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Journal of Affective Disorders Mar 2023There is emerging evidence to suggest that Cognitive Behavioral Therapy for depression may have a secondary effect on self-esteem, but less is known about non-CBT based... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is emerging evidence to suggest that Cognitive Behavioral Therapy for depression may have a secondary effect on self-esteem, but less is known about non-CBT based interventions. To examine this, we had two main aims; (1) to meta-analyze psychotherapy effects on (i) depression and (ii) self-esteem, and (2) to investigate the relationship between reductions in depression symptoms and improvements in self-esteem.
DESIGN
A systematic review and meta-analysis.
METHODS
Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of psychotherapy for adult depression, which included a self-esteem outcome at post-treatment. Nineteen studies with a total of 3423 participants met the inclusion criteria. For each comparison between psychotherapy and a control condition, we calculated Hedges' g both for depression and self-esteem and pooled them in two separate meta-analyses. Furthermore, meta-regression was used to explore the association between the effect of psychotherapy for depression and its effect on self-esteem.
RESULTS
The effects on depression were large and significant (Hedges' g = -0.95; [95 % CI: -1.27, -0.63]). We found evidence of smaller, albeit still moderate, effects on self-esteem (Hedges'g = 0.63; [95 % CI:0.32, 0.93]), with sustained effects at 6-12 months (Hedges'g = 0.70; [95 % CI: -0.03, 1.43]). We also found a strong inverse association between the effects of psychotherapy for depression and self-esteem (β = -0.60, p < 0.001).
LIMITATIONS
Heterogeneity was very high (I = 97 %), and out of 19 trials, only 6 trials were rated as having a low risk of bias.
CONCLUSIONS
The results suggest that psychotherapy for depression may improve self-esteem to a moderate degree.
Topics: Adult; Humans; Depression; Psychotherapy; Cognitive Behavioral Therapy; Self Concept
PubMed: 36642316
DOI: 10.1016/j.jad.2023.01.047 -
Clinical Psychology & Psychotherapy 2023Treatment of schizotypal personality disorder is complex. Currently, there are no clear evidence-based recommendations for use of psychotherapy for individuals suffering... (Review)
Review
BACKGROUND
Treatment of schizotypal personality disorder is complex. Currently, there are no clear evidence-based recommendations for use of psychotherapy for individuals suffering from this mental illness, and studies are sparse. Our aim in this review is to map and describe the existing research and to answer the research question: What do we know about the use of psychotherapy for people with schizotypal personality disorder?
METHODS
We conducted a scoping review using systematic searches in the Embase, MEDLINE and PsycINFO databases. Two reviewers screened possible studies and extracted data on subject samples, type of psychotherapy, outcomes and suggested mechanisms of change. The review is based on the PRISMA checklist for scoping reviews.
RESULTS
Twenty-three papers were included, and we found a wide variety of study types, psychotherapeutic orientations and outcomes. Few studies emerged that focused solely on schizotypal personality disorder.
CONCLUSION
Psychotherapy as a treatment for schizotypal personality disorder is understudied compared with diagnoses such as schizophrenia and borderline personality disorder. Our results included two randomized controlled studies, as well as mainly smaller studies with different approaches to diagnostic criteria, psychotherapeutic orientation and outcome measures. The findings are too sparse and too diverse to make any evidence-based recommendations. We found some indications that psychotherapy may support and assist individuals with schizotypal personality disorder.
Topics: Humans; Schizotypal Personality Disorder; Psychotherapy; Borderline Personality Disorder; Schizophrenia; Outcome Assessment, Health Care
PubMed: 37675964
DOI: 10.1002/cpp.2901 -
Telemedicine Journal and E-health : the... Jun 2019research design,
research design,
Topics: Cognitive Behavioral Therapy; Depression; Humans; Psychotherapy; Videoconferencing
PubMed: 30048211
DOI: 10.1089/tmj.2018.0058 -
Journal of Psychiatric and Mental... Jun 2023WHAT IS KNOWN ON THE SUBJECT?: Researchers have examined several interventions for psychological distress, mindfulness being a popular one. One intervention that fosters... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
WHAT IS KNOWN ON THE SUBJECT?: Researchers have examined several interventions for psychological distress, mindfulness being a popular one. One intervention that fosters mindfulness is mantram repetition. Mantram repetition is an ancient traditional practice of repeating a sacred word/phrase at various times throughout the day and whenever needed. Psychologically, mantram repetition can mitigate immediate stressors. When used consistently, mantram repetition promotes resilience and deepens mindfulness, thereby promoting recovery from distress. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper examines the overall effect of mantram repetition on psychological distress symptoms (i.e., depression, anxiety and somatization). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The portable, cost-effective, mantram repetition intervention outperformed standard therapies. In people who are prone to psychological distress, practitioners might teach this technique, encouraging them to use it initially as they go through their day and then when they are experiencing distress. Mantram repetition can quiet the mind and pairs well with breathing exercises and routine activities such as walking or exercising, or during chores, thus, integrating the mantram into daily life.
ABSTRACT
INTRODUCTION: Researchers have examined several interventions for psychological distress, mindfulness being a popular one. One mindfulness intervention is mantram repetition. Mantram repetition is an ancient traditional practice of repeating a sacred word/phrase at various times throughout the day and whenever needed.
AIM
To examine the evidence of the effect of mantram repetition on psychological distress (i.e., depression, anxiety and somatization).
METHOD
We searched 16 databases and retrieved 12 studies testing the effects of mantram repetition; only four of these measured aspects of psychological distress with comparison groups.
RESULTS
All studies showed positive effects ranging from very mild (.08) to very strong (.71). The summary effect across all studies was small (.23, p = .015). Importantly, this small effect was found when compared to treatment as usual and even psychotherapy.
DISCUSSION
The portable, cost-effective, mantram repetition intervention outperformed standard therapies.
IMPLICATIONS FOR PRACTICE
In patients who are prone to psychological distress, practitioners might teach this technique, encouraging them to use it initially as they go through their day and then when they are experiencing distress. Mantram repetition could be practiced with breathing exercises, when walking or exercising, or during chores, integrating the mantram into daily life.
Topics: Humans; Meditation; Psychotherapy; Psychological Distress; Anxiety Disorders; Anxiety; Mindfulness; Stress, Psychological
PubMed: 36427257
DOI: 10.1111/jpm.12886 -
Journal of Affective Disorders May 2018Interpersonal psychotherapy (IPT) has demonstrated efficacy for the prevention and treatment of perinatal depression. Previous systematic reviews have not evaluated the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Interpersonal psychotherapy (IPT) has demonstrated efficacy for the prevention and treatment of perinatal depression. Previous systematic reviews have not evaluated the effects of IPT on other outcomes, most notably symptoms of anxiety and interpersonal functioning, or assessed moderators of treatment efficacy specific to IPT.
METHOD
A systematic review identified 28 studies assessing the efficacy of IPT during pregnancy or the first year postpartum. Random effects meta-analyses assessed the average change in outcomes (depression, anxiety, relationship quality, social adjustment, and social support) from pre- to post-treatment, the difference in the change in outcomes between treatment and comparison conditions, and the difference in prevalence of depressive episodes between treatment and comparison conditions. Study, intervention, and sample characteristics were evaluated as potential moderators of effect sizes.
RESULTS
In prevention studies, IPT was effective for reducing depressive symptoms and the prevalence of depressive episodes. In treatment studies, IPT reduced symptoms of depression and anxiety and improved relationship quality, social adjustment and social support. Few significant moderators were identified, and results of moderation analyses were inconsistent across outcomes.
LIMITATIONS
There are insufficient studies to evaluate the effects of preventive IPT on anxiety and interpersonal outcomes. Analyses of potential moderators were limited by the number of studies available for subgroup comparisons.
CONCLUSIONS
IPT is an effective preventive intervention for perinatal depression. IPT is clearly effective for treating depressive symptoms and promising as a treatment for anxiety and improving interpersonal functioning. Further research is necessary to assess whether adaptations to IPT enhance its efficacy.
Topics: Depression; Female; Humans; Perinatal Care; Pregnancy; Psychotherapy; Treatment Outcome
PubMed: 29501991
DOI: 10.1016/j.jad.2018.01.018 -
Psychotherapy Research : Journal of the... Sep 2023This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic... (Meta-Analysis)
Meta-Analysis
This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices.
Topics: Humans; Professional-Patient Relations; Psychotherapy; Treatment Outcome
PubMed: 37001119
DOI: 10.1080/10503307.2023.2191803 -
Sleep Medicine Reviews Oct 2022This study aims to explore the comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combinations for insomnia. MEDLINE, EMBASE,... (Meta-Analysis)
Meta-Analysis Review
Comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combination for the treatment of adult insomnia: A systematic review and network meta-analysis.
This study aims to explore the comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combinations for insomnia. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and ClinicalTrials.gov were searched for randomized clinical trials (RCTs) examining the comparative efficacy in which a psychotherapy and a pharmacotherapy for insomnia were directly compared with each other, or in which a combination of psychotherapy and pharmacotherapy was compared with either alone. The analysis included data from 23 RCTs. In 18 of 23 studies, cognitive behavior therapy for insomnia (CBT-I) was the psychotherapy. At post-treatment, CBT-I showed higher subjective sleep efficiency (SE), and lower subjective wake time after sleep onset (WASO) and insomnia severity index (ISI) score. Compared with CBT-I plus pharmacotherapy, pharmacotherapy showed lower subjective SE, and higher subjective sleep latency (SL), PSG measured SL, subjective WASO, and ISI score. Overall, the findings derived from post-treatment data suggested that CBT-I is more beneficial in treating insomnia compared with pharmacotherapy. CBT-I combined with pharmacotherapy is beneficial in improving some sleep parameters (i.e., subjective SE, SL, WASO, and PSG measured SL) compared with pharmacotherapy alone. Daily clinical decisions should consider these findings on the relative efficacy of the principal approaches to insomnia treatment.
Topics: Adult; Cognitive Behavioral Therapy; Humans; Network Meta-Analysis; Psychotherapy; Sleep; Sleep Initiation and Maintenance Disorders; Treatment Outcome
PubMed: 36027795
DOI: 10.1016/j.smrv.2022.101687 -
The Cochrane Database of Systematic... May 2015Delusional disorder is commonly considered to be difficult to treat. Antipsychotic medications are frequently used and there is growing interest in a potential role for... (Review)
Review
BACKGROUND
Delusional disorder is commonly considered to be difficult to treat. Antipsychotic medications are frequently used and there is growing interest in a potential role for psychological therapies such as cognitive behavioural therapy (CBT) in the treatment of delusional disorder.
OBJECTIVES
To evaluate the effectiveness of medication (antipsychotic medication, antidepressants, mood stabilisers) and psychotherapy, in comparison with placebo in delusional disorder.
SEARCH METHODS
We searched the Cochrane Schizophrenia Group's Trials Register (28 February 2012).
SELECTION CRITERIA
Relevant randomised controlled trials (RCTs) investigating treatments in delusional disorder.
DATA COLLECTION AND ANALYSIS
All review authors extracted data independently for the one eligible trial. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis with a fixed-effect model. Where possible, we calculated illustrative comparative risks for primary outcomes. For continuous data, we calculated mean differences (MD), again with a fixed-effect model. We assessed the risk of bias of the included study and used the GRADE approach to rate the quality of the evidence.
MAIN RESULTS
Only one randomised trial met our inclusion criteria, despite our initial search yielding 141 citations. This was a small study, with 17 people completing a trial comparing CBT to an attention placebo (supportive psychotherapy) for people with delusional disorder. Most participants were already taking medication and this was continued during the trial. We were not able to include any randomised trials on medications of any type due to poor data reporting, which left us with no usable data for these trials. For the included study, usable data were limited, risk of bias varied and the numbers involved were small, making interpretation of data difficult. In particular there were no data on outcomes such as global state and behaviour, nor any information on possible adverse effects.A positive effect for CBT was found for social self esteem using the Social Self-Esteem Inventory (1 RCT, n = 17, MD 30.5, CI 7.51 to 53.49, very low quality evidence), however this is only a measure of self worth in social situations and may thus not be well correlated to social function. More people left the study early if they were in the supportive psychotherapy group with 6/12 leaving early compared to 1/6 from the CBT group, but the difference was not significant (1 RCT, n = 17, RR 0.17, CI 0.02 to 1.18, moderate quality evidence). For mental state outcomes the results were skewed making interpretation difficult, especially given the small sample.
AUTHORS' CONCLUSIONS
Despite international recognition of this disorder in psychiatric classification systems such as ICD-10 and DSM-5, there is a paucity of high quality randomised trials on delusional disorder. There is currently insufficient evidence to make evidence-based recommendations for treatments of any type for people with delusional disorder. The limited evidence that we found is not generalisable to the population of people with delusional disorder. Until further evidence is found, it seems reasonable to offer treatments which have efficacy in other psychotic disorders. Further research is needed in this area and could be enhanced in two ways: firstly, by conducting randomised trials specifically for people with delusional disorder and, secondly, by high quality reporting of results for people with delusional disorder who are often recruited into larger studies for people with a variety of psychoses.
Topics: Cognitive Behavioral Therapy; Humans; Psychotherapy; Randomized Controlled Trials as Topic; Schizophrenia, Paranoid; Self Concept
PubMed: 25997589
DOI: 10.1002/14651858.CD009785.pub2 -
Psychotherapy (Chicago, Ill.) Mar 2017The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy... (Comparative Study)
Comparative Study Meta-Analysis Review
The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence. (PsycINFO Database Record
Topics: Combined Modality Therapy; Humans; Object Attachment; Patient Dropouts; Placebo Effect; Psychotherapeutic Processes; Psychotherapy; Psychotropic Drugs; Treatment Refusal
PubMed: 28263651
DOI: 10.1037/pst0000104 -
Neuropsychobiology 2021Psychotherapy and pharmacotherapy are first-line treatments for mental disorders. Despite recent improvements, only approximately 50% of the patients reach sustained... (Review)
Review
BACKGROUND
Psychotherapy and pharmacotherapy are first-line treatments for mental disorders. Despite recent improvements, only approximately 50% of the patients reach sustained remission, indicating a need for novel developments. The main concept put forward in this systematic review and hypothesis article is the targeted co-administration of defined neurobiological interventions and specific psychotherapeutic techniques.
METHODS
We conducted a systematic literature search for randomized controlled trials comparing the efficacy of augmented psychotherapy to psychotherapy alone.
RESULTS
Thirty-five trials fulfilled the inclusion criteria. The majority (29 trials) used augmentation strategies such as D-cycloserine, yohimbine, or sleep to enhance the effects of exposure therapy for anxiety disorders. Fewer studies investigated noninvasive brain stimulation with the aim of improving cognitive control, psychedelic compounds with the aim of enhancing existentially oriented psychotherapy, and oxytocin to improve social communication during psychotherapy. Results demonstrate small augmentation effects for the enhancement of exposure therapy - however, some of the studies found negative results. Other methods are less thoroughly researched, and results are mixed.
CONCLUSIONS
This approach provides an open matrix for further research and has the potential to systematically guide future studies.
Topics: Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Psychotherapy; Sleep
PubMed: 33910218
DOI: 10.1159/000514564