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Luo M, Allman-Farinelli M. Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020. Nutrients 2021; 13:nu13114161. [PMID: 34836417 PMCID: PMC8623843 DOI: 10.3390/nu13114161] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 01/08/2023] Open
Abstract
Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.
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Affiliation(s)
- Man Luo
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia;
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, China
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia;
- Correspondence: ; Tel.: +61-2-90367045
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Motevalli M, Drenowatz C, Tanous DR, Khan NA, Wirnitzer K. Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies. Nutrients 2021; 13:1200. [PMID: 33917383 PMCID: PMC8067342 DOI: 10.3390/nu13041200] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023] Open
Abstract
As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.
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Affiliation(s)
- Mohamad Motevalli
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University College of Teacher Education Upper Austria, A-4020 Linz, Austria;
| | - Derrick R. Tanous
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
| | - Naim Akhtar Khan
- Nutritional Physiology & Toxicology Division, INSERM UMR 1231, Université de Bourgogne, F-21000 Dijon, France;
| | - Katharina Wirnitzer
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
- Department of Subject Didactics and Educational Research & Development, University College of Teacher Education Tyrol, A-6020 Innsbruck, Austria
- Life and Health Science Cluster Tirol, Subcluster Health/Medicine/Psychology, A-6020 Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria
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3
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Motevalli M, Drenowatz C, Tanous DR, Khan NA, Wirnitzer K. Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies. Nutrients 2021; 13:1200. [PMID: 33917383 PMCID: PMC8067342 DOI: 10.3390/nu13041200&set/a 931824908+802380262] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.
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Affiliation(s)
- Mohamad Motevalli
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
- Correspondence:
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University College of Teacher Education Upper Austria, A-4020 Linz, Austria;
| | - Derrick R. Tanous
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
| | - Naim Akhtar Khan
- Nutritional Physiology & Toxicology Division, INSERM UMR 1231, Université de Bourgogne, F-21000 Dijon, France;
| | - Katharina Wirnitzer
- Department of Sport Science, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria; (D.R.T.); (K.W.)
- Department of Subject Didactics and Educational Research & Development, University College of Teacher Education Tyrol, A-6020 Innsbruck, Austria
- Life and Health Science Cluster Tirol, Subcluster Health/Medicine/Psychology, A-6020 Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, A-6020 Innsbruck, Austria
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Tauben DJ, Langford DJ, Sturgeon JA, Rundell SD, Towle C, Bockman C, Nicholas M. Optimizing telehealth pain care after COVID-19. Pain 2020; 161:2437-2445. [PMID: 32826752 PMCID: PMC7566302 DOI: 10.1097/j.pain.0000000000002048] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Affiliation(s)
- David J. Tauben
- Departments of Anesthesiology & Pain Medicine
- Medicine, University of Washington, Seattle, WA, United States
| | | | | | - Sean D. Rundell
- Departments of Rehabilitation Medicine
- Health Services, University of Washington, Seattle, WA, United States
| | - Cara Towle
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Christina Bockman
- Department of Pharmacy, University of Washington, Harborview Medical Center, Seattle, WA, United States
| | - Michael Nicholas
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Abstract
PURPOSE OF REVIEW Technological advancement has led to the development of novel treatment approaches for attention deficit hyperactivity disorder (ADHD). This review aims to review recent studies which employ the use of technology to treat ADHD, with particular focus on studies published during a 1-year period from February 2019 to February 2020. RECENT FINDINGS Most recent studies involved children aged 12 years and below. Interventions included cognitive training through games, neurofeedback and a combination of several approaches. More novel approaches included trigeminal nerve stimulation and brain-computer interface, and studies had utilized technology such as X-box Kinect and eye tracker. There was a shift towards delivering intervention at home and in school, enabled by technology. The study outcomes were variable and mainly included executive functioning measures and clinical ratings. These interventions were generally safe with few reported adverse events. SUMMARY Technology has enabled interventions to be delivered outside of the clinic setting and presented an opportunity for increased access to care and early intervention. Better quality studies are needed to inform on the efficacy of these interventions.
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Affiliation(s)
- Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
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Hutchesson MJ, de Jonge Mulock Houwer M, Brown HM, Lim S, Moran LJ, Vincze L, Rollo ME, Hollis JL. Supporting women of childbearing age in the prevention and treatment of overweight and obesity: a scoping review of randomized control trials of behavioral interventions. BMC Womens Health 2020; 20:14. [PMID: 31973716 PMCID: PMC6979060 DOI: 10.1186/s12905-020-0882-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Women of childbearing age are vulnerable to weight gain. This scoping review examines the extent and range of research undertaken to evaluate behavioral interventions to support women of childbearing age to prevent and treat overweight and obesity. METHODS Eight electronic databases were searched for randomized controlled trials (RCT) or systematic reviews of RCTs until 31st January 2018. Eligible studies included women of childbearing age (aged 15-44 years), evaluated interventions promoting behavior change related to diet or physical activity to achieve weight gain prevention, weight loss or maintenance and reported weight-related outcomes. RESULTS Ninety studies met the inclusion criteria (87 RCTs, 3 systematic reviews). Included studies were published from 1998 to 2018. The studies primarily focused on preventing excessive gestational weight gain (n = 46 RCTs, n = 2 systematic reviews), preventing postpartum weight retention (n = 18 RCTs) or a combination of the two (n = 14 RCTs, n = 1 systematic review). The RCTs predominantly evaluated interventions that aimed to change both diet and physical activity behaviors (n = 84) and were delivered in-person (n = 85). CONCLUSIONS This scoping review identified an increasing volume of research over time undertaken to support women of childbearing age to prevent and treat overweight and obesity. It highlights, however, that little research is being undertaken to support the young adult female population unrelated to pregnancy or preconception.
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Affiliation(s)
- Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.
| | - Mette de Jonge Mulock Houwer
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Hannah M Brown
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Lisa Vincze
- School of Allied Health Science, Griffith University, Gold Coast, Queensland, Australia
| | - Megan E Rollo
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Jenna L Hollis
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Longworth Avenue, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Abstract
Continuing professional development (CPD) is a widely used and evolving set of complex interventions that seeks to update and improve the knowledge, skills, and performance of health care professionals to ultimately improve patient care and outcomes. While synthesized evidence shows CPD in general to be effective, effects vary, in part due to variation in CPD interventions and limited understanding of CPD mechanisms of action. We introduce two behavioral science tools-the Behavior Change Technique Taxonomy version 1 and the Theoretical Domains Framework-that can be used to characterize the content of CPD interventions and the determinants of behaviour potentially targeted by the interventions, respectively. We provide a worked example of the use of these tools in coding the educational content of 43 diabetes quality improvement trials containing clinician education as part of their multicomponent intervention. Fourteen (of a possible 93; 15%) behavior change techniques were identified in the clinician education content of the quality improvement trials, suggesting a focus of addressing the behavioral determinants beliefs about consequences, knowledge, skills, and social influences, of diabetes care providers' behavior. We believe that the Behavior Change Technique Taxonomy version 1 and Theoretical Domains Framework offer a novel lens to analyze the CPD content of existing evidence and inform the design and evaluation of future CPD interventions.
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Affiliation(s)
- Kristin J Konnyu
- Dr. Konnyu: Assistant Professor, Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, RI, and Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI. Dr. McCleary: Postdoctoral Fellow, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, and Postdoctoral Fellow, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. Dr. Presseau: Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, Associate Professor, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, and School of Psychology, University of Ottawa, Ottawa, Ontario, Canada. Dr. Ivers: Family Physician, Family Practice Health Centre, Women's College Research Institute, and Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada, and Associate Professor, Department of Family and Community Medicine, and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Dr. Grimshaw: Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, Full Professor, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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8
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Zhu J, Hou W, Xu Y, Ji F, Wang G, Chen C, Lin C, Lin X, Li J, Zhuo C, Shao M. Antipsychotic drugs and sudden cardiac death: A literature review of the challenges in the prediction, management, and future steps. Psychiatry Res 2019; 281:112598. [PMID: 31622875 DOI: 10.1016/j.psychres.2019.112598] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
Abstract
Sudden cardiac death (SCD) is relatively uncommon, yet it is a deadly consequence of some antipsychotic medications in patients with psychiatric disorders. The widespread concerns about the adverse cardiac effects associated with antipsychotics and their unpredictable nature have led to a restriction on the use of some antipsychotic medications. Recent progress has been made in the identification of important genetic factors that may contribute to the adverse complication of antipsychotic drugs, suggesting that high-risk individuals can be identified prior to initiating therapy. In addition, some high-tech smart wearable medical devices have recently been developed, allowing users to record and analyze the electrocardiogram (ECG) in couple with artificial intelligence (AI) technologies, and notifying of irregular heart rhythms or arrhythmias, a medical condition well documented in most SCD cases. In this literature review, we summarize recent advances in understanding the link between SCD and antipsychotic drug usage, as well as in utilizing wearable medical devices for monitoring of cardiac arrhythmias. New strategies for improving the care of patients receiving antipsychotic medications are proposed. As it is now possible to evaluate the risk of SCD in patients on antipsychotic medications, preventative measures and close monitoring may be used to detect the early signs of adverse cardiac events and SCD.
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Affiliation(s)
- Jingjing Zhu
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Weihong Hou
- Department of Biochemistry and Molecular Biology, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China,; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China; National Key Disciplines, Key Laboratory for Cellular Physiology, Ministry of Education, Department of Neurobiology, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Feng Ji
- Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining, Shandong, 272191, China
| | - Guowei Wang
- Department of Psychiatry, Linyi Mental Health Center, Linyi, Shandong, 271000, China
| | - Ce Chen
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Chongguang Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Xiodong Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China
| | - Jie Li
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China
| | - Chuanjun Zhuo
- Department of Psychiatry, School of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining, Shandong, 272191, China; Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325000, China; Department of Biochemistry and Molecular Biology, Zhengzhou University, Zhengzhou, Henan, 450001, China; Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Nankai University Affiliated Anding Hospital, Tianjin Mental Health Center, Mental Health Teaching Hospital, Tianjin Medical University, Tianjin 300222, China; Department of China-Canada Biological Psychiatry Lab, Xiamen Xianyue Hospital, Xiamen, Fujian, 361000, China
| | - Mingjng Shao
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, 100029, China
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9
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Berger A. Learning from patients. BMJ Sex Reprod Health 2019; 45:220. [PMID: 31289101 DOI: 10.1136/bmjsrh-2018-200256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 06/09/2023]
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10
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Lechner WV, Sidhu NK, Cioe PA, Kahler CW. Effects of time-varying changes in tobacco and alcohol use on depressive symptoms following pharmaco-behavioral treatment for smoking and heavy drinking. Drug Alcohol Depend 2019; 194:173-177. [PMID: 30445275 PMCID: PMC7364819 DOI: 10.1016/j.drugalcdep.2018.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/20/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Complete abstinence from alcohol as well as smoking cessation have been shown to predict reductions in depressive symptoms over time. However, whether reducing alcohol use or smoking positively affect depressive symptoms has yet to be examined. The current study examined depressive symptoms as a function of time-varying changes in alcohol use and smoking status following a pharmaco-behavioral treatment addressing smoking cessation and alcohol reduction. METHODS Participants were heavy-drinking smokers (n = 150) followed for 26 weeks after their quit smoking date, with assessments of smoking, alcohol use, and depressive symptoms at baseline and 2, 8, 16, and 26 weeks. RESULTS Abstinence from smoking was associated with significantly lower depressive symptoms, as compared to little to no reduction in smoking (B = -6.1) as well as significant reductions in smoking (B = 4.01). Exploratory analyses, which excluded observations in which a participant was abstinent, revealed a significant effect of percent change in cigarettes smoked, modeled continuously, on depressive symptoms, (B = 4.39). By contrast, no differences were observed in depressive symptoms in relation to changes in alcohol use. CONCLUSION It appears that smoking abstinence is associated with improvements in depression as compared to any level of sustained or reduced use and that the magnitude of smoking reduction may be associated with lower depressive symptoms among those who did not quit successfully. If replicated, these findings may inform treatment for individuals for whom depression is a major barrier to cessation and who have been unable or are unwilling to be completely abstinent from smoking.
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Affiliation(s)
- William V Lechner
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, P.O. Box 5190, Kent, OH, 44242-0001, USA; Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Box G-S121-5, Providence, RI, USA.
| | - Natasha K Sidhu
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, P.O. Box 5190, Kent, OH, 44242-0001, USA
| | - Patricia A Cioe
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Box G-S121-5, Providence, RI, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Box G-S121-5, Providence, RI, USA
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11
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Kent M, Scott S, Lambert S, Kirk E, Terhune-Cotter B, Thompson B, Neal S, Dozier B, Bardi M, Lambert K. Contingency Training Alters Neurobiological Components of Emotional Resilience in Male and Female Rats. Neuroscience 2018; 386:121-136. [PMID: 29928950 PMCID: PMC8112904 DOI: 10.1016/j.neuroscience.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/02/2017] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
Prior research with a rat model of behavioral therapy [i.e., effort-based reward (EBR) contingency training] suggests that strengthened associations between physical effort and desired outcomes enhance neurobiological indices of resilience. In the current study, male and female Long-Evans rats were exposed to either six weeks of EBR training or noncontingent training prior to 10 days of exposure to chronic unpredictable stress (CUS). Subsequently, all animals were exposed to a problem-solving task and then trained in a spatial learning/foraging task, the Dry Land Maze (DLM). Following habituation training and test trials, rats were assessed in a probe trial that generated a prediction error (cognitive uncertainty). Results indicated that, during CUS exposure, contingency-training enhanced dehydroepiandrosterone/corticosterone ratios (consistent with healthier stress responses), especially in male rats. Additionally, contingency training increased exploratory behaviors in the probe trial as well as differentially influenced on-task problem-solving performance in males and females. Following the probe trial, brains were exposed to histological analyses to determine the effects of sex and contingency training on various neurobiological markers. Contingency training decreased BDNF-immunoreactivity (ir) in the hippocampus CA1 and lateral habenula, implicating differential neuroplasticity responses in the training groups. Further, coordinated fos-ir activation in areas associated with emotional resilience (i.e., motivation-regulation) was observed in contingent-trained animals. In sum, the current findings confirm that behavioral training is associated with neurobiological markers of emotional resilience; however, further assessments are necessary to more accurately determine the therapeutic potential for the EBR contingency training model.
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Affiliation(s)
- M Kent
- Department of Psychology, Neuroscience Concentration, University of Richmond, Richmond, VA 23173, United States
| | - S Scott
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - S Lambert
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - E Kirk
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - B Terhune-Cotter
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - B Thompson
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - S Neal
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - B Dozier
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - M Bardi
- Department of Psychology and Behavioral Neuroscience, Randolph-Macon College, Ashland, VA 23005, United States
| | - K Lambert
- Department of Psychology, Neuroscience Concentration, University of Richmond, Richmond, VA 23173, United States.
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12
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Wells MH, McCarthy BA, Tseng CH, Law CS. Usage of Behavior Guidance Techniques Differs by Provider and Practice Characteristics. Pediatr Dent 2018; 40:201-208. [PMID: 29793567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to determine provider and practice characteristics influencing usage of behavior guidance techniques (BGTs). METHODS A 24-item survey was emailed to 4,117 active AAPD members to identify factors influencing pediatric dentists' use of BGTs. RESULTS A total of 1,081 surveys were returned, for a 26 percent response rate. The mean age of respondents was 44.7 years old, with recent graduates comprising the largest group (30.5 percent). Usage of voice control, nitrous oxide, sedation, and general anesthesia (GA) differed significantly, according to experience. Respondents with at least 30 years of experience reported changes in usage. Tell-show-do, nitrous oxide, oral sedation, and passive restraint were significantly more frequent among female respondents. Parental absence, oral sedation, and GA were significantly more frequent in respondents serving low income populations. Parental absence, pharmacologic techniques, and restraint were significantly different in frequencies among the different geographic regions. CONCLUSIONS Usage of behavior guidance techniques has changed over the past three decades, with more recent graduates and experienced practitioners now emphasizing pharmacologic techniques. More assertive behavior guidance techniques are used more frequently by experienced providers and those in practices in the southwest or serving lower income populations. Pharmacologic techniques are used at a higher prevalence by recent graduates and providers who are female or serving lower income populations.
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Affiliation(s)
- Martha H Wells
- Associate professor and graduate program director, Department of Pediatric Dentistry and Community Oral Health, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tenn., USA
| | - Brigid A McCarthy
- General Internal Medicine-Health Services Research student worker, Department of Statistics, at UCLA, Los Angeles, Calif., USA
| | - Chi-Hong Tseng
- Professor, Department of Medicine, at UCLA, Los Angeles, Calif., USA
| | - Clarice S Law
- Associate clinical professor, Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, School of Dentistry, at UCLA, Los Angeles, Calif., USA;,
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Werb D, Bluthenthal RN, Kolla G, Strike C, Kral AH, Uusküla A, Des Jarlais D. Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future. J Urban Health 2018; 95:91-98. [PMID: 28948444 PMCID: PMC5862695 DOI: 10.1007/s11524-017-0192-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dan Werb
- Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
| | - R N Bluthenthal
- Division of Health Behavior Research, Institute for Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - G Kolla
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - C Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - A H Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, CA, USA
| | - A Uusküla
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - D Des Jarlais
- Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Zhou X, Perez-Cueto FJA, Santos QD, Monteleone E, Giboreau A, Appleton KM, Bjørner T, Bredie WLP, Hartwell H. A Systematic Review of Behavioural Interventions Promoting Healthy Eating among Older People. Nutrients 2018; 10:E128. [PMID: 29373529 PMCID: PMC5852704 DOI: 10.3390/nu10020128] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
Because eating habits are inseparably linked with people's physical health, effective behaviour interventions are highly demanded to promote healthy eating among older people. The aim of this systematic review was to identify effective diet interventions for older people and provide useful evidence and direction for further research. Three electronic bibliographic databases-PubMed, Scopus and Web of Science Core Collection were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria. English language peer-reviewed journal articles published between 2011 and 2016 were selected for data extraction and quality assessment. Finally, a total of 16 studies were identified. The studies' duration ranged from three weeks to seven years. The majority of studies were carried out in European countries. Seven studies had a moderate quality while the remaining studies were at a less than moderate level. Three dietary educational interventions and all meal service related interventions reported improvements in older people's dietary variety, nutrition status, or other health-related eating behaviours. Multicomponent dietary interventions mainly contributed to the reduction of risk of chronic disease. The results supported that older people could achieve a better dietary quality if they make diet-related changes by receiving either dietary education or healthier meal service. Further high-quality studies are required to promote healthy eating among older people by taking regional diet patterns, advanced information technology, and nudging strategies into account.
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Affiliation(s)
- Xiao Zhou
- Department of Food Science, University of Copenhagen, 1958 Frederiksberg C, Denmark.
| | | | - Quenia Dos Santos
- Department of Food Science, University of Copenhagen, 1958 Frederiksberg C, Denmark.
| | - Erminio Monteleone
- Department of Management of Agricultural, Food and Forestry Systems, University of Florence, 50144 Florence, Italy.
| | - Agnès Giboreau
- Centre for Food and Hospitality Research, Institute Paul Bocuse, 69130 Ecully, France.
| | - Katherine M Appleton
- Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK.
| | - Thomas Bjørner
- Department of Architecture, Design and Media Technology, Aalborg University, 9000 Aalborg, Denmark.
| | - Wender L P Bredie
- Department of Food Science, University of Copenhagen, 1958 Frederiksberg C, Denmark.
| | - Heather Hartwell
- Faculty of Management, Bournemouth University, Poole BH12 5BB, UK.
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Hudson CG. Behavioral Mental Health: An Emerging Field of Service or an Oxymoron? Soc Work 2018; 63:27-36. [PMID: 29136247 DOI: 10.1093/sw/swx048] [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: 11/18/2017] [Accepted: 05/01/2017] [Indexed: 06/07/2023]
Abstract
Proliferation in the use of the terminology around behavioral mental health suggests, on one hand, an emerging field of service that integrates psychiatric, substance abuse, and related services. On the other hand, this development also raises questions about the coherence of this approach. This review explores the history, definitional issues, current trends, and available data on the impact of this field. It considers a variety of critiques of behavioral mental health, such as possibility that the field attempts to integrate fundamentally incompatible domains, that the term "behavioral mental health" is thus an oxymoron, and that it represents a co-optation by the insurance industry of traditional ideals of mental health and of behavioral medicine or as code for the implementation of a medical model that emphasizes short-term, behavioral, and psychopharmacological treatments at the expense of a truly biopsychosocial orientation. Other concerns include the focus on individual change and the effectiveness of behavioral health as a strategy for destigmatizing mental health. Recommendations for addressing the various barriers to realizing the ideals of behavioral mental health include revamping the role of managed care in oversight of treatment decisions, broadening the implementation of evidence-based treatment, and the development of treatment models that build on traditional social work practice models.
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Affiliation(s)
- Christopher G Hudson
- Christopher G. Hudson, PhD, is professor, School of Social Work, Salem State University, 357 Lafayette Street, Salem, MA 01970; e-mail:
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Abstract
Chronic pain and mental health disorders are common in the general population, and epidemiological studies suggest that a bidirectional relationship exists between these 2 conditions. The observations from functional imaging studies suggest that this bidirectional relationship is due in part to shared neural mechanisms. In addition to depression, anxiety, and substance use disorders, individuals with chronic pain are at risk of other mental health problems including suicide and cigarette smoking and many have sustained sexual violence. Within the broader biopsychosocial model of pain, the fear-avoidance model explains how behavioral factors affect the temporal course of chronic pain and provides the framework for an array of efficacious behavioral interventions including cognitive-behavioral therapy, acceptance-based therapies, and multidisciplinary pain rehabilitation. Concomitant pain and mental health disorders often complicate pharmacological management, but several drug classes, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and anticonvulsants, have efficacy for both conditions and should be considered first-line treatment agents.
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Affiliation(s)
- W Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.
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Abstract
Chronic cough (CC) can be refractory to medical treatment and newer strategies are required for these patients. Behaviour modification therapies are a potential approach for management of cough that does not respond to medical management. Behaviour modification therapy for CC involves an individually tailored programme teaching individuals to increase control over cough symptoms and includes education, specific strategies to suppress the cough, vocal hygiene training and psychoeducational counselling. Several case series have described speech pathology treatment for CC and a recent randomized control trial has demonstrated a significant improvement in symptoms. Possible mechanisms for this improvement include reduced cough reflex sensitivity, increased voluntary control of the cough and reduced stimulation of cough receptors. Respiratory retraining used by physiotherapists may also have potential for use in CC. The validity of psychological therapeutic approaches to CC rests on concepts of CC as a disorder with a psychogenic component, and the ability of cognitive therapies to modify the cough pathway. This work outlines current literature into behavioural management of CC and suggests new directions for practice and research in adults with this condition. Chronic Respiratory Disease 2007; 4: 89—97
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Affiliation(s)
- A E Vertigan
- Hunter New England Health (Southern), Newcastle, Division of Speech Pathology, University of Queensland, Brisbane, and Department of Respiratory and Sleep Medicine, John Hunter Hospital, Australia.
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Affiliation(s)
- Steven M Teutsch
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Public Health Institute, Oakland, California.
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Pbert L, Druker S, Flint AJ, Young MH, DiFranza JR. Perspectives in Implementing a Pragmatic Pediatric Primary Care-Based Intervention Trial. Am J Prev Med 2015; 49:S200-7. [PMID: 26296555 PMCID: PMC4548280 DOI: 10.1016/j.amepre.2015.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
The 2013 U.S. Preventive Services Task Force (USPSTF) concluded that behavioral interventions are effective in reducing initiation of smoking in youth, recommending primary care clinicians provide education or brief counseling to prevent initiation, and that there are promising trends toward behavioral interventions improving cessation in this population. Our primary care-based intervention RCT conducted between 2000 and 2004, Air It Out, informed these USPSTF recommendations. Our trial was designed to determine whether a pediatric primary care practice-based smoking prevention and cessation intervention would be effective in increasing abstinence rates among adolescents under usual clinic conditions, to inform clinical practice. Therefore, the trial was designed to be largely a pragmatic trial. In this paper, we describe where each of the Air It Out study components falls along the pragmatic-explanatory continuum regarding participant eligibility criteria, intervention and comparison condition design, follow-up and outcomes, compliance and adherence assessments, and analysis. Such an assessment assists researchers by providing a framework to guide decisions regarding study design and implementation. We then share a few principles and lessons learned in developing and implementing the primary care-based intervention trial, focusing on study setting selection, engaging providers who will be delivering the intervention and the target population who will be receiving it in designing the trial and interventions to be tested, and the need to carefully plan recruitment and retention procedures. The hope is to increase the number of well-designed studies that can be included in the evidence reviews to guide future USPSTF recommendation statements.
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Affiliation(s)
- Lori Pbert
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Susan Druker
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alan J Flint
- Harvard School of Public Health, Boston, Massachusetts
| | - Martin H Young
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joseph R DiFranza
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts
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Rotella F, Lazzeretti L, Barbaro V, Castellini G, Bigiarini M, Cresci B, Ricca V, Rotella CM, Mannucci E. All roads bring to Rome: a different way for predicting success in the therapy of obesity through psychological features. J Endocrinol Invest 2014; 37:1187-94. [PMID: 25038905 DOI: 10.1007/s40618-014-0130-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/26/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE Obesity treatment based on lifestyle modifications is characterized by a high proportion of treatment failures. The study of predictors of success could be useful for a better definition of therapeutic needs in individual patients. Few studies have attempted a comprehensive assessment of psychological factors related with treatment response. Aim of the study is the identification of psychological and psychopathological features associated with a good treatment response in patients referring for obesity. METHODS This prospective observational study was conducted on a consecutive series of 270 obese patients and a six-month follow-up was performed. At enrollment, a complete medical history was collected and, psychopathology and psychological features were assessed with: General psychopathology: Symptom Checklist 90-revised, Eating Disorder Examination-Questionnaire, Obesity Related well-being and Treatment, Motivation and Readiness test. RESULTS Among the 231 patients evaluated at follow-up, the mean weight loss was 3.2% of initial body weight and 68 patients (29.4%) reached the pre-defined therapeutic target of 5% weight loss. Higher psychopathology was associated with a worse outcome in women only; whereas motivation was higher in patients achieving therapeutic targets among men, but not in women. CONCLUSIONS Mean weight loss obtained with lifestyle interventions is confirmed to be rather small and a more accurate selection of patients to be enrolled in lifestyle intervention programs is needed. The present study provides some intriguing information on predictors of weight loss, which could be useful for the identification of patients with a higher chance of succeeding with lifestyle programs for the treatment of obesity.
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Affiliation(s)
- Francesco Rotella
- Section of Psychiatry, Careggi University Hospital, Largo Brambilla 3, Florence, Italy,
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Sorbi MJ, Kleiboer AM, van Silfhout HG, Vink G, Passchier J. Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months. Cephalalgia 2014; 35:608-18. [PMID: 25228685 DOI: 10.1177/0333102414547137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 04/25/2014] [Accepted: 07/06/2014] [Indexed: 01/27/2023]
Abstract
AIM This randomized, controlled trial examined the medium-term effectiveness of online behavioral training in migraine self-management (oBT; N = 195) versus waitlist control (WLC; N = 173) on attack frequency, indicators of self-management (primary outcomes), headache top intensity, use of rescue medications, quality of life and disability (secondary outcomes). METHODS An online headache diary following the ICHD-II and questionnaires were completed at baseline (T0), post-training (T1) and six months later (T2). Missing data (T1: 24%; T2: 37%) were handled by multiple imputation. We established effect sizes (ES) and tested between-group differences over time with linear mixed modelling techniques based on the intention-to-treat principle. RESULTS At T2, attack frequency had improved significantly in oBT (-23%, ES = 0.66) but also in WLC (-19%; ES = 0.52). Self-efficacy, internal and external control in migraine management--and triptan use--improved only in oBT, however. This indicates different processes in both groups and could signify (the start of) active self-management in oBT. Also, only oBT improved migraine-specific quality of life to a sizable extent. CONCLUSIONS oBT produced self-management gains but could not account for improved attack frequency, because WLC improved as well. The perspective that BT effects develop gradually, and that online delivery will boost BT outreach, justifies further research.
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Affiliation(s)
- M J Sorbi
- Department of Clinical and Health Psychology, Utrecht University, the Netherlands
| | - A M Kleiboer
- Department of Clinical and Health Psychology, Utrecht University, the Netherlands Department of Clinical Psychology, VU University, the Netherlands
| | - H G van Silfhout
- Department of Clinical and Health Psychology, Utrecht University, the Netherlands
| | - G Vink
- Department of Methodology and Statistics, Utrecht University, the Netherlands Department of Quality and Methodology, Statistics Netherlands, the Netherlands
| | - J Passchier
- Department of Clinical Psychology, VU University, the Netherlands
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Abstract
The empirical support for three behavioral treatments (relaxation, biofeedback and cognitive therapy) for managing migraine headaches in children and adults is reviewed. Meta-analyses and evidence-based reports show that these approaches are of considerable value, they appear to work equally well when applied individually, in groups or in limited contact formats. Meta-analyses comparing behavioral and prophylactic medication show equivalent results. However, outcomes are optimized when these treatments are combined. Researchers are currently seeking to identify factors predictive of response to behavioral approaches. Patients experiencing medication-overuse, refractory, cluster or post-traumatic forms of headache or comorbid conditions present special challenges that can require intensive, comprehensive and multidisciplinary approaches to treatment. Behavioral treatments have met with mixed success for menstrual migraine in the few studies that have been conducted. This review concludes by highlighting directions for future research efforts such as importing treatments to settings where headache patients most often seek care and developing algorithms for optimizing combinations of behavioral and pharmacological treatments to enhance effectiveness, reduce costs, minimize dosing requirements and improve adherence to needed medications. Other research efforts include developing treatments that target the underlying pathophysiology more directly, gaining a greater understanding of mediators and moderators of behavioral treatments, exploiting e-technology for assessment and treatment, and assessing outcome in multiple ways--such as quality of life.
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Affiliation(s)
- Frank Andrasik
- Institute for Human and Machine Cognition, University of West Florida, 40 South Alcaniz Street, Pensacola, FL 32502, USA.
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Abstract
PURPOSE Variations in the use of health coaching documented in the literature indicate a lack of conceptual clarity. The purpose of this article was to clarify the meaning of health coaching and propose an operational definition. CONCLUSIONS Seven attributes were identified and used to propose an operational definition of health coaching as a goal-oriented, client-centered partnership that is health-focused and occurs through a process of client enlightenment and empowerment. PRACTICE IMPLICATION This operational definition and the proposed empirical measures of each attribute can be used to validate the presence of health coaching, develop theory-based applications, and consistently test the effectiveness of interventions using this concept.
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Affiliation(s)
- Jeanette M Olsen
- Wisconsin Indianhead Technical College, Rice Lake, WI; University of Wisconsin Milwaukee, Milwaukee, WI
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Abstract
Obesity and other eating-related problems are widespread and are associated with harmful physical, psychological, and social problems. The dramatic increases in rates of pediatric obesity has created a mounting need for psychologists and other mental health care providers to play a significant role in the assessment and treatment of youth with eating- and weight-related problems. Therefore, it is imperative for providers to be aware of the causes and consequences of eating- and weight-related problems and to be familiar with evidence-based assessment and intervention approaches. Currently, the most well-established intervention approaches are family-based behavioral treatments, and weight loss maintenance treatments with a socio-ecological focus are promising. This paper provides a comprehensive review of these topics and highlights the important roles that mental health care providers can have. Medical settings are often the patient's first point of contact within the healthcare system, making mental health care providers in such settings uniquely suited to assess for a broad range of eating- and weight-related problems and associated comorbidities, to deliver relevant evidence-based interventions, and to make appropriate referrals. Moving forward, providers and researchers must work together to address key questions related to the nature of eating- and weight-related problems in youth and to achieve breakthroughs in the prevention and treatment of such problems in this vulnerable population.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Box 8134, St. Louis, MO 63110, USA.
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Wolfenden L, Brennan L, Britton BI. Intelligent obesity interventions using Smartphones. Prev Med 2010; 51:519-20. [PMID: 20851141 DOI: 10.1016/j.ypmed.2010.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/05/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
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Hohagen F. [Behaviour therapy - a changing psychotherapeutic approach]. Fortschr Neurol Psychiatr 2010; 78:631. [PMID: 21069628 DOI: 10.1055/s-0029-1245787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Llaneza DC, DeLuke SV, Batista M, Crawley JN, Christodulu KV, Frye CA. Communication, interventions, and scientific advances in autism: a commentary. Physiol Behav 2010; 100:268-76. [PMID: 20093134 PMCID: PMC2860058 DOI: 10.1016/j.physbeh.2010.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [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: 07/31/2009] [Revised: 01/11/2010] [Accepted: 01/12/2010] [Indexed: 12/20/2022]
Abstract
Autism spectrum disorders (ASD) affect approximately 1 in 150 children across the U.S., and are characterized by abnormal social actions, language difficulties, repetitive or restrictive behaviors, and special interests. ASD include autism (autistic disorder), Asperger Syndrome, and Pervasive Developmental Disorder not otherwise specified (PDD-NOS or atypical autism). High-functioning individuals may communicate with moderate-to-high language skills, although difficulties in social skills may result in communication deficits. Low-functioning individuals may have severe deficiencies in language, resulting in poor communication between the individual and others. Behavioral intervention programs have been developed for ASD, and are frequently adjusted to accommodate specific individual needs. Many of these programs are school-based and aim to support the child in the development of their skills, for use outside the classroom with family and friends. Strides are being made in understanding the factors contributing to the development of ASD, particularly the genetic contributions that may underlie these disorders. Mutant mouse models provide powerful research tools to investigate the genetic factors associated with ASD and its co-morbid disorders. In support, the BTBR T+tf/J mouse strain incorporates ASD-like social and communication deficits and high levels of repetitive behaviors. This commentary briefly reviews the reciprocal relationship between observations made during evidence-based behavioral interventions of high- versus low-functioning children with ASD and the accumulating body of research in autism, including animal studies and basic research models. This reciprocity is one of the hallmarks of the scientific method, such that research may inform behavioral treatments, and observations made during treatment may inform subsequent research.
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Affiliation(s)
- Danielle C. Llaneza
- Department of Psychology, University at Albany, State University of New York, Albany, NY
| | - Susan V. DeLuke
- Department of Literacy and Special Education, College of Saint Rose, Albany, NY
| | - Myra Batista
- Kevin G. Langan School, Center for Disability Services, Albany, NY
| | - Jacqueline N. Crawley
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute of Mental Health, Bethesda, MD
| | - Kristin V. Christodulu
- Center for Autism and Related Disabilities, University at Albany, State University of New York, Albany, NY
| | - Cheryl A. Frye
- Department of Psychology, University at Albany, State University of New York, Albany, NY
- Department of Biology, University at Albany, State University of New York, Albany, NY
- Centers for Life Science, University at Albany, State University of New York, Albany, NY
- Neuroscience Research, University at Albany, State University of New York, Albany, NY
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Underhill K. Transferring behavioral interventions for global health: intellectual property barriers, information constraints, and possible solutions. Yale J Health Policy Law Ethics 2010; 10:357-398. [PMID: 20681439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Garaulet M, Pérez de Heredia F. Behavioural therapy in the treatment of obesity (I): new directions for clinical practice. NUTR HOSP 2009; 24:629-639. [PMID: 20049365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 05/21/2009] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES Behavioural therapy (BT) in obesity treatment helps individuals to develop skills to achieve healthier body weights. Instead of helping to decide what to change, it helps to identify how to change; lifestyle modification is essential for any treatment of obesity, be it dieting, medication, surgery, etc. Physicians often tend to be unwilling to use BT considering it time-consuming and skill-intensive. However, BT can be standardized and used more readily in clinical practice. Besides, new approaches have been developed which contribute to increase the success of the treatments, like non face-to-face techniques, or the new cognitive therapy. SETTING Classical knowledge on BT has been updated with recent publications and information on these new approaches, combined with our own experience in the clinical treatment of obesity. RESULTS Most research on BT has been conducted in university-based programs which, despite their importance, tell us little about its effectiveness in actual clinical practice. Future research might focus on determining how BT can be best applied in a real-world setting. Examples of new directions are increased maintenance periods, use of Internet, and new cognitive therapy. Besides, elucidating the genetic component in the prognosis of weight management -the nutrigenomic approach- could assist in the development of more effective and individually tailored therapeutic strategies; indeed, single nucleotide polymorphisms in candidate genes have been related with eating patterns. CONCLUSIONS This review gives a renewed perspective of BT for obesity, offers key-pointers and describes specific ways in which medical professionals can promote and encourage self-care of patients.
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Affiliation(s)
- M Garaulet
- Department of Physiology, Faculty of Biology, University of Murcia, Murcia, Spain.
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Abstract
PURPOSE OF REVIEW To describe the short-term and long-term results of lifestyle modification for obesity. RECENT FINDINGS Randomized controlled trials, which compared different diet and activity interventions were reviewed. Studies that investigated the efficacy of new technologies to provide lifestyle modification, such as web-based delivery, also were examined. SUMMARY In general, comprehensive lifestyle modification programs delivered in person induce a loss of approximately 10% of initial weight in 16-26 weeks of treatment. The use of portion-controlled diets, which typically involve the use of meal replacement products, was associated with significantly larger weight losses in the short term. In contrast, interventions delivered via the Internet induced a loss of approximately 5%. However, web-based programs appear to have potential in facilitating the continuation on patient-provider contact, which along with high levels of physical activity, appear to be key strategies for successful long-term weight control. Recent studies also have suggested that the combination of lifestyle modification with long-term use of pharmacotherapy holds promise for maximizing initial weight losses and promoting long-term maintenance.
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Affiliation(s)
- David B Sarwer
- Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Affiliation(s)
- David A Rotholz
- Center for Disability Resources (UCEDD), University of South Carolina, School of Medicine, Columbia, SC 29208, USA.
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Abstract
OBJECTIVE To determine the efficacy and safety of common complementary and alternative medicine (CAM) therapies used to relieve the menopausal symptoms. DESIGN Comprehensive literature search was conducted through the databases Medline, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Centre for Complementary and Alternative Medicine) to identify relevant monographs in English language. RESULTS Studies have shown that some therapies such as clonidine, selective serotonin receptor inhibitors (SSRIs) and gabapentin are effective in decreasing the degree and frequency of somatic symptoms in menopause, while phytooestrogens and black cohosh have shown mixed results. Use of Ginseng, evening primrose, Dong Quai or vitamin E appears not to be efficacious for the relieving hot flushes. Other effects of these therapies including possible improvements in mood are yet to be substantiated. INCLUSION CRITERIA All available human complementary medicine studies on menopausal women with regard to the relief of menopausal symptoms. EXCLUSION CRITERIA Studies not meeting the inclusion criteria, published in languages other than English or animal studies. CONCLUSION There is a general lacking of longer-term follow-up beyond the trial lengths of 6-12 weeks in the use of CAM, although women may be taking these medications for many years. Well-designed, randomised control trials are needed to elucidate the true effect of these therapies above the placebo effect.
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Affiliation(s)
- Veronica Chi Ken Wong
- Department of Obstetrics & Gynaecology, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Overcoming cocaine or stimulant addiction. Medications offer modest help; vaccines are in development. Harv Ment Health Lett 2009; 25:6-7. [PMID: 19368038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Feuerstein M. Workstyle: It’s probably time we address both biomechanical and biobehavioral approaches? Pain 2007; 132:3-4. [PMID: 17825489 DOI: 10.1016/j.pain.2007.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 08/02/2007] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Tailoring substance abuse treatment to women often leads to better outcomes. Previous evidence, however, suggests limited availability of such options. OBJECTIVES This investigation sought to depict recent changes in outpatient substance abuse treatment (OSAT) tailoring to women and to identify unit and contextual factors associated with these practices. RESEARCH DESIGN Data were from 2 waves of a national OSAT unit survey (N = 618 in 1995, N = 566 in 2005). Comparisons of weighted means between waves indicate which practices changed over time. Multiple logistic regressions with generalized estimating equations test associations between unit and contextual attributes and tailoring to women. MEASURES Tailoring to women was measured as availability of prenatal care, child care, single sex therapy, and same sex therapists, and the percentage of staff trained to meet female clients' needs. RESULTS Two measures of tailoring to women declined significantly between 1995 and 2005: availability of single sex therapy (from 66% to 44% of units) and percent of staff trained to work with women (from 42% to 32% of units). No aspect of tailoring to women became more common. Proportion of female clients, total number of clients, methadone status, and private and government managed care were associated with higher odds of tailoring to women. For-profit facilities, which became more prevalent during the study period, had lower odds than other units of tailoring treatment to women. CONCLUSIONS Some key aspects of OSAT tailoring to women decreased significantly in the last decade. Managed care contracts may offer 1 mechanism for counteracting these trends.
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36
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Abstract
The view of headache as a psychophysiological disorder predates contemporary behavioural research and also the concept that psychosomatic illnesses are the result of specific emotional conflicts that eventually produce physical symptoms. Behavioural interventions include strategies for the identification and modification of behavioural headache triggers and the acquisition and use of self-regulation skills aimed at prevention of headache episodes. Consequently, research in behavioural medicine has matured scientifically, although methodological imperfections have had an impact on contemporary headache management. The evidence suggests that the level of headache improvement with behavioural interventions may rival those obtained by using medications. As side effects and complications are minimal, these approaches are optimal options for young patients or for patients where the medications remain contraindicated.
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Affiliation(s)
- L Grazzi
- Neurological Institute C. Besta, Via Celoria 11, I-20133 Milan, Italy.
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37
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Abstract
Behavioural treatments (predominantly biofeedback, relaxation and cognitive-behavioural) have been utilised in headache management for nearly 4 decades. This paper examines their clinical efficacy, drawing upon 2 primary sources of evidence: meta-analytic and evidenced-based reviews. Behavioural treatments have demonstrated efficacy and have been endorsed by various reviewing groups, such as the US Headache Consortium. Outcomes from behavioural treatments appear to endure over longer-term follow-up intervals as well. Meta-analyses comparing behavioural and pharmacological treatments have revealed similar levels of outcome. The article closes with a brief discussion of methods investigators are exploring to make behavioural treatments more available and affordable to headache patients.
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Affiliation(s)
- F Andrasik
- Department of Psychology, University of West Florida, 11000 University Parkway, Pensacola, FL 32514, USA.
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38
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Abstract
Whither, or wither, empirically supported therapies? Increasingly rigorous research in behavioral therapies has yielded a large number of effective therapies, but comparatively little work, demonstrating that integrating empirically supported therapies (ESTs) into standard practice results in meaningful improvements in patient outcomes. Methodology and strategies for evaluating ESTs and their effectiveness in clinical practice is a fairly recent innovation, and a host of unanswered questions remain regarding issues such as selection among different ESTs and what type of ESTs should be emphasized in dissemination efforts, what type of clinicians should be trained in what type of ESTs, the most effective training strategies for various types of clinicians, the need for ongoing supervision to maintain minimum levels of treatment fidelity and skill. In this review, we call for broader use of new research strategies and methods relevant to dissemination of ESTs; these may include adaptive designs, identification of mechanisms of action to foster greater emphasis on effective change principles, training and adoption trials, as well as novel implementation strategies including computer-assisted therapy and computer-assisted training.
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Affiliation(s)
- Kathleen M Carroll
- Division of Substance Abuse, Yale University School of Medicine, West Haven, CT 06516, USA.
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39
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Abstract
Most clinicians agree that biobehavioural factors are important considerations in the assessment and treatment of headache patients. Attention to psychological and behavioural issues may become even a greater concern as the frequency of a patient's headaches increases, there is increased disability secondary to headaches and/or there is inadequate response to usually effective treatment. The present article will highlight biobehavioural factors that should be considered in the assessment process involving headache patients and will provide a model for integration of behavioural treatment into clinical practice.
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Affiliation(s)
- R E Weeks
- The New England Institute for Behavioral Medicine, 778 Long Ridge Road, Stamford, CT 06902, USA.
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40
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Abstract
This paper reviews non-invasive behavioural approaches - broadly construed as cognitive, affective, behavioural and psychophysiological interventions - and examines whether they can impact central, peripheral or autonomic nervous system components responsive to pain in general and headache in particular. It focuses on two developing bodies of literature - neurophysiology of migraine and fMRI studies of pain networks. The available literature suggests behavioural interventions can affect neuromodulation, although further research is clearly warranted.
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Affiliation(s)
- F Andrasik
- Department of Psychology, University of West Florida, 11000 University Parkway, Pensacola, FL 32514, USA.
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41
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Abstract
The relationship between psychotherapy and psychiatry has become a beleagured one in recent years. The swing of the pendulum in the direction of biological psychiatry has led to a marginalization of psychotherapy within the discipline of psychiatry as a whole. However, psychotherapy continues to be a basic science of psychiatry with application in all clinical settings. It must be regarded as a biological treatment that works by changing the brain and is therefore just as important as pharmacotherapy in terms of overall treatment planning. The combined treatment of medication and psychotherapy has become the most common mode of psychiatric treatment planning in current practice. Both the two-treater model and the single-treater model have a set of advantages and disadvantages that are explicated. Further research is needed to identify clinical situations in which psychotherapy is essential, whether alone or in combination with medication. Moreover, as greater insights are gained into the brain mechanisms responsible for therapeutic changes, more specifically targeted psychotherapies can be developed.
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42
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Huge V, Schloderer U, Steinberger M, Wuenschmann B, Schöps P, Beyer A, Azad SC. Impact of a Functional Restoration Program on Pain and Health-Related Quality of Life in Patients with Chronic Low Back Pain. Pain Med 2006; 7:501-8. [PMID: 17112363 DOI: 10.1111/j.1526-4637.2006.00238.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Functional restoration programs for chronic low back pain (CLBP) have been shown to be successful in improving function and, to a lesser extent, in reducing pain. The Munich Functional Restoration Program (MFRP) is a 4-week outpatient program designed to reduce pain and to improve health-related quality of life in patients with a long history of CLBP. DESIGN In a retrospective matched concurrent-controls therapeutic study, 44 patients with CLBP, who had either undergone MFRP or received an outpatient standard treatment (control) after initial evaluation at the pain center, completed questionnaires 1 year after the respective therapy (t1). The following parameters were assessed: health-related quality of life with Short Form-36 (SF-36), Pain Disability Index (PDI), Numeric Rating Scale (NRS) for pain, depression with the Center for Epidemiological Studies Depression Test (CES-D), and occupational situation. These data were compared with baseline values assessed by a questionnaire completed before starting the respective treatment (baseline, t0). RESULTS Compared with control, NRS and PDI were significantly better in patients completing the MFRP. Patients of the MFRP group showed also a significant reduction in CES-D as well as an improvement in three of eight SF-36 subscales. No changes were detected in the control group receiving standard treatment. CONCLUSIONS Compared with standard treatment, a functional restoration program for CLBP significantly improves some aspects of health-related quality of life. It results in a decrease of pain and pain-related disability even in patients with a long history of CLBP.
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Affiliation(s)
- Volker Huge
- Department of Anaesthesiology, Interdisciplinary Pain Clinic, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistrasse 15, Munich 81377, Germany.
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43
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Abstract
It is well established that Tourette syndrome has a neurobiologic origin. Although pharmacotherapy is the most commonly prescribed intervention, there is considerable evidence to support the use of behavior therapy, specifically habit reversal training, as an alternative or adjunct treatment for some individuals with Tourette syndrome. Unfortunately, many professionals are unfamiliar with habit reversal training. The purpose of this review is to provide readers with a brief review of empiric studies on habit reversal training, update readers on the current state and future of behavior therapy for Tourette syndrome, and provide resources for those readers interested in additional information.
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Affiliation(s)
- Michael B Himle
- Department of Psychology, University of Wisconsin-Milwaukee, WI, USA
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44
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Abstract
Migraine is a chronic, neurological disorder generally manifesting itself in attacks with severe headache, nausea and an increased reactivity to sensory stimuli. A low migraine threshold is set by genetic factors, although the phenotype also modulates the manifestations. The 1-year prevalence is approximately 13% and is higher among women. Patients usually experience neuropsychological dysfunction, and sometimes also reversible focal neurological symptoms. The trajectories of the characteristic symptoms of acute migraine usually follow a similar time course, indicating a reciprocal underlying mechanism. A central nervous system hyperexcitability has been demonstrated in neurophysiological studies. The dibilitating effects of migraine are not confined to the attacks per se. Many individuals do not recover completely between the attacks and most report a negative impact on the most important life domains, and an interest in testing other treatments. Young persons have a higher frequency of attacks. Acute treatment should routinely be initiated with an analgesic plus a prokinetic anti-emetic. Triptans must not be provided early during the attack to ensure their efficacy. The natural course of attacks is commonly only temporarily altered by acute treatment. Non-pharmacological treatment and drugs may be equally viable in prophylaxis for migraine. In more complicated cases, conjoint therapy should be considered. New strategies to improve adherence with existing therapeutic regimens might yield greater benefits than will new pharmacological agents.
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Affiliation(s)
- M Linde
- Cephalea Headache Centre and Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden.
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45
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Abstract
This chapter focuses on behavioral interventions involving skill acquisition for children and adolescents with autism over the last 12 years. Literature and outcome data are reviewed with respect to three categories: language, social skills, and self-management. Generalization of results is somewhat problematic, as all of the interventions discussed consist of relatively small sample sizes and utilize single case design methodology. However, expansion and refinement of research methodology over the last decade, with more researchers replicating previous studies, may make broader application of research findings possible.
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Affiliation(s)
- Dorothy Scattone
- Department of Pediatrics, Division of Child Development and Behavioral Medicine The University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
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46
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Cummings NA. Delivering the nuts without the bolts: the plight of clinical psychology practice. J Clin Psychol 2006; 61:1071-5. [PMID: 15965914 DOI: 10.1002/jclp.20139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A vision as bold as that expressed by C.R. Snyder and Timothy R. Elliott in their target article, "Twenty-First Century Graduate Education in Clinical Psychology: A Four Level Matrix Model" (this issue, pp 1033-1054), should make the long-awaited breakthrough in training that would include development, implementation, and evaluation of large-scale health delivery systems. The realization that clinical psychology is part of the health care industry, and not just psychotherapy or mental health, would enable psychologists to go beyond the laboratory and become important decision makers in the health care arena and thus command a greater share of health care funding.
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Affiliation(s)
- Nicholas A Cummings
- University of Nevada, Reno and the Cummings Foundation for Behavioral Health, Inc, USA.
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47
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Brehm SS. Another take on the matrix: interactionism. J Clin Psychol 2006; 61:1091-3. [PMID: 15965922 DOI: 10.1002/jclp.20143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This response to C.R. Snyder and T.R. Elliott's article, "Twenty-First Century Graduate Education in Clinical Psychology: A Four Level Matrix Model" (this issue, PP 1033-1054), focuses on the importance of three types of interactions: between mind and body, humans and machines, and individuals and groups. It is proposed that the clinical psychology training programs of the future will need to ensure that their students are well versed in the relevance of these interactions for understanding human behavior and developing effective treatments.
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48
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Abstract
The 21st century clinical psychologist will need to become actively engaged in establishing our nation's health care policies and priorities to ensure that the psychological aspects of care are given greater priority. The clinician's workplace and target clientele will drastically change, with the development of a global and preventive perspective becoming the key to the profession's future.
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49
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Abstract
This paper describes forces that have adversely affected the place of the psychodynamic perspective within psychiatric practice and training over the last generation. One effect of these forces has been to create a lost generation of psychiatrists with little knowledge or experience with psychodynamic treatment. The article addresses opportunities to reverse some of the detrimental effects of recent changes. The Residency Review Committee's introduction of a requirement that residents achieve a measurable level of competence in five schools of psychotherapy represents a major opportunity to influence psychiatric training and practice. The past and present work of the Committee on Psychotherapy by Psychiatrists (COPP) is summarized, including efforts to integrate and revise the five existing core competencies in psychotherapy into a "Y"-shaped model in a way that secures the future of psychodynamic therapy training in residencies. One existing unusual training opportunity with a central psychodynamic focus is described.
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Affiliation(s)
- Eric M Plakun
- Admissions and Professional Relations, Austen Riggs Center, Stockbridge, MA 01262, USA.
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50
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Abstract
Although Medicaid is the largest public payer of behavioral health services, information on access and utilization of services is lacking, and no data on the frequency of service use or types of services provided for children with autism spectrum disorders (ASDs) are available. As states move toward managed care approaches for their Medicaid program, services information is critical. Behavioral health service data for children with autism spectrum disorders were collected from a state Medicaid Managed Care (MMC) program and analyzed from fiscal years 1995 through 2000. Findings revealed that the number of children who received services over time increased significantly; however, the rate of service use was only one tenth of what should be expected based on prevalence rates. The mean number of service days provided per child decreased significantly, about 40%, and the most prevalent forms of treatment changed. Day treatment vanished and medication and case management increased disproportionately to the number of children served. Explanations and implications of the findings are presented as well as recommendations for future research.
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Affiliation(s)
- Lisa A Ruble
- Department of Pediatrics, Weisskopf Center for the Evaluation of Children, University of Louisville, KY 40202, USA.
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