The efficacy of Cognitive Behavioral Therapy for adults with ADHD: a systematic review and meta-analysis of Randomized Controlled Trials

Objective: To systematically review the literature on published randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) for adult ADHD and to establish the effectiveness of CBT in reducing ADHD symptoms. Method: A systematic review of nine RCTs and two subsequent meta-analyses of eight of the studies were conducted. Results: Just nine studies were identified, of generally good quality but with some limitations. Four trials (total N = 160) compared CBT with waiting list controls, and three trials (total N = 191) compared CBT with appropriate active control groups. Meta-analyses showed that CBT was superior to waiting list with a moderate to large effect size (standardized mean difference [SMD] = 0.76, 95% confidence interval [CI] [0.21, 1.31], p = .006) and superior to active control groups with a small to moderate effect size (SMD = 0.43, 95% CI [0.14, 0.71], p = .004). Conclusion: These results give support to the efficacy of CBT in reducing symptoms of ADHD post-intervention

The transition into adulthood for children with a severe intellectual disability: parents’ views

Objectives: This study used the grounded theory to explore parents’ views of the transition into adulthood of their child with a severe intellectual disability. The study also sought to explore the processes that parents engage in for making psychological adjustments, to appreciate their role during this transition. This study is imperative for developing a psychologically informed theory that can be understood by both parents and clinicians. Methods: Twelve parents of 11 children with a severe intellectual disability were recruited for interview from charitable organizations accessed by parents (e.g. Mencap). Data collection used a combination of open-ended structured questions and non-directed probing. NVivo 10 software was used to assist the grounded theory coding and analysis process. Results: The analysis developed five processes that parents engaged in during their child’s transition into adulthood: ‘defining adulthood’, ‘noticing adult development’, ‘perceiving barriers to adulthood’, ‘worrying,’ and ‘making psychological adjustments’. Common to these was seen to be a core process of ‘making comparisons with perceived “norms”’. Contrasting findings are critically discussed alongside extant literature. Additionally, a transition model of parents’ views and adjustments is proposed, grounded in the study findings. Conclusions: Parents engage in a series of interactional processes throughout the transition trajectory, which are likely to influence how they make adjustments. Clinical interventions could challenge parent perceptions; encourage peer support; embrace systemic ways of working with parents through their child’s transition into adulthood; and use the presented model to help parents understand their experiences and any adjustment-related problems

Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta-analysis

Introduction The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting. Method Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted. Results A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting. Conclusion Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions

“I don’t want to take buprenorphine for the rest of my life”: Acceptance and Commitment Therapy for a Client Struggling to Reduce Low-Dose Buprenorphine (a Hermeneutic Single-Case Efficacy Design)

The misuse of substances is often maintained by both physical and psychological factors. Opioid-substitution medications manage physical aspects of addiction; however, difficulties with emotional regulation and avoidance perpetuate continued substance misuse. In the UK, individuals who misuse substances are often excluded from mental health services, meaning these underlying difficulties are not addressed. Acceptance and Commitment Therapy (ACT) seeks to reduce emotional avoidance. A hermeneutic single-case efficacy design was used to evaluate the effects of ACT within drugs and alcohol service. Quantitative and qualitative data was critically analysed to understand factors involved in identified changes. Analysis recognised the client progressed towards two of three of their goals, related to motivation and anxiety. Their psychological flexibility also increased. ACT processes played a key role in this; however, the therapeutic relationship and psychopharmacological factors were also noted. Study limitations and clinical and research implications are discussed

A brief acceptance and commitment intervention for work‐related stress and burnout amongst frontline homelessness staff: A single case experimental design series

Purpose Recent intervention research for burnout amongst those working in health and social care contexts has found acceptance and commitment therapy (ACT) interventions to be of use but has provided less clarity on the role of psychological flexibility (a key ACT construct). This study further evaluated the usefulness of ACT for burnout and work-engagement and assessed the role of psychological flexibility in contributing to therapeutic change. Procedure A nonconcurrent multiple-baseline across-participants single-case experimental design was used. Four participants were recruited from a homelessness organization in the East Midlands, England. The ACT-intervention was split into three modules to reflect the three aspects of the ACT triflex, and the sequence of delivery was randomized for each participant in order to test the relationship between these aspects. Findings Support was found for the ACT intervention reducing exhaustion and increasing work-engagement. Psychological Flexibility increased in all participants and was temporally related to increases in other outcome variables in some instances. Delivery of the intervention focussed on any given aspect of the ACT triflex could increase different domains of psychological flexibility. Implications This study adds to the growing body of research in favour of ACT interventions for burnout and adds to the understanding of psychological flexibility as a mediating variable

Factors associated with psychological distress for couples facing head and neck cancer: A systematic literature review

Objectives Cancer patients in supportive relationships display improved health and survival outcomes. Identifying factors that might respond to intervention for Head and Neck Cancer (HNC) dyads is important as HNC patients and their partners experience heightened distress. This article systematically reviewed and evaluated the research findings and methodological quality of studies which identified factors influencing psychological distress for couples facing HNC. Methods PsycINFO, Medline, and CINAHL were searched. Studies were included if they used validated psychological distress measures and quantitative data collection methods. Eleven studies satisfied inclusion criteria. Results Studies identified factors associated with the psychological distress experienced by couples facing HNC, with substantial effect size variation. These factors included clinical, sociodemographic, relational, and psychological variables. Factors associated with increased psychological distress included disease burden, reduced social contact, perception of reduced relationship quality, and less adaptive/assimilative coping although the effect sizes displayed considerable heterogeneity. Overall, studies possessed good methodological quality but generally could have been improved by minimising the risk of non-response bias and fully reporting relational characteristics. Conclusions The implications of these results for clinical practice and future research are discussed. Further research is recommended to report effect sizes more consistently for both dyad members to gain greater insight into couple-level distress and to perform moderator analyses to identify which variables influence the magnitude of psychological distress

The impacts of the visible differences in appearance caused by burn injuries, and medical tattooing as an appearance-based intervention

Portfolio Abstract Burns injuries can affect both adults and children. They can cause severe and enduring physical and psychological consequences, for both the individual and their family. Changes to appearance are a fundamental part of a burn injury. Medical tattooing (MT) is an intervention designed to address appearance/body dissatisfaction. Systematic Review: a systematic search was completed of five electronic databases (CINAHL, Cochrane Library, MEDLINE, EMBOSE and PsycINFO), reference lists and ‘cited by’ referencing sources to identify and evaluate all published qualitative research literature on the psychological experiences of parents of children who have experienced burn injuries. Seven studies met the selection criteria and four themes were identified: ‘the trauma of witnessing a family member’s burn injury’, ‘the ‘mixed blessing’ of hospitalisation’, ‘attempting to return to ‘normal’ life -adapting to new roles’, and ‘guilt and blame: core issues’. The results suggest parents experience three phases of recovery following a child’s burn, all impacted on by feelings of guilt and blame. Journal Article: Interpretative Phenomenological Analysis (IPA) was applied to eight in-depth interviews with burn survivors with medical tattoos. Three themes were extracted: Management of Hope, The Process and Impacts of MT: ‘Normal-ish is Fantastic’ which were set within a context of ‘Conflict about Legitimacy’. The findings suggest MT may facilitate a regained sense of normality and an improved sense of being acceptable in society. However, a potential paradox was identified between a pressure to conform to certain expectations of appearance and a sense that a desire to meet these expectations is also not viewed as important or acceptable. By understanding these experiences, healthcare professionals can increase awareness of the lived experienced of individuals with burn injuries and of those around them. It also demonstrates that MT is a potentially valuable intervention. Further research needs are highlighted

Functional Neurological Disorder: A Qualitative Study Exploring Individuals' Experiences of Psychological Services

Objectives: Individuals with a diagnosis of FND report experiencing stigma in medical settings, however, there is a paucity of research exploring their experiences in psychological services. The aim of this research was to explore experiences of accessing UK psychological services, from the perspective of those with FND. Methods: This study utilised a qualitative approach with data collected from semi-structured interviews (n = 15) and analysed using reflexive thematic analysis. Results: One superordinate theme, 'the stigmatised self within the therapeutic relationship', and five interrelated subthemes were identified: 'internalised stigma and self-doubt', 'selective disclosure to professionals', 'perceptions of psychological explanations', 'having to educate the professionals' and 'attunement and trust within the therapeutic relationship'. Positive therapeutic relationships were perceived to mitigate the impact of these perceived barriers. The conceptualisation of FND and the perception of how this was responded to by services and professionals was a central tenet throughout the related themes. Conclusions: Intra-personal, interpersonal and organisational stigma impact access and engagement to psychological treatment. The findings of this study highlight the need for increased training provision for practitioners with a focus on actively challenging FND stigma within services at both an individual and systemic level