Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review.

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers

Mediators and theories of change in psychotherapy with adolescents: a systematic review protocol

Introduction Approximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The 'European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders', funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents. Method A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer from a mental disorder or psychological difficulties and receive an intervention that aims at preventing, ameliorating and/or treating psychological problems. Ethics and dissemination Ethical approval is not required for this systematic review as no primary data will be collected. The results will be published in a peer-reviewed journals and at conference presentations and will be shared with stakeholder groups. The whole data set will be offered to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. PROSPERO registration number CRD42020177535

Que "diferença faz a diferença" na recuperação da anorexia nervosa?

CONTEXTO: As dificuldades inerentes ao tratamento da anorexia nervosa são bem conhecidas e é, ainda hoje, predominante a concepção da anorexia nervosa enquanto doença crônica. Contudo, diversos estudos mostram não só que a recuperação é possível como também que há inclusivamente mulheres que se recuperam espontaneamente, sem terem sido sujeitas a tratamento. OBJETIVO: Este estudo pretende, assim, rever a literatura existente relativamente a fatores que contribuíram para a recuperação na anorexia nervosa, quer relacionados com o tratamento quer com extratramento. MÉTODO E RESULTADOS: Para tal, a partir da revisão de 13 estudos existentes sobre a perspectiva de ex-pacientes acerca do que contribuiu para a recuperação, este artigo irá pôr em destaque que "diferenças fizeram a diferença", bem como em que medida os estudos existentes permitem uma compreensão de como essas diferenças podem fazer a diferença. CONCLUSÃO: Conclui-se que, apesar de a investigação estar, sobretudo, centrada na compreensão dos fatores de tratamento mais úteis, muitas ex-pacientes parecem destacar mais a utilidade dos fatores extratratamento, nomeadamente a importância das relações na manutenção e resolução do problema. Os mesmos fatores são considerados prejudiciais e/ou úteis para diferentes entrevistadas, o que remete para a complexidade do fenômeno da recuperação que ainda carece de mais investigação

Childhood overweight and obesity intervention: effectiveness of a program based on parents as agents of change (LifeStyle)

The rates of childhood overweight (OW) and obesity (OB) significantly increased in the past decades. The prevalence of children with OW and OB (OW/OB children) in Portugal is one of the highest in the European Union and in the OECD area. A comprehensive approach to prevent and treat childhood OW and OB is needed. Since parents have a crucial role in children's diet and physical activity, interventions should include the family's lifestyle and focus on the parenting practices. Programs targeting parents by increasing parents' awareness and responsibility in providing environments that lead children to healthy behaviors are imperative in the treatment of childhood OW and OB. Considering the beneficial effects of parents as agents of change in pediatric weight management, this study's purpose is to implement and evaluate the efficacy and effectiveness of Group Lifestyle Triple P (GLTP) in a Portuguese sample of parents of OW/OB children. This is particularly relevant as, to date, there are no such structured interventions available in Portugal. GLTP is the only evidenced-based program that teaches parents of children with OW (not only with OB) to use positive parenting in order to promote a healthy lifestyle in their families, through healthy eating and physical activity. It stems from the Triple P - Positive Parenting Program, and targets parents of OW/OB children aged 5 to 10 through a 14-session intervention. It aims to decrease child's weight and weight-related problem behavior, by increasing parents' self-efficacy in managing the child's behavior, and by decreasing the use of ineffective parenting practices. To accomplish the study's purposes, a RCT with parents of OW and OB children and a change process analysis will be conducted. The outcome variables include the child's anthropometric measures and weight-related problem behavior, parents' self-efficacy in managing the child's weight-related problem, parental feeding style, parenting practices, parental self-regulation, and parental perception of change. A total of 120 parents of OW/OB children, aged 5 to 10, will be recruited from the Nutrition Unit of the Pediatric Department (NUPD) of Porto University Central Hospital (Centro Materno-Infantil do Norte, CMIN). Participants will be randomly allocated to the experimental and control conditions. Control condition includes treatment as usual in the health care services. The study will include three assessment waves (pre-test, post-test and 6-month follow-up). Participants of the control group will have the opportunity to receive the intervention after the RCT evaluation. With this study we expect to obtain knowledge on the effectiveness of GLTP as secondary prevention tool of childhood OW and OB, contributing to the development of public health and health care policies and to a decrease of the significant health care costs inherent to childhood OW and OB

Mediators and Theories of Change in Psychotherapy for Young People With Personality Disorders: A Systematic Review Protocol

Background: Personality disorders (PDs) are a severe health issue already prevalent among adolescents and young adults. Early detection and intervention offer the opportunity to reduce disease burden and chronicity of symptoms and to enhance long-term functional outcomes. While psychological treatments for PDs have been shown to be effective for young people, the mediators and specific change mechanisms of treatment are still unclear. Aim: As part of the "European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders" (TREATme), funded by the European Cooperation in Science and Technology (COST), we will conduct a systematic review to summarize the existing knowledge on mediators of treatment outcome and theories of change in psychotherapy for young people with personality disorders. In particular, we will evaluate whether mediators appear to be common or specific to particular age groups, treatment models, or outcome domains (e.g., psychosocial functioning, life quality, and adverse treatment effects). Method: We will follow the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched for prospective, longitudinal, and case-control designs of psychological treatment studies, which examine mediators published in English. Participants will be young people between 10 and 30years of age who suffer from subclinical personality symptoms or have a personality disorder diagnosis and receive an intervention that aims at preventing, ameliorating, and/or treating psychological problems. Results: The results will be published in a peer-reviewed journal and at conference presentations and will be shared with relevant stakeholder groups. The data set will be made available to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. The review has been registered in PROSPERO (evaluation is pending, registration number ID 248959). Implications: This review will deliver a comprehensive overview on the empirical basis to contribute to the further development of psychological treatments for young people with personality disorders