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The Psychiatric Quarterly Dec 2020No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of... (Review)
Review
No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of remission but also suicide. The purpose of this review is to establish an inventory on the management of impulsivity in BPD and determine the effective treatments. A systematic review on the PubMed and Ovid databases was conducted up to September 2019 to December 2019 using the PRISMA guidelines. The inclusion criteria were: studies with patients with borderline personality disorder, were published between 1989 and 2019, used English-language and evaluated impulsivity before and after treatment. 41 articles selected were included for pharmacological treatment. 24 articles were found for psychotherapeutic management and one randomized study of transcranial magnetic stimulation. Based on this review, we must focus on psychotherapy in BPD, particularly the schema therapy, dialectical behavioral therapy, psychoeducation, system training of emotional predictability and problem solving and psychotherapy using mentalisation. The use of neuroleptics and mood stabilizers appears to be more effective than antidepressants. Another approach, such as transcranial magnetic stimulation, may prove useful in the near future if this technique is studied further.
Topics: Behavior Therapy; Borderline Personality Disorder; Humans; Impulsive Behavior; Psychotherapy; Suicide; Suicide Prevention
PubMed: 32989635
DOI: 10.1007/s11126-020-09845-z -
Clinical Psychology Review Aug 2017The efficacy of interpersonal psychotherapy (IPT) to treat depression and other disorders is well established, yet it remains unknown which patients will benefit more... (Review)
Review
The efficacy of interpersonal psychotherapy (IPT) to treat depression and other disorders is well established, yet it remains unknown which patients will benefit more from IPT than another treatment. This review summarizes 46years of clinical trial research on patient characteristics that moderate the relative efficacy of IPT vs. different treatments. Across 57 studies from 33 trials comparing IPT to pharmacotherapy, another psychotherapy, or control, there were few consistent indicators of when IPT would be more or less effective than another treatment. However, IPT may be superior to school counseling for adolescents with elevated interpersonal conflict, and to minimal controls for patients with severe depression. Cognitive-behavioral therapy may outpace IPT for patients with avoidant personality disorder symptoms. There was some preliminary evidence that IPT is more beneficial than alternatives for patients in some age groups, African-American patients, and patients in an index episode of depression. The included studies suffered from several limitations and high risk of Type I and II error. Obstacles that may explain the difficulty in identifying consistent moderators, including low statistical power and heterogeneity in samples and treatments, are discussed. Possible remedies include within-subjects designs, manipulation of single treatment ingredients, and strategies for increasing power such as improving measurement.
Topics: Humans; Interpersonal Relations; Mental Disorders; Psychotherapy
PubMed: 28710917
DOI: 10.1016/j.cpr.2017.07.001 -
Clinical Psychology & Psychotherapy Nov 2018Videoconferencing psychotherapy (VCP)-the remote delivery of psychotherapy via secure video link-is an innovative way of delivering psychotherapy, which has the... (Meta-Analysis)
Meta-Analysis Review
Videoconferencing psychotherapy (VCP)-the remote delivery of psychotherapy via secure video link-is an innovative way of delivering psychotherapy, which has the potential to overcome many of the regularly cited barriers to accessing psychological treatment. However, some debate exists as to whether an adequate working alliance can be formed between therapist and client, when therapy is delivered through such a medium. The presented article is a systematic literature review and two meta-analyses aimed at answering the questions: Is working alliance actually poorer in VCP? And is outcome equivalence possible between VCP and face-to-face delivery? Twelve studies were identified which met inclusion/exclusion criteria, all of which demonstrated good working alliance and outcome for VCP. Meta-analyses showed that working alliance in VCP was inferior to face-to-face delivery (standardized mean difference [SMD] = -0.30; 95% confidence interval [CI] [-0.67, 0.07], p = 0.11; with the lower bound of the CI extending beyond the noninferiority margin [-0.50]), but that target symptom reduction was noninferior (SMD = -0.03; 95% CI [-0.45, 0.40], p = 0.90; CI within the noninferiority margin [0.50]). These results are discussed and directions for future research recommended.
Topics: Humans; Mental Disorders; Professional-Patient Relations; Psychotherapy; Telemedicine; Treatment Outcome; Videoconferencing
PubMed: 30014606
DOI: 10.1002/cpp.2315 -
Journal of Affective Disorders Feb 2023The purpose of this systematic review and network meta-analysis is to compare the effectiveness and acceptability of psychotherapies for late-life depression. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The purpose of this systematic review and network meta-analysis is to compare the effectiveness and acceptability of psychotherapies for late-life depression.
METHODS
We searched PubMed, Embase, PsycINFO, CINAHL, The Cochrane Library, China National Knowledge Infrastructure, WANFANG database, and Chinese Biomedicine literature (CBM) for randomized controlled trials (RCTs) from their respective inception dates to March 30, 2022. Comparative effectiveness and acceptability of these psychological interventions were evaluated by conducting standard pairwise meta-analyses and network meta-analyses. A battery of analyses and assessments, such as the risk of bias and certainty of the evidence were performed.
RESULTS
A total of 68 studies with 4550 participants on six psychotherapies compared with two control groups were included in the final analysis. Notably, there were no statistically significant differences between behavioral activation therapy, cognitive behavior therapy (CBT), cognitive therapy, life review therapy, mindfulness, and combined psychotherapy. Compared with the non-active control group, six psychological interventions were statistically effective in reducing depression symptoms (standardized mean differences (SMDs) range, -1.08 to -0.73). While, only CBT, life review therapy, mindfulness, and combined psychotherapy were more effective than the active control group (SMDs range, -0.85 to -0.74). Life review therapy was ranked as the best option according to effectiveness and acceptability, while behavioral activation therapy was the worst by acceptability. The certainty of the evidence was mostly rated as low to very low.
CONCLUSIONS
Despite the scarcity of high-quality evidence, all six psychotherapies were effective for late-life depression, and life review therapy seemed to be the best choice in terms of effectiveness and acceptability. The findings of our review could provide policymakers and service commissioners with evidence-based practice for making decisions among different psychotherapies.
Topics: Humans; Network Meta-Analysis; Depression; Psychotherapy; Cognitive Behavioral Therapy; Behavior Therapy; Mindfulness
PubMed: 36470553
DOI: 10.1016/j.jad.2022.11.089 -
The Australian and New Zealand Journal... Jul 2022This is the first systematic review to investigate non-response to psychotherapy for borderline personality disorder.
HIGHLIGHT
This is the first systematic review to investigate non-response to psychotherapy for borderline personality disorder.
BACKGROUND
Psychotherapy is the recommended treatment for borderline personality disorder. While systematic reviews have demonstrated the effectiveness of psychotherapy for borderline personality disorder, effect sizes remain small and influenced by bias. Furthermore, the proportion of people who do not respond to treatment is seldom reported or analysed.
OBJECTIVE
To obtain an informed estimate of the proportion of people who do not respond to psychotherapy for borderline personality disorder.
METHODS
Systematic searches of five databases, PubMed, Web of Science, Scopus, PsycINFO and the Cochrane Library, occurred in November 2020. Inclusion criteria: participants diagnosed with borderline personality disorder, treated with psychotherapy and data reporting either (a) the proportion of the sample that experienced 'reliable change' or (b) the percentage of sample that no longer met criteria for borderline personality disorder at conclusion of therapy. Exclusion criteria: studies published prior to 1980 or not in English. Of the 19,517 studies identified, 28 met inclusion criteria.
RESULTS
Twenty-eight studies were included in the review comprising a total of 2436 participants. Average treatment duration was 11 months using well-known evidence-based approaches. Approximately half did not respond to treatment; M = 48.80% (SD = 22.77).
LIMITATIONS
Data regarding within sample variability and non-response are seldom reported. Methods of reporting data on dosage and comorbidities were highly divergent which precluded the ability to conduct predictive analyses. Other limitations include lack of sensitivity analysis, and studies published in English only.
CONCLUSION
Results of this review suggest that a large proportion of people are not responding to psychotherapy for borderline personality disorder and that factors relating to non-response are both elusive and inconsistently reported. Novel, tailored or enhanced interventions are needed to improve outcomes for individuals not responding to current established treatments.
Topics: Borderline Personality Disorder; Humans; Psychotherapy; Research Design
PubMed: 34525867
DOI: 10.1177/00048674211046893 -
Journal of Behavioral Addictions Oct 2023Increasingly, gambling features migrate into non-gambling platforms (e.g., online gaming) making gambling exposure and problems more likely. Therefore, exploring how to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Increasingly, gambling features migrate into non-gambling platforms (e.g., online gaming) making gambling exposure and problems more likely. Therefore, exploring how to best treat gambling disorder (GD) remains important. Our aim was to review systematically and quantitatively synthesize the available evidence on psychological intervention for GD.
METHODS
Records were identified through searches for randomized controlled trials (RCTs) evaluating psychological intervention for GD via six academic databases without date restrictions until February 3, 2023. Study quality was assessed with the revised Cochrane risk-of-bias tool for randomized trials (RoB2). Primary outcomes were GD symptom severity and remission of GD, summarized as Hedges' g and odds ratios, respectively. The study was preregistered in PROSPERO (#CRD42021284550).
RESULTS
Of 5,541 records, 29 RCTs (3,083 participants analyzed) were included for meta-analysis of the primary outcomes. The efficacy of psychological intervention across modality, format and mode of delivery corresponded to a medium effect on gambling severity (g = -0.71) and a small effect on remission (OR = 0.47). Generally, risk of bias was high, particularly amongst early face-to-face interventions studies.
DISCUSSION AND CONCLUSIONS
The results indicate that psychological intervention is efficacious in treating GD, with face-to-face delivered intervention producing the largest effects and with strongest evidence for cognitive behavioral therapy. Much remains to be known about the long-term effects, and investigating a broader range of treatment modalities and digital interventions is a priority if we are to improve clinical practice for this heterogeneous patient group.
Topics: Humans; Psychotherapy; Gambling; Psychosocial Intervention; Cognitive Behavioral Therapy
PubMed: 37450372
DOI: 10.1556/2006.2023.00034 -
Journal of Medical Internet Research Nov 2023The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes... (Review)
Review
BACKGROUND
The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues.
OBJECTIVE
This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention.
METHODS
This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety.
RESULTS
From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome.
CONCLUSIONS
In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
Topics: Adult; Humans; Pandemics; Psychotherapy; Anxiety Disorders; Stress Disorders, Post-Traumatic; Internet
PubMed: 37921863
DOI: 10.2196/40710 -
International Journal of Behavioral... Dec 2022Although psychotherapy is a common treatment for hopelessness and hope, the effectiveness remains controversial. The purpose of this study was to quantitatively... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although psychotherapy is a common treatment for hopelessness and hope, the effectiveness remains controversial. The purpose of this study was to quantitatively synthesize available evidence related to the effect of a broad range of psychotherapy interventions on hope/hopelessness in cancer patients.
METHOD
Eight electronic databases were searched for studies with adult cancer patients (mean age ≥ 18 years) receiving psychotherapy interventions with hope/hopelessness measured as outcomes and written in English. We used the random-effects model to compute effect size using Hedges' g and conducted moderator analyses.
RESULTS
We found 27 primary studies which included 1,998 participants who were 57.6 ± 8.0 years old across studies. The psychotherapy effect size ranged from - 0.86 to 2.92. Researchers who conducted psychotherapy at hospital/health centers showed higher effects, that is, improved hope scores (g = 0.63), than those who conducted psychotherapy in the community (g = 0.05). When researchers enrolled participants alone, psychotherapy resulted in higher effects (g = 0.62) than when partners/caregivers were involved (g = - 0.04). Researchers who included group discussion showed lower effects (g = 0.36) than without group discussion (g = 1.10). Researchers who examined fidelity found lower effects (g = 0.16) than researchers who did not examine fidelity (g = 0.66). Interestingly, researchers who studied people with breast cancer showed higher effects (g = 0.96) than those who studied people with other types of cancer (g = 0.26). Researchers who included higher percentages of women showed greater effects (slope = 0.008, Q = 3.99, p = 0.046). Finally, the greater the time span between psychotherapy and the measurement of hope, the lower the psychotherapy effects (slope = - 0.002, Q = 4.25, p = 0.039).
CONCLUSION
Psychotherapy had a solid moderate effect on reducing hopelessness and improving hope in cancer patients compared to controls.
Topics: Adult; Humans; Female; Adolescent; Middle Aged; Aged; Psychotherapy; Neoplasms; Affect; Self Concept
PubMed: 35137362
DOI: 10.1007/s12529-021-10051-9 -
Journal of Trauma & Dissociation : the... 2020Mindfulness-based interventions (MBIs), with postures, breath, relaxation, and meditation, such as Mindfulness-based Stress Reduction (MBSR) and yoga, are complex... (Meta-Analysis)
Meta-Analysis
Mindfulness-based interventions (MBIs), with postures, breath, relaxation, and meditation, such as Mindfulness-based Stress Reduction (MBSR) and yoga, are complex interventions increasingly used for trauma-related psychiatric conditions. Prior reviews have adopted a disorder-specific focus. However, trauma is a risk factor for most psychiatric conditions. We adopted a transdiagnostic approach to evaluate the efficacy of MBIs for the consequences of trauma, agnostic to diagnosis. AMED, CINAHL, Central, Embase, Pubmed/Medline, PsycINFO, and Scopus were searched to 30 September 2018 for controlled and uncontrolled trials of mindfulness, yoga, tai chi, and qi gong in people specifically selected for trauma exposure. Of >12,000 results, 66 studies were included in the systematic review and 24 controlled studies were meta-analyzed. There was a significant, pooled effect of MBIs (g = 0.51, 95%CI 0.31 to 0.71, < .001). Similar effects were observed for mindfulness (g = 0.45, 0.26 to 0.64, < .001), yoga (g = 0.46, 0.26 to 0.66, < .001), and integrative exercise (g = 0.94, 0.37 to 1.51, = .001), with no difference between interventions. Outcome measure or trauma type did not influence the effectiveness, but interventions of 8 weeks or more were more effective than shorter interventions (Q = 8.39, df = 2, = .02). Mindfulness-based interventions, adjunctive to treatment-as-usual of medication and/or psychotherapy, are effective in reducing trauma-related symptoms. Yoga and mindfulness have comparable effectiveness. Many psychiatric studies do not report trauma exposure, focusing on disorder-specific outcomes, but this review suggests a transdiagnostic approach could be adopted in the treatment of trauma sequelae with MBIs. More rigorous reporting of trauma exposure and MBI treatment protocols is recommended to enhance future research.
Topics: Humans; Meditation; Mindfulness; Psychological Trauma; Yoga
PubMed: 32453668
DOI: 10.1080/15299732.2020.1760167 -
Journal of Affective Disorders Mar 2023Depression is one of the leading diseases globally. It can severely interfere with daily and occupational functioning of people affected. Both pharmacological... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Depression is one of the leading diseases globally. It can severely interfere with daily and occupational functioning of people affected. Both pharmacological interventions and psychotherapy are used for adult depression. The aim of the review is to evaluate the efficacy of short-term psychodynamic psychotherapy (STPP) by comparing STPP with different types of interventions.
MATERIALS AND METHODS
A systematic review with meta-analysis on the efficacy of STPP in depressive disorders was performed.
RESULTS
Meta-analysis findings confirm the superiority of STPP versus no interventions. The average effect size of depressive symptoms severity at the end of the treatment is -0.91 (95% CI: -1.49 - -0.33) in favor of STPP, while for clinical improvement of depressive symptoms is -0.78 (95% CI: -1.56 - 0.01). Results confirm a clear superiority of STPP to usual treatments unstructured. A mild superiority of efficacy of STPP on support psychotherapy emerged. Comparison of the efficacy of STPP vs cognitive-behavioral psychotherapy (CBT) shows little superior in case of STPP. No substantial differences in efficacy in case of STPP than control interventions emerged. Antidepressant therapy is resulted to be slightly more effective to STPP.
DISCUSSION
While all the other results confirm current literature, this review shows no superiority of combined treatment than STPP only.
LIMITATIONS
The review has some limitations such as the lack of moderation analysis and the high heterogenicity of the type of the studies.
CONCLUSIONS
The results confirm the efficacy of STPP in depressive disorders and endorse the guidelines of National Institute for Health and Clinical Excellence (NICE).
Topics: Adult; Humans; Psychotherapy, Psychodynamic; Psychotherapy, Brief; Psychotherapy; Cognitive Behavioral Therapy; Combined Modality Therapy; Depressive Disorder; Treatment Outcome
PubMed: 36623570
DOI: 10.1016/j.jad.2022.12.161