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Leveraging digital technology to intervene on personality processes to promote healthy aging.
Marsch, LA, Hegel, MT, Greene, MA
Personality disorders. 2019;(1):33-45
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Abstract
The scientific evidence is clear that personality processes (particularly conscientiousness and neuroticism) play an important role in healthy aging. Assuming it would be desirable to assist individuals to change their personality in directions that would promote healthy aging, the next step is designing interventions for the task. During the past decade, technological advances have made it possible to develop and evaluate interventions delivered via web and mobile digital technologies. The purpose of this article is to discuss the possibilities for leveraging technology to intervene on personality processes to promote healthy aging, with a specific emphasis on applications for older adults. We begin by reviewing interventions that target personality change to treat mental health problems and physical health, followed by the scant research leveraging digital technologies in targeting personality processes. We present a rationale for adopting a transdiagnostic model to guide intervention development and review the brief literature supporting transdiagnostic interventions when adapted for digital delivery (transdiagnostic Internet-based cognitive-behavioral therapy). We then summarize the literature on designing technology interventions to meet the specific needs of older adults and some of the impressive results from digital technology (Internet-based cognitive-behavioral therapy) intervention studies. We conclude with suggestions for addressing gaps in this important but understudied area of research, with a focus on research targeted to older adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Modern approaches to the treatment of anorexia nervosa. "The third wave" of cognitive behavioral therapy.
Starzomska, M, Wilkos, E, Kucharska, K
Psychiatria polska. 2018;(4):651-662
Abstract
Anorexia nervosa (AN) is being considered one of the most difficult mental disorders to treat. The ego-syntonic nature of this mental disorder makes patients particularly reluctant to engage in or consent to treatment with relatively high drop-out rate. For all these reasons the treatment often takes a very long time, and the illness progresses to the chronic form, increasing the suffering of patients. Researchers have been discussing for many years how to provide these patients with measurable aid. Recent years have seen the emergence of arange of new treatment methods for eating disorders, including AN, that provide evidence of their effectiveness, especially in adults. Among them, of special note are those belonging to the third wave of cognitive therapy, mostly offered in the form of training programs. They are discussed in this paper in conjunction with evidence based therapy. This knowledge may help clinicians to decide how to complement traditional forms of treatment in outpatient and inpatient settings.
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Economic Impact of Third-Wave Cognitive Behavioral Therapies: A Systematic Review and Quality Assessment of Economic Evaluations in Randomized Controlled Trials.
Feliu-Soler, A, Cebolla, A, McCracken, LM, D'Amico, F, Knapp, M, López-Montoyo, A, García-Campayo, J, Soler, J, Baños, RM, Pérez-Aranda, A, et al
Behavior therapy. 2018;(1):124-147
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Abstract
The term third-wave cognitive behavioral therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to randomized controlled trials (RCTs) focused on clinical effectiveness; however, the number and quality of economic evaluations in these RCTs has been unknown and may be few. Evidence about efficiency of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the economic impact of third-wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third-wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration's tool for assessing risk of bias, respectively. Eleven RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some evidence that MBCT, MBSR, ACT, DBT, and eBA are efficient from a societal or a third-party payer perspective. No economic analysis was found for many third-wave therapies. Therefore, more economic evaluations with high methodological quality are needed.
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Contemporary psychotherapeutic interventions in patients with anorexia nervosa - a review.
Starzomska, M, Wilkos, E, Kucharska, K
Psychiatria polska. 2018;(4):663-672
Abstract
Due to its ego-syntonic nature, anorexia nervosa (AN) is considered one of the most difficult mental disorders to treat. Patients are often reluctant to accept treatment, while a large group of those who receive therapy have a poor prognosis. Unfortunately, despite suffering from physical and psychosocial impairment, patients with AN are often reluctant to receive any intervention whatsoever. Recent years have seen the development of many new treatment methods for eating disorders in general, and AN in particular. Therapy of anorexia nervosa requires a multidisciplinary approach based on the "cornerstone" of psychotherapy. Despite the growing body of studies and publications concerning psychological treatment of AN, there is still a dearth of high-quality randomized controlled trials which could serve as the basis for developing guidelines in this area.This paper offers a compendium of knowledge on treatment standards recommended for AN, as well as on psychotherapeutic paradigms and programs. Most of the therapies presented herein have been empirically proven effective. Therefore, the paper may facilitate the selection of the most appropriate treatment choices, whether in outpatient or inpatient settings.
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Promising technological innovations in cognitive training to treat eating-related behavior.
Forman, EM, Goldstein, SP, Flack, D, Evans, BC, Manasse, SM, Dochat, C
Appetite. 2018;:68-77
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Abstract
One potential reason for the suboptimal outcomes of treatments targeting appetitive behavior, such as eating and alcohol consumption, is that they do not target the implicit cognitive processes that may be driving these behaviors. Two groups of related neurocognitive processes that are robustly associated with dysregulated eating and drinking are attention bias (AB; selective attention to specific stimuli) and executive function (EF; a set of cognitive control processes such as inhibitory control, working memory, set shifting, that govern goal-directed behaviors). An increasing body of work suggests that EF and AB training programs improve regulation of appetitive behaviors, especially if trainings are frequent and sustained. However, several key challenges, such as adherence to the trainings in the long term, and overall potency of the training, remain. The current manuscript describes five technological innovations that have the potential to address difficulties related to the effectiveness and feasibility of EF and AB trainings: (1) deployment of training in the home, (2) training via smartphone, (3) gamification, (4) virtual reality, and (5) personalization. The drawbacks of these innovations, as well as areas for future research, are also discussed. The above-mentioned innovations are likely to be instrumental in the future empirical work to develop and evaluate effective EF and AB trainings for appetitive behaviors.
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Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: a systematic review and meta-analyses.
Barrett, S, Begg, S, O'Halloran, P, Kingsley, M
BMC public health. 2018;(1):1160
Abstract
BACKGROUND The aim of this study was to investigate whether integrated motivational interviewing and cognitive behaviour therapy leads to changes in lifestyle mediators of overweight and obesity in community-dwelling adults. METHOD Six electronic databases were systematically searched up to 04 October, 2017. Analyses were restricted to randomised controlled trials that examined the effect of integrated motivational interviewing and cognitive behaviour therapy on lifestyle mediators of overweight and obesity (physical activity, diet, body composition) in community-dwelling adults. Meta-analyses were conducted using change scores from baseline in outcome measures specific to the lifestyle mediators of overweight and obesity to determine standardized mean differences (SMD) and 95% confidence intervals (95% CI). The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. RESULTS Ten randomised controlled trials involving 1949 participants were included. Results revealed moderate quality evidence that integrated motivational interviewing and cognitive behaviour therapy had a significant effect in increasing physical activity levels in community-dwelling adults (SMD: 0.18, 95% CI: 0.06 to 0.31, p < 0.05). The combined intervention resulted in a small, non-significant effect in body composition changes (SMD: -0.12, 95% CI: -0.24 to 0.01, p = 0.07). Insufficient evidence existed for outcome measures relating to dietary change. DISCUSSION The addition of integrated motivational interviewing and cognitive behaviour therapy to usual care can lead to modest improvements in physical activity and body composition for community-dwelling adults. The available evidence demonstrates that it is feasible to integrate MI with CBT and that this combined intervention has the potential to improve health-related outcomes. CONCLUSION This review details recommendations for future research including the adoption of uniform objective outcome measures and well-defined interventions with sufficient follow-up durations and assessments of treatment fidelity.
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The Efficacy of Psychological Therapies in Reducing Weight and Binge Eating in People with Bulimia Nervosa and Binge Eating Disorder Who Are Overweight or Obese-A Critical Synthesis and Meta-Analyses.
Palavras, MA, Hay, P, Filho, CA, Claudino, A
Nutrients. 2017;(3)
Abstract
Recurrent binge eating episodes, the core feature of Bulimia Nervosa (BN) and Binge Eating Disorder (BED), are frequently comorbid with obesity. Psychological interventions, notably Cognitive Behavioural Therapy (CBT), are effective for binge eating reduction in BED or BN but less so for weight loss. Behavioural Weight Loss Therapy (BWLT) shows effectiveness for binge eating reduction and weight loss but the latter appears poorly sustained over time. Our aim was to review evidence for efficacy of psychological therapies for BN/BED associated with overweight or obesity in reducing binge frequency and weight. A systematic search for randomized controlled trials with adult samples who had BN or BED was conducted considering articles in English, French, Spanish and Portuguese with no restrictions for the timeline publication ending in March 2016. A quality appraisal of the trials and meta-analyses comparing BWLT to CBT were done. This review identified 2248 articles for screening and 19 published articles were selected. No trials of BN were identified. This review found CBT was favoured compared to BWLT with regard to short-term binge eating reduction. However, insufficient evidence was found for superiority for BWLT efficacy compared to CBT considering binge eating remission, reduction of binge eating frequency and weight loss. More research is needed to test the efficacy of psychological treatments for BED or BN with co-morbid overweight or obesity, including trials evaluating binge eating remission and weight loss in the long-term.
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Pathophysiological targets for non-pharmacological treatment of migraine.
Coppola, G, Di Lorenzo, C, Serrao, M, Parisi, V, Schoenen, J, Pierelli, F
Cephalalgia : an international journal of headache. 2016;(12):1103-1111
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Background Migraine is the most prevalent neurological disorder worldwide and ranked sixth among all diseases in years lived with disability. Overall preventive anti-migraine therapies have an effect in one patient out of two at the most, many of them being endowed with disabling adverse effects. No new disease-modifying drugs have come into clinical practice since the application to migraine of topiramate and botulinum toxin, the latter for its chronic form. There is thus clearly a need for more effective treatments that are devoid of, or have acceptable side effects. In recent years, scientific progress in migraine research has led to substantial changes in our understanding of the pathophysiology of migraine and paved the way for novel non-drug pathophysiological-targeted treatment strategies. Overview Several such non-drug therapies have been tested in migraine, such as oxidative phosphorylation enhancers, diets and non-invasive central or peripheral neurostimulation. All of them are promising for preventive migraine treatment and are quasi-devoid of side effects. Their advantage is that they can in theory be selected for individual patients according to their pathophysiological profile and they can (and probably should) be combined with the classical pharmacological armamentarium. Conclusion We will review here how knowledge of the functional anatomy and physiology of migraine mechanisms holds the key for more specific and effective non-pharmacological treatments.
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Treatment of behavioral sleep problems in children and adolescents - literature review.
Kaczor, M, Skalski, M
Psychiatria polska. 2016;(3):571-84
Abstract
AIM: To collect data on treatment of behavioural sleep disorders in children and adolescents. MATERIALS AND METHODS A literature review based on the PUBMED database. RESULTS Based on the analysed materials three basic complementary procedures were identified - implementation of sleep hygiene, behavioural interventions and pharmacological treatment. The rules of sleep hygiene proven to be effective include: regular sleep schedule, adequately prepared place to sleep (a dark, quiet bedroom without multimedia), bedtime routine, avoiding caffeinated beverages. The following issues require further studies to confirm their effectiveness: falling asleep independently without parent's assistance, bedtime reading, physical activity, reducing daytime multimedia use, tryptophan rich breakfasts. Behavioural interventions and pharmacological treatment may in some cases be temporarily implemented to complement the sleep hygiene. CONCLUSIONS The implementation of sleep hygiene is a primary, fully acceptable to the child and parents, way to improve the baby sleep. In case of ineffectiveness of the proposed rules, those can be complemented with behavioural methods that are highly effective but some parents do not accept them or make mistakes in their introduction. Pharmacotherapy can be used as a temporary support for families with severe behavioural problems as an aid in the implementation of sleep hygiene and behavioural methods.
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Cognitive intervention therapy as treatment for behaviour disorders in Alzheimer disease: evidence on efficacy and neurobiological correlations.
García-Alberca, JM
Neurologia (Barcelona, Spain). 2015;(1):8-15
Abstract
INTRODUCTION The prevalence of behavioural and psychological symptoms (BPS) is very high among patients with Alzheimer disease (AD); more than 90% of AD patients will present such symptoms during the course of the disease. These symptoms result in poorer quality of life for both patients and caregivers and increased healthcare costs. BPS are the main factors involved in increases to the caregiver burden, and they often precipitate the admission of patients to residential care centres. DEVELOPMENT Current consensus holds that intervention models combining pharmacological and non-pharmacological treatments are the most effective for AD patients. Several studies have shown cholinesterase inhibitors and memantine combined with cognitive intervention therapy (CIT) to be effective for improving patients' cognitive function and functional capacity for undertaking daily life activities. However, the efficacy of CIT as a treatment for BPS has not yet been clearly established, which limits its use for this purpose in clinical practice. The objective of this review is to gather available evidence on the efficacy of cognitive intervention therapy (CIT) on BPS in patients with AD. CONCLUSIONS The results of this review suggest that CIT may have a beneficial effect on BPS in patients with AD and should therefore be considered a treatment option for patients with AD and BPS.