6,632 research outputs found

    A Randomized Controlled Trial of Motivational Interviewing for Binge Eating

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    Rationale: Motivational Interviewing (MI) is a collaborative therapy that focuses on strengthening a person’s internal motivation to change (Miller & Rollnick, 2002, 2012). Research suggests that MI may be helpful for treating binge eating; however, findings are limited and little is known about how MI for binge eating compares to active therapy controls. As such, the present study aimed to build on the current literature by comparing the efficacy of MI as a prelude to self-help treatment for binge eating to psychoeducation as a prelude to self-help treatment for binge eating. Method: Participants with full or subthreshold DSM-IV Binge Eating Disorder (BED) or nonpurging Bulimia Nervosa (BN-NP) were randomly assigned to receive either 60 minutes of MI followed by an unguided cognitive behavioural self-help manual (n = 24) or 60 minutes of psychoeducation followed by an unguided cognitive behavioural self-help manual (n = 21). Questionnaires were completed immediately before and after the treatment session, as well as at 1 month and 4 months post-session. Changes in readiness to change, confidence in ability to control binge eating, binge eating frequency and severity, eating disorder behaviours and attitudes, self-esteem, and depression were examined. Results: Findings revealed that MI significantly increased readiness to change and confidence in ability to control binge eating, whereas psychoeducation did not. Participants in the MI condition reported a significantly stronger therapeutic alliance than did participants in the psychoeducation condition. No group differences were found when changes in eating disorder and associated symptoms were examined; both groups showed significant overall improvements in eating disorder symptoms, binge eating frequency and severity, and self-esteem. Conclusions: MI offers benefits for increasing motivation, self-efficacy, and therapeutic alliance in treating individuals with clinically significant binge eating problems. However, it is not a uniquely effective treatment approach for reducing binge eating and other eating disorder symptoms

    Testing an Acceptance and Commitment Therapy Website for Hoarding: A Randomized Waitlist-Controlled Trial

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    Hoarding disorder is relatively common and seriously affects those who experience it. However, it is difficult to access hoarding treatment, due to barriers such as availability and stigma. Moreover, only one treatment is well-established for hoarding (CBT), and it does not directly address important processes such as mindfulness and acceptance. Therefore, in order to make treatment more useful and easy to access, this study tested a self-help program that focused on teaching mindfulness and acceptance as related to hoarding. The self-help program was compared to a waitlist condition; participants were randomly assigned to use the website or wait 12 weeks. The website was structured as 16 self-help modules tailored for hoarding. The program was implemented as an 8-week treatment with a 4-week follow-up period, and supportive coaching was provided during the 8-week treatment period. The sample included 73 individuals with problematic hoarding symptoms; as is common in hoarding treatment studies, participants were mostly white and female. These participants were slightly less white and somewhat younger compared to participants in studies on traditional therapy. Overall, results suggested that the program was helpful and participants found it satisfactory. Those who used the website improved significantly more than the waitlist on overall hoarding symptoms, overall difficulties in functioning, self-stigma, and progress toward personal values. Many participants did not finish the program, and many still had a problematic level of hoarding symptoms after treatment, which suggests room for improvement. Participants overall found the website satisfactory and easy to use, and perceived it as likely to be helpful. It is unclear what processes led to improvement in the treatment condition, although increasing mindful awareness and reducing rigid responses to thoughts and feelings about acquiring belongings may have contributed. Future studies should test this treatment in more diverse participants and compare it to other types of treatment options. However, these results suggest that a self-help website teaching mindfulness and acceptance skills is likely to be useful for people with hoarding problems

    EXPECTANCY VIOLATION DURING EXPOSURE THERAPY: A RANDOMIZED CONTROLLED TRIAL

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    Despite empirical support for the efficacy of exposure-based cognitive-behavioral therapy (CBT) for anxiety-related disorders, many individuals do not respond to this intervention or experience a return of fear after treatment. Inhibitory learning theory has informed novel approaches to exposure therapy that aim to improve both short- and long-term outcomes. One exposure optimization strategy is to maximize expectancy violation (i.e., the difference between expected outcomes and actual outcomes), which is thought to strengthen inhibitory (i.e., non-threat) associations and enhance long-term fear extinction. In practice, exposure therapy is often preceded by cognitive restructuring, which is designed to lessen the magnitude of harm expectancies. According to inhibitory learning theory, this technique may restrict the discrepancy between expected outcomes and actual outcomes, thus reducing the potency of exposure therapy and limiting the durability of treatment gains. Although theoretically plausible, this hypothesis had not previously been empirically investigated. Accordingly, the present study examined the effects of the timing of cognitive techniques during exposure-based CBT by randomly assigning 45 participants with spider phobia to one of three intervention conditions: (a) cognitive restructuring before exposure (CR-EXP), (b) exposure before cognitive restructuring (EXP-CR), and (c) stress management (SM) control. No significant outcome differences were detected between CR-EXP and EXP-CR conditions on measures of fear, avoidance, or spider-related cognitions. There were also no group differences in expectancy change, surprise, or treatment acceptability and adherence. Clinical implications, study limitations, and future directions are discussed regarding the timing of cognitive restructuring in conjunction with exposure therapy.Doctor of Philosoph

    Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies.

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    Background There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. Objective This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. Methods Three case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). Results In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. Conclusions The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials

    Trauma Therapy for Very Young Children Living in Poverty: A Randomized Controlled Trial

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    This study used a randomized control design with immediate treatment and wait list control conditions to evaluate the efficacy of the New Hope program, a home-based, parent-and-child therapy program that has been developed for very young children living in poverty who experienced one or more potentially traumatizing events. Within a three-phase model of treatment, the New Hope program is designed to establish safety, build the caregiver child relationship, create a nurturing environment, teach coping skills, address trauma-related thoughts and feelings, and develop prosocial skills. Training in this program included discussions regarding the cultural implications of providing therapy services in the context of urban poverty. Sixty-four children under the age of six were referred to a community agency for behavior problems and emotional difficulties. All children had experienced at least one potentially traumatic event, and all families received some kind of government assistance indicating that the family’s income was below the federal definition for poverty. Participants were randomly assigned to immediate treatment or wait list control groups. Analyses of covariance (ANCOVAs) revealed significant between-group differences on all post-test measures with pre-test scores as covariates. After the waitlist group completed treatment, repeated measures analyses of variance (ANOVAs) showed significant improvement for both groups on all measures at 4-6 week follow-up. Outcomes included reductions in challenging behaviors and emotional symptoms of trauma, improved caregiver-child relationships, and increased caregiver use of treatment strategies. Participating caregivers also reported a high level of general satisfaction with the treatment program and provided qualitative feedback in response to a follow-up interview. This study offers support for early intervention using a home-based parent-and-child therapy program for very young children exposed to potentially traumatic events

    Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial

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    Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemi- nation of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. In- dividuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to- treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help. Trial registration: Clinicaltrials.gov as NCT04074681. Registered 22 July 2019

    Therapeutic Education and Physical Activity to Support Self-management of Cancer-related Fatigue in Hematologic Cancer Patients: Protocol of a Feasibility Randomized Controlled Trial

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    Introduction: Hematologic malignancies account for nearly 8% of new cancer diagnosis in Italy. Cancer-related fatigue (CRF) is one of the most distressing symptoms reported by patients with cancer. As CRF has a multifactorial etiology, physical activity and therapeutic education may be beneficial for managing CRF, both during and after cancer treatment. However, there is a lack of evidence specific to hematologic malignancies. This paper describes the protocol of a feasibility study on Therapeutic Education and Physical Activity (TEPA) intervention to support self-management of CRF in patients with hematologic malignancies. Methods: TEPA was addressed to newly diagnosed adult individuals with hematologic malignancy able to take part in a rehabilitation programme at the AUSL-IRCCS of Reggio Emilia. The protocol was developed in 2 phases. Phase I was an observational cohort study involving a convenience sample of 10 participants with the aim to evaluate the feasibility of the assessment schedule and to register longitudinal clinical data regarding CRF (FACIT-F), psychologic distress (NCCN Distress Thermometer), QoL (EORTC QLQ-C30), physical performance (TUG and 6MWT) and habitual level of physical activity during first months after diagnosis. Phase II (underway) is a feasibility randomized controlled trial (TEPA) involving a convenience sample of 40 participants and comparing 2 parallel active interventions (Therapeutic Education versus Therapeutic Education and Physical Activity) on top of usual care. The primary aim is to estimate the feasibility of TEPA, measured by the adherence rate to the intervention. Secondary aims are: to estimate the effect size of TEPA in terms of changes in CRF, psychological distress, QoL, physical performance and habitual level of physical activity (measured as in Phase I); to collect patient satisfaction, perception of usefulness of the TEPA intervention and data on long-term adherence to an active lifestyle. Data are collected in both phases at the time of diagnosis and then at 1-, 3- (completion of intervention) and 7-month follow-up. Discussion: Data on feasibility and effect size of TEPA will be analyzed upon completion of Phase II, allowing us to design a large, adequately powered RCT to verify the effectiveness of this intervention on CRF management in patients with hematologic cancer. Trial registration: clinicaltrials.gov; Trial registration number: NCT0340307

    Online guided self-help to augment standard treatment for people with anorexia nervosa: feasibility, efficacy and process measures

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    Background: There is mounting evidence on the effectiveness of guided self-help (GSH) interventions to augment, shorten or replace standard care for eating disorders (EDs). However, only few studies have tested the use of GSH for people with anorexia nervosa (AN). Aims: 1) to conduct a systematic review and meta-analysis of GSH in AN, with a focus on clinical outcomes and feasibility; 2) to evaluate the feasibility, acceptability and efficacy of a novel digital GSH intervention for AN (RecoveryMANTRA) tested in addition to treatment as usual (TAU) in the outpatient setting, 3) to assess predictors of drop-out from the RecoveryMANTRA + TAU condition; 4) to establish the role of working alliance (WA) with mentors guiding the use of RecoveryMANTRA on patient’s symptom change over time and 5) to measure how language style matching between mentors and patients predicts clinical outcomes in the RecoveryMANTRA + TAU condition. Method: 187 patients accessing outpatient services for AN across different sites in England were randomized to receive TAU only (n= 88; control group) or TAU plus RecoveryMANTRA (n= 99; experimental group). The primary outcome included change in body mass index (BMI) at the end of six weeks of intervention and changes in eating disorder symptoms at 6 and 12 months follow-up. Process measures, such as motivation for treatment, confidence to change, and working alliance with the therapist at the outpatient service were longitudinally investigated. The GSH intervention was delivered by peer mentors (recovered individuals or carers, n=12) or mentors (psychology graduates, n=14) over six weekly synchronous chat-based sessions. The impact of type of mentorship and of linguistic style matching between patients and mentors on clinical outcomes and treatment adherence was measured. Results: Findings showed that: 1) GSH in AN was associated with significantly lower drop-out rates from the end of treatment assessments compared to a control condition; 2) those in the RecoveryMANTRA + TAU condition reported a trend level reduction in anxiety, higher levels of confidence in own ability to change, and a better alliance with the therapist at the outpatient service; 3) patient’s clinical outcomes were in part associated with the characteristics of the mentor delivering guidance 4) peer mentors working alliance in the previous session was significantly associated with eating psychopathology ratings in the next session, and 5) greater linguistic style matching between patients and mentors was associated to patient’s engagement with clinical treatment. Conclusions: Findings provided empirical support for the feasibility and effectiveness of online GSH for adults with AN. Strengths, weaknesses and clinical implications have been discussed
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