Thérapie cognitive des troubles mentaux graves et persistants

Cet article présente un survol de la thérapie cognitive appliquée au traitement de trois symptômes psychotiques : les délires, les hallucinations et les symptômes négatifs qui sont très souvent réfractaires au traitement médicamenteux. Il décrit les conditions thérapeutiques essentielles pour la réussite d'une telle thérapie, entres autres, l'alliance thérapeutique. Des vignettes cliniques illustrent le déroulement des sessions. Enfin l'article conclue par des résultats qui rendent compte de l'efficacité de cette intervention.This article presents an overview of cognitive therapy applied to the treatment of three psychotic symptoms: delusions, hallucinations and negative symptoms often resistant to medication. It describes the essential therapeutic conditions for the success of such a therapy including therapeutic alliance. Clinical vignettes illustrate how sessions work. Finally, the article concludes with results on the efficiency of this intervention.Este articulo présenta un sobrevuelo de la terapia cognoscitiva aplicada al tratamiento de très sintomas psicoticos : los delirios, las alu-cinaciones y los sintomas negativos que con frecuencia son refractarios al tratamiento con medicamentos. Se describen las condiciones terapéu-ticas esenciales al logro de tal terapia, entre otros, la alianza terapéutica. Las vinuelas clinicas ilustran el desarrollo de las sesiones. En fin, el ar-tîculo concluye en los resultados que dan cuenta de la eficacia de esta intervention

Barriers to Implementation of a Technology-Based Mental Health Intervention in a Rural Setting

This study utilized qualitative focus groups with rural health providers and patients to explore barriers to implementation of a technology-based mental health intervention for the treatment of depression in a primary care setting. A randomized controlled trial (RCT) was implemented in both urban and rural primary care practices to test the feasibility and effectiveness of computerized cognitive behavioral therapy (CCBT) for depression. Early implementation identified lower rates of willingness to participate in the intervention by rural patients. Subsequently, focus groups were conducted with rural providers and patients to explore barriers to participation and strategies to overcome these barriers in future implementation efforts. Two focus groups of five to seven participants each were conducted to understand patient experiences. Groups lasted approximately one hour and were recorded and transcribed for coding purposes. Key themes identified about barriers to use of CCBT by rural patients emerged included: 1) technical barriers, 2) stigma, 3) distrust of outsiders, 4) effort/motivational barriers, and 5) staff resistance/frustration. Conversely, several positive themes related to supports for CCBT also emerged, including: 1) readiness to change/symptom severity, 2) program supports and incentives, 3) clinician support, 4) components of the intervention, and 5) individual patient characteristics

Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial

Importance Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. Objectives To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. Design, Setting, and Participants This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire–9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion. Enrollment occurred from June 24, 2016, to May 13, 2019. The last follow-up assessment was conducted on January 30, 2020. Interventions CCBT included use of the 9-lesson computer program Good Days Ahead, along with as many as 12 weekly telephonic support sessions of approximately 20 minutes with a master’s level therapist, in addition to TAU, which consisted of the standard clinical management procedures at the primary care sites. TAU was uncontrolled, but use of antidepressants and psychotherapy other than CCBT was recorded. Main Outcomes and Measures The primary outcome measure (PHQ-9) and secondary outcome measures (Automatic Thoughts Questionnaire for negative cognitions, Generalized Anxiety Disorder–7, and the Satisfaction with Life Scale for quality of life) were administered at baseline, 12 weeks, and 3 and 6 months after treatment completion. Satisfaction with treatment was assessed with the Client Satisfaction Questionnaire–8. Results The sample of 175 patients was predominately female (147 of 174 [84.5%]) and had a high proportion of individuals who identified as racial and ethnic minority groups (African American, 44 of 162 patients who reported [27.2%]; American Indian or Alaska Native, 2 [1.2%]; Hispanic, 4 [2.5%]; multiracial, 14 [8.6%]). An annual income of less than $30 000 was reported by 88 of 143 patients (61.5%). Overall, 95 patients (54.3%) were randomly assigned to CCBT and 80 (45.7%) to TAU. Dropout rates were 22.1% for CCBT (21 patients) and 30.0% for TAU (24 patients). An intent-to-treat analysis found that CCBT led to significantly greater improvement in PHQ-9 scores than TAU at posttreatment (mean difference, −2.5; 95% CI, −4.5 to −0.8; P = .005) and 3 month (mean difference, −2.3; 95% CI, −4.5 to −0.8; P = .006) and 6 month (mean difference, −3.2; 95% CI, −4.5 to −0.8; P = .007) follow-up points. Posttreatment response and remission rates were also significantly higher for CCBT (response, 58.4% [95% CI, 46.4-70.4%]; remission, 27.3% [95% CI, 16.4%-38.2%]) than TAU (response, 33.1% [95% CI, 20.7%-45.5%]; remission, 12.0% [95% CI, 3.3%- 20.7%]). Conclusions and Relevance In this randomized clinical trial, CCBT was found to have significantly greater effects on depressive symptoms than TAU in primary care patients with depression. Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings. Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome

The folded tree

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32525/1/0000623.pd

Shale Oil Value Enhancement Research. Quarterly Report, June 1 - August 31, 1996

The overall objective is to develop a new technology for manufacturing valuable marketable products from shale oil. The quarter`s efforts were concentrated on (a) THDA and reaction of alkylpyridines at elevated conditions, (b) compound type analysis of kerogen oil and its derived products, (b) thermal hydrodealkylation of the > 290{degrees}C polar fraction, (c) secondary reactions of pyridinic type compounds to form marketable products, and (d) preparation of presentation to the Dawnbreaker Commercial Assistance Program. Excellent progress is being made in all cases. Our market analysis and industrial feedback indicate that the low molecular weight pyridines are the main market driving force. We are concentrating our effort toward increasing the yield of ``light`` pyridines before the end of Phase II(a). Our current laboratory set-up can only produce analytical quantity of samples, which is not sufficient for marketing purpose. However, the completion of a secondary flow THDA unit for a pilot-scale production depends on the availability of the Phase-II(b) and Phase-III funding

Shale Oil Value Enhancement Research. Quarterly Report, March 1 - May 31, 1996

The overall objective is to develop a new technology for manufacturing valuable marketable products from shale oil. Phase I objectives are to identify desirable components in shale oil, develop separations techniques for those components, identify market needs and to identify plausible products manufacturable from raw shale oil to meet those needs. The quarter`s efforts were concentrated on (a) compound type analysis of shale oil and its extraction products, (b) thermal hydrodealkylation of the >290{degrees}C polar fraction, (c) reaction of pyridinic type compounds to form secondary products, (d) updating SPX economic analysis, and (e) preparation of a business plan for presentation before the Dawnbreaker Commercial Assistance Program. The subcontract on the thermal hydrodealkylation work at the University of Utah ended at May 3 1, 1996. We have obtained valuable information from the batch experiments. The progress on the flow reactor proved somewhat limited because of the restriction of the existing reactor configuration. The liaison with potential industrial partners is continuing. An additional company has reached agreement to proceed with a geochemical testing of shale oil derived products

Shale Oil Value Enhancement Research. Quarterly Report, September 1 - November 30, 1995

Activities during this quarter focused on compound type analysis of shale oil extraction products and improvement of the continuous extraction process. We have installed a walk-in fume hood to improve the ventilation of our working environment while handling of larger amounts of shale oil and volatile solvents in our Phase-II(a) work. The fume hood accommodates the distillation column, rotary evaporator, and the CLLX column. During the construction period, experimental work was carried on at a smaller scale. Modifications to the thermal hydrodealkylation process unit at the University of Utah have been completed. The higher boiling polar fraction of shale oil was fed and the preliminary ran showed promising results. The search for potential industrial partners is continuing. During this period, the prijcipal investigator has visited six industrial companies that are candidates for partner/buyer relationship. Currently, we are pursuing confidentiality agreements with four of them. It is the intent to focus our research toward addressing the objectives of those companies who show sufficient interest in the shale oil value enhancement project to enter the next level of discussions

Improving cost-effectiveness and access to cognitive behavior therapy for depression: providing remote-ready, computer-assisted psychotherapy in times of crisis and beyond

Introduction. There is growing evidence that computer-delivered or –assisted forms of cognitive-behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. Objective. To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard CBT. Method. 154 drug-free MDD outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-minute sessions) or CCBT using the Good Days Ahead program (including up to 5.5 hours of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months post-treatment. Economic analyses took into account the costs of services received and work/social role impairment. Results. In the context of almost identical efficacy, a form of CCBT that used only about onethird the amount of therapist contact as conventional CBT was highly cost-effective compared to conventional therapy and reduced cost of treatment by $928 per patient. Conclusions. A method of CCBT that blended internet-delivered modules and abbreviated therapeutic contact reduced the cost of treatment substantially without adversely affecting outcomes. Results suggest that use of this approach can more than double the access to CBT. Because clinician support in CCBT can be provided by telephone, videoconference, and/or email, this highly efficient form of treatment could be a major advance in remote treatment delivery