Psykoterapian tarve ylittää tarjonnan - ratkaisuna edulliset tutkimukseen perustuvat hoidot

Olemme yhteisen haasteen edessä. Mielenterveysongelmien kasvun myötä psykoterapiapalveluiden tarve on suurempi kuin tarjonta. Nykyinen terveydenhuollon rakenne ei riitä vastaamaan tähän tarpeeseen. Vastausta tähän kysymykseen voidaan hakea psykoterapiaa koskevasta tieteellisestä kirjallisuudesta. Psykoterapian kirjallisuus tarjoaa laajaan vahvaan tieteelliseen näyttöön perustuvia menetelmiä (kuten vaikutehallinta, käyttäytymisen aktivointi ja KKT yleisesti) ja lupaavaan näyttöön perustuvia uusia menetelmiä (kuten Bergenin neljän päivän hoitomalli, Barlown yhtenäistetty hoito sekä hyväksy-mis- ja omistautumisterapia). Kirjallisuudesta nostetaan myös esiin tehokkaita ja edullisia tietokonepohjaisia hoito-ohjelmia. Lopuksi pohditaan miten psykoterapian kirjallisuudesta löytyneitä tehokkaita hoitomenetelmiä tulisi soveltaa ja mihin tutkimusresursseja tulisi tulevaisuudessa suunnata ongelman ratkaisemiseksi.acceptedVersionPeer reviewe

Beyond PTSD and Fear-Based Conditioning: Anger-Related Responses Following Experiences of Forced Migration—A Systematic Review

Introduction: Experiences of forced migration include traumas that are interpersonal in nature, as well as ongoing emotional responses, stress, and frustration in post-migration setti ngs. Open questions exist, regarding anger/anger-like responses following experiences of persecution and ongoing stress. The aim of this study was to explore the adaptive and maladaptive underlying mechanisms of anger/anger-like responses, cultural, linguistic, and social contingencies, and possible interventions for problematic anger behavior.Method: We searched two databases (PsycINFO and PILOTS) with the following search terms: (refugee OR “asylum seek*” OR IDP OR “internal* displac*” OR “forced migra*” OR “involuntary migra*”) AND anger.Findings: This search yielded 34 studies that were included in the final review. Although, anger is a moral, adaptive, and prosocial response, dysfunctional anger/anger-like responses arise from PTSD, “moral injury,” complicated grief, and independent forms of anger behavior. Cultural, linguistic, and social issues also emerged from the search. Finally, considerations for treatment and intervention are discussed.Discussion: Anger responses following experiences of forced migration may require assessment beyond PTSD models currently framed by DSM and ICD. A very promising framework is the Adaptation and Development after Persecution and Trauma (ADAPT) model.Implications: Further longitudinal and epidemiological research will be necessary to continue testing the ADAPT model and to begin the process of assessing its cross-cultural coherence in other refugee populations (e.g., see Hinton et al., 2003). As anger behavior is also a societal issue, avenues for reconciliation, expression of grievances, employment, civic participation, and integration are needed

Käyttäytymisanalyysin eettiset periaatteet

acceptedVersio

A longitudinal study of changes in psychosocial well-being during orthognathic treatment

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n = 22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n = 22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2–T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.</p

Does orthognathic treatment improve patients' psychosocial well-being?

Objective: To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed. Materials and methods: Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test. Results: OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function. Conclusions: Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.</p

Definition and Characteristics of Behavioral Medicine, and Main Tasks and Goals of the International Society of Behavioral Medicine—an International Delphi Study

© 2020, The Author(s). Background: In the past decades, behavioral medicine has attained global recognition. Due to its global reach, a critical need has emerged to consider whether the original definition of behavioral medicine is still valid, comprehensive, and inclusive, and to reconsider the main tasks and goals of the International Society of Behavioral Medicine (ISBM), as the umbrella organization in the field. The purpose of the present study was to (i) update the definition and scope of behavioral medicine and its defining characteristics; and (ii) develop a proposal on ISBM’s main tasks and goals. Method: Our study used the Delphi method. A core group prepared a discussion paper. An international Delphi panel rated questions and provided comments. The panel intended to reach an a priori defined level of consensus (i.e., 70%). Results: The international panel reached consensus on an updated definition and scope of behavioral medicine as a field of research and practice that builds on collaboration among multiple disciplines. These disciplines are concerned with development and application of behavioral and biomedical evidence across the disease continuum in clinical and public health domains. Consensus was reached on a proposal for ISBM’s main tasks and goals focused on supporting communication and collaboration across disciplines and participating organizations; stimulating research, education, and practice; and supporting individuals and organizations in the field. Conclusion: The consensus on definition and scope of behavioral medicine and ISBM’s tasks and goals provides a foundational step toward achieving these goals

Päihdeasiakkaan taustan ja motivoivan alkuhaastattelun yhteydet hoidon tuloksiin

Tutkimme, mitkä asiakasta sekä asiakkaan ja työntekijän välistä vuorovaikutusta kuvaavat tekijätmotivoivassa alkuhaastattelussa ennustivat päihteiden käytön vähentämistä puolen vuodenseurannassa. Aineisto koostui asiakkaiden (n=38) taustatietolomakkeista ja seurantahaastatteluista sekä nauhoitetuista ja litteroiduista ensikeskusteluista A-klinikalla. Koodasimme terapiassa tapahtuvaa vuorovaikutusta motivoivan haastattelun (MH) noudattamiseen ja asiakkaan muutospuheen tutkimiseen kehitetyillä menetelmillä. Asiakkaan taustatekijöiden ja vuorovaikutuksen yhteyttä hoidon jatkuvuuteen ja päihteiden vähentämiseen analysoimme kuvailevilla ja korrelaatioiden laskemiseen perustuvilla menetelmillä sekä hierarkkisella lineaarisella regressioanalyysillä. Asiakkaan muutospystyvyys ja riippuvuustekijät vaikuttivat MH:n toteutumiseen. Alun vähentämistavoite ja työntekijän empaattinen suhtautuminen edistivät hoitoon sitoutumista. Hierarkkinen lineaarinen regressiomalli ennusti 49 % tuloksista (