical health behavior with important implications for child development. This chapter discusses the effects of sleep problems on early child executive functioning (EF), with an emphasis on individual differences that might moderate this relationship. Specifically, we (1) provide a brief background on sleep and EF in early childhood; (2) review literature on the association between sleep and EF; (3) review literature on individual differences in the effects of sleep problems on EF; (4) offer recommendations for future research on moderators of the sleep-EF association, and (5) briefly describe an ongoing study examining the moderators of the sleep-EF association within a longitudinal study from pregnancy to preschool.
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Affiliation(s)
- Timothy D Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States.
| | - Anna B Johnson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Erin L Ramsdell
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Rebecca L Brock
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
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Dzierzewski JM, Dautovich ND, Ravyts SG, Perez E, Soto P, Donovan EK. Insomnia symptoms during the COVID-19 pandemic: an examination of biopsychosocial moderators. Sleep Med 2021:S1389-9457(21)00116-7. [PMID: 33658155 DOI: 10.1016/j.sleep.2021.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE/BACKGROUND Healthy sleep is vital for physical and psychological health, and poor sleep can result in a myriad of negative physical and psychological outcomes. Insomnia symptoms often manifest as a result of acute life stressors or changes, and COVID-19 experiences may be one such stressor. Other known predisposing factors to insomnia may moderate the impact of COVID-19 experiences on sleep. The present study aimed to determine current levels of insomnia severity in a US sample, to investigate the relation of COVID-19 experiences to insomnia symptoms, and to determine which individuals are most susceptible to this association. METHODS Data were drawn from a larger online survey investigating sleep and health outcomes across the lifespan. COVID-19 experiences were assessed with the exposure and impact subscales of the CAIR Pandemic Impact Questionnaire (C-PIQ). The Insomnia Severity Index (ISI) measured insomnia symptoms. Biological, psychological, and social moderators were measured using other brief self-report measures. RESULTS Insomnia symptoms prevalence was as follows: moderate-to-severe symptoms (25.5%), subthreshold symptoms (37.7%), and no symptoms (36.7%). Individuals' COVID-19 experiences significantly predicted insomnia symptom severity [F(1,997) = 472.92, p < 0.001, R2 = 0.32]. This association was moderated by race, anxiety symptoms, depressive symptoms, physical somatization, and social loneliness, but not age, gender, or education. CONCLUSIONS Although negative experiences with COVID-19 are associated with worse insomnia symptoms, this relationship is not the same for everyone.
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Røssberg JI, Evensen J, Dammen T, Wilberg T, Klungsøyr O, Jones M, Bøen E, Egeland R, Breivik R, Løvgren A, Ulberg R. Mechanisms of change and heterogeneous treatment effects in psychodynamic and cognitive behavioural therapy for patients with depressive disorder: a randomized controlled trial. BMC Psychol 2021; 9:11. [PMID: 33482927 PMCID: PMC7821688 DOI: 10.1186/s40359-021-00517-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/15/2021] [Indexed: 01/21/2023] Open
Abstract
Background Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. Methods One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. Discussion The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. Trial registration ClinicalTrials.gov Identifier: NCT03022071.
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Affiliation(s)
- J I Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424, Nydalen, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318, Blindern, Oslo, Norway. .,Division of Psychiatric Treatment Research, Oslo University Hospital, Oslo, Norway.
| | - J Evensen
- Nydalen Outpatient Clinic, P.O. Box 4959, 0424, Nydalen, Oslo, Norway
| | - T Dammen
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424, Nydalen, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318, Blindern, Oslo, Norway
| | - O Klungsøyr
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424, Nydalen, Oslo, Norway
| | - M Jones
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424, Nydalen, Oslo, Norway
| | - E Bøen
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - R Egeland
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - R Breivik
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424, Nydalen, Oslo, Norway
| | - A Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424, Nydalen, Oslo, Norway
| | - R Ulberg
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318, Blindern, Oslo, Norway.,Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
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Pierce M, Emsley R. A comparison of approaches for combining predictive markers for personalised treatment recommendations. Trials 2021; 22:20. [PMID: 33407760 PMCID: PMC7788953 DOI: 10.1186/s13063-020-04901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background In the presence of heterogeneous treatment effects, it is desirable to divide patients into subgroups based on their expected response to treatment. This is formalised via a personalised treatment recommendation: an algorithm that uses biomarker measurements to select treatments. It could be that multiple, rather than single, biomarkers better predict these subgroups. However, finding the optimal combination of multiple biomarkers can be a difficult prediction problem. Methods We described three parametric methods for finding the optimal combination of biomarkers in a personalised treatment recommendation, using randomised trial data: a regression approach that models outcome using treatment by biomarker interactions; an approach proposed by Kraemer that forms a combined measure from individual biomarker weights, calculated on all treated and control pairs; and a novel modification of Kraemer’s approach that utilises a prognostic score to sample matched treated and control subjects. Using Monte Carlo simulations under multiple data-generating models, we compare these approaches and draw conclusions based on a measure of improvement under a personalised treatment recommendation compared to a standard treatment. The three methods are applied to data from a randomised trial of home-delivered pragmatic rehabilitation versus treatment as usual for patients with chronic fatigue syndrome (the FINE trial). Prior analysis of this data indicated some treatment effect heterogeneity from multiple, correlated biomarkers. Results The regression approach outperformed Kraemer’s approach across all data-generating scenarios. The modification of Kraemer’s approach leads to improved treatment recommendations, except in the case where there was a strong unobserved prognostic biomarker. In the FINE example, the regression method indicated a weak improvement under its personalised treatment recommendation algorithm. Conclusions The method proposed by Kraemer does not perform better than a regression approach for combining multiple biomarkers. All methods are sensitive to misspecification of the parametric models.
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Affiliation(s)
- Matthias Pierce
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, 1st Floor, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Roddy MK, Boykin DM, Hadlandsmyth K, Marchman JN, Green DM, Buckwalter JA 4th, Garvin L, Zimmerman B, Bae J, Cortesi J, Rodrigues M, Embree J, Rakel BA, Dindo L. One-day Acceptance and Commitment Therapy workshop for preventing persistent post-surgical pain and dysfunction in at-risk veterans: A randomized controlled trial protocol. J Psychosom Res 2020; 138:110250. [PMID: 32961500 DOI: 10.1016/j.jpsychores.2020.110250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Persistent post-surgical pain is common among patients undergoing surgery, is detrimental to patients' quality of life, and can precipitate long-term opioid use. The purpose of this randomized controlled trial is to assess the effects of a behavioral intervention offered prior to surgery for patients at risk for poor post-surgical outcomes, including persistent pain and impaired functioning. METHODS Described herein is an ongoing randomized, patient- and assessor-blind, attention-controlled multisite clinical trial. Four hundred and thirty Veterans indicated for total knee arthroplasty (TKA) with distress and/or pain will be recruited for this study. Participants will be randomly assigned to a one-day (~5 h) Acceptance and Commitment Therapy workshop or one-day education and attention control workshop. Approximately two weeks following their TKA surgery, patients receive an individualized booster session via phone. Following their TKA, patients complete assessments at 1 week, 6 weeks, 3 months, and 6 months. RESULTS The primary outcomes are pain intensity and knee-specific functioning; secondary outcomes are symptoms of distress and coping skills. Mediation analyses will examine whether changes in symptoms of distress and coping skills have an impact on pain and functioning at 6 months in Veterans receiving ACT. This study is conducted mostly with older Veterans; therefore, results may not generalize to women and younger adults who are underrepresented in this veteran population. CONCLUSIONS The results of this study will provide the first evidence from a large-scale, patient- and assessor-blind controlled trial on the effectiveness of a brief behavioral intervention for the prevention of persistent post-surgical pain and dysfunction.
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Dedousis-Wallace A, Drysdale SA, McAloon J, Ollendick TH. Parental and Familial Predictors and Moderators of Parent Management Treatment Programs for Conduct Problems in Youth. Clin Child Fam Psychol Rev 2020; 24:92-119. [PMID: 33074467 DOI: 10.1007/s10567-020-00330-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
Despite the established efficacy of Parent Management Training (PMT) for conduct problems in youth, evidence suggests that up to half of all treated youth still display clinical levels of disruptive behavior post-treatment. The reasons for these unsatisfactory outcomes are poorly understood. The aim of the present review was to provide an updated analysis of studies from the past 15 years that examined parental and familial predictors and moderators of improvement in PMT for conduct problems. A systematic literature review of indicated prevention (children with conduct problem symptoms) and intervention (children with clinical diagnoses) studies published between 2004 and 2019 was conducted. This 15-year time period was examined since the last systematic reviews were reported in 2006 and summarized studies completed through mid-2004 (see Lundahl et al. in Clin Psychol Rev 26(1):86-104, 2006; Reyno and McGrath in J Child Psychol Psychiatry 47(1):99-111, 2006). Risk of bias indices was also computed (see Higgins et al. in Revised Cochrane risk of bias tool for randomized trials (RoB 2.0), University of Bristol, Bristol, 2016) in our review. A total of 21 studies met inclusion criteria. Results indicated that a positive parent-child relationship was most strongly associated with better outcomes; however, little additional consistency in findings was evident. Future PMT research should routinely examine predictors and moderators that are both conceptually and empirically associated with treatment outcomes. This would further our understanding of factors that are associated with poorer treatment outcome and inform the development of treatment components or modes of delivery that might likely enhance evidence-based treatments and our clinical science. Protocol Registration Number: PROSPERO CRD42017058996.
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Affiliation(s)
- Anna Dedousis-Wallace
- The Kidman Centre, University of Technology Sydney, Randwick, NSW, 2031, Australia. .,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Sophia A Drysdale
- The Kidman Centre, University of Technology Sydney, Randwick, NSW, 2031, Australia
| | - John McAloon
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic Institute & State University, Blacksburg, VA, USA
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Ashokkumar A, Talaifar S, Fraser WT, Landabur R, Buhrmester M, Gómez Á, Paredes B, Swann WB Jr. Censoring political opposition online: Who does it and why. J Exp Soc Psychol 2020; 91:104031. [PMID: 32834107 DOI: 10.1016/j.jesp.2020.104031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022]
Abstract
As ordinary citizens increasingly moderate online forums, blogs, and their own social media feeds, a new type of censoring has emerged wherein people selectively remove opposing political viewpoints from online contexts. In three studies of behavior on putative online forums, supporters of a political cause (e.g., abortion or gun rights) preferentially censored comments that opposed their cause. The tendency to selectively censor cause-incongruent online content was amplified among people whose cause-related beliefs were deeply rooted in or “fused with” their identities. Moreover, six additional identity-related measures also amplified the selective censoring effect. Finally, selective censoring emerged even when opposing comments were inoffensive and courteous. We suggest that because online censorship enacted by moderators can skew online content consumed by millions of users, it can systematically disrupt democratic dialogue and subvert social harmony. We use a novel experimental paradigm to study censorship in online environments. People selectively censor online content that challenges their political beliefs. People block online authors of posts they disagree with. When beliefs are rooted in identity, selective censoring is amplified. Selective censoring occurred even for comments without offensive language.
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Fleming GE, Kimonis ER, Furr JM, Comer JS. Internet-Delivered Parent Training for Preschoolers with Conduct Problems: Do Callous-Unemotional Traits Moderate Efficacy and Engagement? J Abnorm Child Psychol 2020; 48:1169-1182. [PMID: 32533295 DOI: 10.1007/s10802-020-00660-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Recent efforts to improve access to evidence-based parent training programs using online delivery have largely neglected findings that young children with callous-unemotional (CU)-type conduct problems receive less benefit from parent training than children with conduct problems alone. The current study aimed to examine the moderating effect of child CU traits on efficacy and engagement outcomes associated with Internet-delivered Parent-Child Interaction Therapy (iPCIT) versus standard, clinic-based PCIT. Forty families (57.6% non-Hispanic Caucasian) with a 3-5 year-old (M = 3.95 years, SD = 0.9; 83.5% boys) child with a disruptive behavior disorder were randomized to either iPCIT or clinic-based PCIT. Families participated in four assessments across time; child conduct problems, global functioning and treatment responder status, and parent-rated treatment satisfaction were measured. Analyses revealed that the negative influence of CU traits on functional gains was not uniform across treatment formats. Specifically, the detrimental effect of CU traits on functional gains was significantly more pronounced among children treated with iPCIT than clinic-based PCIT. CU traits also predicted lower parental treatment satisfaction across delivery formats, but this effect was more pronounced among iPCIT parents. In contrast, CU traits did not moderate differential effects across iPCIT and clinic-based PCIT for conduct problem severity or treatment response status. Findings suggest that iPCIT is a promising treatment option for early conduct problems, particularly when access-to-care barriers exist, but that further research is needed to determine whether strategic adaptations to online programs can more optimally address the distinct needs of children with clinically significant CU traits.
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Affiliation(s)
- Georgette E Fleming
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia.
| | - Eva R Kimonis
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jami M Furr
- Center for Children and Families, Florida International University, Miami, Florida, USA
| | - Jonathan S Comer
- Center for Children and Families, Florida International University, Miami, Florida, USA
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Peris TS, Rozenman MS, Bai S, Perez J, Thamrin H, Piacentini J. Ethnicity moderates outcome in family focused treatment for pediatric obsessive compulsive disorder. J Anxiety Disord 2020; 73:102229. [PMID: 32361032 DOI: 10.1016/j.janxdis.2020.102229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study examined predictors and moderators of treatment outcome in a randomized controlled trial (RCT) comparing two active interventions for pediatric obsessive compulsive disorder that differed with respect to the focus and format of family intervention. We had a particular interest in the role of race/ethnicity in shaping outcomes given our relatively diverse sample composition and the limited prior work in this area. METHOD A total of 62 youths (Mean age = 12.71 years; 57 % male; 34 % non-white) were assigned to either a standard cognitive behavioral therapy (CBT) family intervention (ST) or to a tailored intervention designed for cases of OCD complicated by poor family functioning (Enhanced Family Therapy; ET). Treatment in both arms involved 12 sessions of exposure therapy; the family interventions differed. Predictor and moderator variables were chosen based on the extant literature. RESULTS Minority status did not predict outcome, suggesting that overall, white and non-white youth had comparable treatment response. Race/ethnicity did, however, moderate response with non-white youth faring better in the ET arm of the study. In particular, minority youth in ET had, on average, post-treatment CYBOCS scores consistent with clinical remission whereas their ST counterparts were left with symptoms considered moderately severe. There were no predictors of treatment outcome. CONCLUSIONS Minority status predicts poorer response to standard CBT across disorders, suggesting the need for possible treatment adaptations. The present findings highlight one avenue for matching patients to treatments that might optimize outcomes and underscore the value of family involvement in OCD treatment.
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Affiliation(s)
- Tara S Peris
- Jane and Semel Institute for Neuroscience and Human Behavior, United States.
| | | | - Sunhye Bai
- Pennsylvania State University, United States
| | - Jocelyn Perez
- Jane and Semel Institute for Neuroscience and Human Behavior, United States
| | | | - John Piacentini
- Jane and Semel Institute for Neuroscience and Human Behavior, United States
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