Cognitive behavioral group treatment for low self-esteem in psychosis: a proof of concept study

Abstract Background Patients with a psychotic disorder often suffer from low self-esteem, which has been related to higher suicidal risk, poor quality of life and, the maintenance of psychotic and depression symptoms. However, intervention studies are scarce and reported interventions concern individual therapies provided by highly educated psychologists. Both the individual setting and the required qualifications of the therapist may contribute to a low level of availability of an intervention. Therefore we aimed to investigate the efficacy of an easily accessible psychological group treatment targeting self-esteem in patients with a psychotic disorder. Methods Thirty patients with a psychotic disorder were included in this pilot study. All participants received nine weekly group sessions of 90 min. The therapy was offered in groups of six to eight patients and was provided by a psychiatry nurse and a graduate psychologist. To assess self-esteem the Rosenberg Self-esteem Scale and the Self-Esteem Rating Scale were used, to measure depression symptoms the Beck Depression Inventory-II was administered. Questionnaires were completed at baseline and post-treatment. Results Twenty-seven patients (90%) completed treatment. At post-treatment, self-esteem was significantly increased and depression symptoms were significantly decreased compared to baseline. Discussion This pilot study demonstrates the feasibility and treatment potential of a self-esteem group treatment provided by a psychiatry nurse and graduate psychologist in a patient population that receives little psychological treatment. Results suggest that this easily accessible intervention may be effective in improving self-esteem and reducing depression symptoms

Preoperative embolization in surgical treatment of long bone metastasis: A systematic literature review

Surgery of long bone metastases is associated with a significant risk of perioperative blood loss, which may necessitate blood transfusion. Successful embolization (> 70% obliteration of vascularity) can be achieved in 36-75% of cases. The reported rate of embolization-related complications is 0-9%. Three out of six level III evidence studies showed a reduction in perioperative blood loss and/orblood transfusion requirement after preoperative embolization of renal cell carcinoma metastasis in long bones; three out of six studies did not. One level III evidence study did not show a reduction in perioperative blood loss and/or transfusion requirement after preoperative embolization of hepatocellular carcinoma metastases in long bones. There were no studies found that support preoperative embolization of thyroid metastases or other frequent long bone metastases (e.g. mamma carcinoma, lung carcinoma, or prostate carcinoma). The clinical level of evidence of the studies found is low and randomized studies taking into account primary tumour, location of metastases and type of surgery are therefore desired

Advances in immersive virtual reality interventions for mental disorders:A new reality?

Immersive virtual reality (VR) has been identified as a potentially revolutionary tool for psychological interventions. This study reviews current advances in immersive VR-based therapies for mental disorders. VR has the potential to make psychiatric treatments better and more cost-effective and to make them available to a larger group of patients. However, this may require a new generation of VR therapeutic techniques that use the full potential of VR, such as embodiment, and self-led interventions. VR-based interventions are promising, but further well-designed studies are needed that use novel techniques and investigate efficacy, efficiency, and cost-effectiveness of VR interventions compared with current treatments. This will be crucial for implementation and dissemination of VR in regular clinical practice

COMPETITION ANALYSIS OF SPEED SKATING USING IMU’S

For feedback to be effective, we must first identify relevant performance indicators for speed skating. We instrumented the skating of 10 junior elite Dutch speed skaters with two inertial measurement units during two competition events. Contact time, stroke frequency and other parameters were derived from collected IMU data and related to performance (finish times). The manner and timing in which the skater initiates a race in the first 100 m, is predictive of the final finish time. A significant correlation was found between finish times and 1) a decrease in stroke frequency and 2) an increase of the contact time of the skate and the ice over the first 100 m of a race. These relations were robust against variations in race distances (i.e., 100, 300, 500 and 1500 m), while the directionality of the relation differed qualitatively between the 100 m sprint and the other distances. We concluded that progression in stroke frequency and contact time are relevant feedback parameters for enhancing performance in speed skating

Virtual reality facial emotion recognition in social environments:An eye-tracking study

BACKGROUND: Virtual reality (VR) enables the administration of realistic and dynamic stimuli within a social context for the assessment and training of emotion recognition. We tested a novel VR emotion recognition task by comparing emotion recognition across a VR, video and photo task, investigating covariates of recognition and exploring visual attention in VR. METHODS: Healthy individuals (n = 100) completed three emotion recognition tasks; a photo, video and VR task. During the VR task, emotions of virtual characters (avatars) in a VR street environment were rated, and eye-tracking was recorded in VR. RESULTS: Recognition accuracy in VR (overall 75%) was comparable to the photo and video task. However, there were some differences; disgust and happiness had lower accuracy rates in VR, and better accuracy was achieved for surprise and anger in VR compared to the video task. Participants spent more time identifying disgust, fear and sadness than surprise and happiness. In general, attention was directed longer to the eye and nose areas than the mouth. DISCUSSION: Immersive VR tasks can be used for training and assessment of emotion recognition. VR enables easily controllable avatars within environments relevant for daily life. Validated emotional expressions and tasks will be of relevance for clinical applications

Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis:Health-Economic Evaluation Within a Randomized Controlled Trial

Background: Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking. Objective: This study aimed to determine the short-term cost-effectiveness of VR-CBT. Methods: The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline and at 3 and 6 months postbaseline. Treatment response was defined as a pre-post improvement of symptoms of at least 20% in social participation measures. Change in quality-adjusted life years (QALYs) was estimated by using Sanderson et al's conversion factor to map a change in the standardized mean difference of Green's Paranoid Thoughts Scale score on a corresponding change in utility. The incremental cost-effectiveness ratios were calculated using 5000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder gained and per QALY gained. Results: The average mean incremental costs for a treatment responder on social participation ranged between €8079 and €19,525, with 90.74%-99.74% showing improvement. The average incremental cost per QALY was €48,868 over the 6 months of follow-up, with 99.98% showing improved QALYs. Sensitivity analyses show costs to be lower when relevant baseline differences were included in the analysis. Average costs per treatment responder now ranged between €6800 and €16,597, while the average cost per QALY gained was €42,030. Conclusions: This study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach toward improving patients' health in a cost-effective manner. Long-term effects need further research. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657

Effect of an education and activation programme on functional limitations and patient-perceived recovery in acute and sub-acute shoulder complaints – a randomised clinical trial

<p>Abstract</p> <p>Background</p> <p>The education and activation programme (EAP) aims at coping with psychosocial determinants to prevent the development of chronic shoulder complaints (SCs). The effect of the EAP on functional limitations and patient-perceived recovery after 6 and 26 weeks is evaluated in a randomised clinical trial.</p> <p>Methods</p> <p>Patients with SCs present at rest or elicited by movement and lasting no longer than 3 months were allocated at random to either EAP as an addition to usual care (UC), or to UC only. Measurements were taken at baseline and after 6 and 26 weeks and were analysed by means of multilevel analysis for the group effect. EAP was administered by GPs or by an ambulant therapist (CDB). Patients in the UC group were given UC by their own GP.</p> <p>Results</p> <p>Multilevel analysis failed to show a significant effect of the EAP on either functional limitations or patient-perceived recovery. Analysis showed coincidentally a relation between catastrophising at baseline and functional limitations.</p> <p>Conclusion</p> <p>The EAP has no significant effect on the outcome of SCs after 6 and 26 weeks. The relation between catastrophising at baseline and functional limitations suggests that an intervention focusing specifically on catastrophising may be more successful in reducing functional limitations in the long term. Further research is however needed to evaluate the effect of catastrophising at baseline on the course of SCs.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN71777817</p

Virtual reality based cognitive behavioral therapy for paranoia:Effects on mental states and the dynamics among them

Background: Negative affective processes may contribute to maintenance of paranoia in patients with psychosis, and vice versa. Successful treatment may break these pathological symptom networks. This study examined whether treatment with virtual reality based cognitive behavioral therapy (VR-CBT) for paranoia influences momentary affective states, and whether VR-CBT changes the adverse interplay between affective states and paranoia. Methods: Patients with a psychotic disorder (n = 91) were randomized to 16-session VR-CBT or treatment as usual (TAU). With the experience sampling method (structured diary technique) mental states were assessed for 6–10 days at baseline, posttreatment and 6-month follow-up. Multilevel analysis were performed to establish treatment effects and time-lagged associations between mental states, that were visualized with networks of mental states. Results: Average levels of paranoia (feeling suspicious [b = −032., p = .04], disliked [b = −49., p < .01] and hurt [b = −0.52, p < .01]) and negative affect (anxious [b = −0.37, p = .01], down [b = −0.33, p = .04] and insecure [b = −0.17, p = .03) improved more after VR-CBT than TAU, but positive affect did not. Baseline mental state networks had few significant connections, with most stable connections being autocorrelations of mental states. The interplay between affective states and paranoia did not change in response to treatment. A trend reduction in average intranode connections (autocorrelations) was found after VR-CBT (b = −0.07, p = .08), indicating that mental states reinforce themselves less after treatment. Conclusions: VR-CBT reduced paranoid symptoms and lowered levels of negative affect in daily life, but did not affect the extent to which mental states influenced each other. Findings do suggest that as a result of treatment mental states regain flexibility

Working mechanisms of virtual reality based cbt for paranoia:A randomized controlled trial examining cognitive biases, schematic beliefs and safety behavior

Background: Recently, the efficacy of a novel virtual reality based cognitive behavior therapy (VR-CBT) for paranoia was demonstrated. Cognitive biases, cognitive limitations, negative schematic beliefs and safety behavior have been associated with paranoid ideations and delusions. It is unknown whether VR-CBT affects these associated factors, and how changes in these factors relate to changes in paranoid ideation. Methods: In this multi-center randomized controlled trial patients with a psychotic disorder and paranoia were randomized to VR-CBT (n = 58) or treatment as usual (TAU; n = 58). VR-CBT consisted of maximally sixteen 60-minute individual therapy sessions. Paranoia, safety behavior, schematic beliefs, cognitive biases and limitations were assessed at baseline, post-treatment (at three months) and follow-up (at six months). Mixed model analyses were conducted to study treatment effects. Mediation analyses were performed to explore putative working mechanisms by which VR-CBT reduced paranoia. Results: VR-CBT, but not TAU, led to reductions in jumping to conclusions, attention for threat bias and social cognition problems. Schematic beliefs remained unaffected. The effect of VR-CBT on paranoia was mediated by reductions in safety behavior and social cognition problems. Discussion: VR-CBT affects multiple mechanisms that are associated with paranoid ideation. Although maintaining factors of paranoia are likely to influence each other, targeting safety behavior and social cognitive problems seems effective in breaking the vicious circle of paranoia