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Psychotherapy Research : Journal of the... Sep 2023: Meditation, mindfulness, and acceptance (MMA) methods have gained popularity among psychotherapists and the public. The impact of these strategies as implemented in...
OBJECTIVE
: Meditation, mindfulness, and acceptance (MMA) methods have gained popularity among psychotherapists and the public. The impact of these strategies as implemented in treatment packages (e.g., mindfulness-based interventions) has been studied extensively. However, the impact of integrating MMA strategies into individual psychotherapy has not been established.
METHODS
: To address this gap in the literature, we conducted a systematic review of empirical (quantitative or qualitative) studies investigating the use of MMA methods during individual psychotherapy in adult samples.
RESULTS
: After reviewing 4671 references, only three studies (one quantitative, two qualitative) met our inclusion criteria. The one experimental study (= 162) provided no evidence that including mindfulness meditation improved outcomes beyond other active interventions (s = 0.00-0.12 for effects on general clinical symptoms vs. progressive muscle relaxation and treatment-as-usual, respectively). Two qualitative studies (= 5 therapist-patient dyads in one study, = 9 adults in one study) provided preliminary evidence that patients may find MMA methods helpful.
CONCLUSIONS
: We highlight future directions for work in this area, including clarifying optimal dosage and timing, identifying patient characteristics associated with beneficial or adverse effects, investigating cultural adaptations, and clarifying how MMA constructs can be measured within individual psychotherapy. We conclude by highlighting training recommendations and therapeutic practices.
Topics: Adult; Humans; Mindfulness; Meditation; Psychotherapy
PubMed: 37155740
DOI: 10.1080/10503307.2023.2209694 -
Journal of Equine Veterinary Science Sep 2023Alternative treatments for Post-traumatic-Stress Disorder (PTSD) have attracted attention, especially Equine-Assisted Services (EAS) including psychotherapy and... (Meta-Analysis)
Meta-Analysis
Alternative treatments for Post-traumatic-Stress Disorder (PTSD) have attracted attention, especially Equine-Assisted Services (EAS) including psychotherapy and occupational therapy involving horses. In this work, we measured the effectiveness of EAS in PTSD through a meta-analysis. An intensive bibliography search focusing in EAS and PTSD was conducted following the PRISMA recommendations. The search was not restricted by date. For the quantitative analyses, 5 works were selected. They were chosen based on the instrument utilized for the assessment of PTSD symptoms: the PTSD Checklist for DSM-5 (PCL-5). A random effects model was carried out, showing significant results in the reduction of PTSD symptoms. In the qualitative synthesis, 10 studies were included which showed interesting results in the improvement of PTSD symptoms and other variables. In conclusion, EAS are beneficial for post-traumatic symptoms in the short term follow-up period. However, EAS require further research and major standardization.
Topics: Animals; Horses; Stress Disorders, Post-Traumatic; Equine-Assisted Therapy; Psychotherapy
PubMed: 37355148
DOI: 10.1016/j.jevs.2023.104871 -
Journal of Affective Disorders Nov 2023This systematic review and meta-analysis aimed to explore whether early interventions can reduce affective symptoms and have long-term benefits among individuals at risk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis aimed to explore whether early interventions can reduce affective symptoms and have long-term benefits among individuals at risk of bipolar disorder (BD).
METHODS
The PubMed, Embase, and Web of Science databases were searched. The primary outcome was continuous symptom scores before and after treatment. Random effects meta-analyses were conducted for each outcome arm studied and pooled mean difference estimates were calculated.
RESULTS
The search identified 10 controlled studies involving 425 participants and 6 single-arm studies involving 90 participants. For controlled trials, meta-analysis showed that the interventions led to greater reduction in clinical global score than placebo (standardized mean differences (SMD) = -0.96, 95 % CI:-1.32, -0.60), and supported a long-term longitudinal effect for pharmacotherapy (SMD = -0.42, 95 % CI: -0.79, -0.05). For single-arm trials, both pharmacotherapy and psychotherapy showed efficacy for depressive symptoms, while pharmacotherapy only showed efficacy for hypomania symptoms (effect size (ES) = -9.16, 95 % CI:-11.29, -7.04). Discontinuation of pharmacotherapy due to adverse effects did not show a difference.
LIMITATIONS
The primary limitations are the small number of RCTs and the influence of medication dosage.
CONCLUSIONS
Based on the limited available data, early interventions show efficacy for individuals at risk of BD. Psychological therapy might be more beneficial for depressive symptoms and have long-term benefits for hypomania. Pharmacotherapy may be appropriate in situations of severe hypomanic symptoms and the poor functioning. Large, well-designed, double-blind -controlled trials are needed to make solid conclusions about the efficacy of early interventions.
Topics: Humans; Bipolar Disorder; Mania; Psychotherapy; Waiting Lists; Randomized Controlled Trials as Topic
PubMed: 37459972
DOI: 10.1016/j.jad.2023.07.021 -
BMC Public Health Aug 2023Smoking cessation can effectively reduce the risk of death, alleviate respiratory symptoms, and decrease the frequency of acute exacerbations in patients with chronic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Smoking cessation can effectively reduce the risk of death, alleviate respiratory symptoms, and decrease the frequency of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Effective smoking cessation strategies are crucial for the prevention and treatment of COPD. Currently, clinical interventions based on theoretical frameworks are being increasingly used to help patients quit smoking and have shown promising results. However, theory-guided smoking cessation interventions have not been systematically evaluated or meta-analyzed for their effectiveness in COPD patients. To improve smoking cessation rates, this study sought to examine the effects of theory-based smoking cessation interventions on COPD patients.
METHODS
We adhered to the PRISMA guidelines for our systematic review and meta-analysis. The Cochrane Library, Web of Science, PubMed, Embase, Wanfang, CNKI, VIP Information Services Platform, and China Biomedical Literature Service System were searched from the establishment of the database to April 20, 2023. The study quality was assessed using the Cochrane Collaboration's risk assessment tool for bias. The revman5.4 software was used for meta-analysis. The I test was used for the heterogeneity test, the random effect model and fixed effect model were used for meta-analysis, and sensitivity analysis was performed by excluding individual studies.
RESULTS
A total of 11 RCTs involving 3,830 patients were included in the meta-analysis. Results showed that theory-based smoking cessation interventions improved smoking cessation rates, quality of life, and lung function in COPD patients compared to conventional nursing. However, these interventions did not significantly affect the level of nicotine dependence in patients.
CONCLUSION
Theory-based smoking cessation intervention as a non-pharmacologically assisted smoking cessation strategy has a positive impact on motivating COPD patients to quit smoking and improving their lung function and quality of life.
TRIAL REGISTRATION
PROSPERO registration Number: CRD42023434357.
Topics: Humans; Smoking Cessation; Quality of Life; Behavior Therapy; Pulmonary Disease, Chronic Obstructive; Smoking
PubMed: 37559043
DOI: 10.1186/s12889-023-16441-w -
Current Diabetes Reports Sep 2023Depression is prevalent and common among individuals living with diabetes. The aim of this review is to systematically assess and meta-analyze the treatment effect of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE OF REVIEW
Depression is prevalent and common among individuals living with diabetes. The aim of this review is to systematically assess and meta-analyze the treatment effect of cognitive-behavioral therapy for depression (and other affective outcomes) among patients with diabetes.
RECENT FINDINGS
Earlier investigations found both psychosocial and pharmacological interventions, including cognitive-behavioral therapy, were promising in managing depression in patients with diabetes, though these findings remain inclusive due to poor study designs and a small number of trials included, which calls for a comprehensive systematic review and meta-analysis. A total of 33 studies (89 effect sizes) reported a moderate and statistically significant treatment effect of cognitive-behavioral therapy for depressive symptoms among individuals with diabetes (d = 0.301, 95% CI 0.115-0.487, p < 0.001). On average, cognitive-behavioral therapy was effective for psychological stress/distress outcomes but not for anxiety or physiological outcomes. The findings of the study confirmed CBT as an effective treatment option for depression among diabetes patients and identified important areas for future research.
Topics: Humans; Depression; Cognitive Behavioral Therapy; Anxiety; Anxiety Disorders; Diabetes Mellitus
PubMed: 37329442
DOI: 10.1007/s11892-023-01517-z -
BMC Psychiatry Feb 2024Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders.
METHODS
We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: "proof", "indication", or "hint" (or none of these categories). PRISMA standards were followed.
RESULTS
Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST.
CONCLUSIONS
Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders.
Topics: Child; Humans; Adolescent; Young Adult; Adult; Psychotherapy; Cognitive Behavioral Therapy; Obsessive-Compulsive Disorder; Treatment Outcome; Substance-Related Disorders
PubMed: 38355466
DOI: 10.1186/s12888-024-05556-y -
Psychiatry Research Sep 2023Bulimia Nervosa is a disorder with high rates of psychiatric and medical comorbidity and substantial societal costs. Cognitive Behavioural Therapy is considered the... (Meta-Analysis)
Meta-Analysis Review
Bulimia Nervosa is a disorder with high rates of psychiatric and medical comorbidity and substantial societal costs. Cognitive Behavioural Therapy is considered the preferred treatment, but access can be problematic. Pharmacotherapy is more accessible but remains significantly underutilised. We aimed to assess the efficacy, tolerability, and safety of all available forms of pharmacotherapy for the treatment of bulimia nervosa. We conducted a comprehensive search of PubMed, EMBASE, CENTRAL, ClinicalTrials.gov, and reference lists of relevant articles up until April 2023. The primary outcomes were remission and binge frequency. 52 randomised controlled trials (RCTs) involving 3313 participants were included in the meta-analysis. Overall, no significant difference was observed between drugs and placebo in terms of remission; however, the available data were limited. Notably, drugs, particularly antidepressants, demonstrated a significant reduction in the frequency of binge episodes compared to placebo. Antidepressants were also found to be more effective than placebo in terms of treatment response and other clinically meaningful outcomes. An important limitation is that few RCTs were available for individual drugs. Our findings provide evidence supporting the increased utilisation of pharmacotherapy in clinical practice and underscore the need for further research involving larger populations and a broader range of outcomes.
Topics: Humans; Bulimia Nervosa; Cognitive Behavioral Therapy; Antidepressive Agents; Comorbidity; Randomized Controlled Trials as Topic
PubMed: 37562154
DOI: 10.1016/j.psychres.2023.115357 -
Psychotherapy (Chicago, Ill.) Sep 2023Interpretations are a hallmark of psychodynamic treatment and a method used in other theoretical orientations as well. Therapists use interpretations to increase...
Interpretations are a hallmark of psychodynamic treatment and a method used in other theoretical orientations as well. Therapists use interpretations to increase patients' insight concerning unconscious and preconscious elements in their lives, with the ultimate aim to reduce mental pain and suffering and improve mental health. This systematic review focuses on the association between the therapists' use and accuracy of interpretation and immediate (within-session), intermediate (between-session), and distal (end-of-treatment) outcomes. This synthesis of the research literature is based on 18 independent samples of 1,011 total patients in individual psychotherapy. The results suggest that the use and accuracy of interpretations were associated, in half the studies, with patient disclosure of emotions and increased insight at the immediate, moment-to-moment enfolding of the session. At the intermediate postsession outcome, the use of interpretations was associated with a stronger alliance and greater depth, in half the studies. At the end of treatment, however, while there is some evidence for a positive effect of the use of interpretations on treatment success, there are also neutral effects and even evidence that interpretations have the potential to be harmful in some particular situations. The article concludes with training implications and therapeutic practices based on the integration of clinical experience and research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Professional-Patient Relations; Psychotherapy; Emotions; Treatment Outcome; Mental Health
PubMed: 37023282
DOI: 10.1037/pst0000479 -
Journal of Medical Internet Research Jul 2023Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as...
BACKGROUND
Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users' mental health.
OBJECTIVE
This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale.
METHODS
The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple's App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs.
RESULTS
We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 "Social support (emotional)," 4.1 "Instructions for how to perform a behavior," 11.2 "Reduce negative emotions," and 6.1 "Demonstration of the behavior." One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts.
CONCLUSIONS
Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions.
Topics: Humans; Mental Health; Artificial Intelligence; Behavior Therapy; Self-Management; Telemedicine; Mobile Applications
PubMed: 37463036
DOI: 10.2196/45984 -
Frontiers in Public Health 2023This systematic review and meta-analysis was to analyze the effects of a mindfulness program on mental health in university students. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This systematic review and meta-analysis was to analyze the effects of a mindfulness program on mental health in university students.
METHODS
A systematic review was conducted using the databases Pubmed, Scopus, Web of Science and CINAHL. The selected studies had to incorporate a mindfulness intervention in university students. The methodological quality of the collected articles was evaluated using the PEDro scale.
RESULTS
We initially identified 321 studies, of which 21 were included in this review. The interventions focused on mindfulness with durations ranging from 8 weeks to 3 months. The results demonstrated significant effects of a mindfulness intervention on mental health in university students.
CONCLUSION
This systematic review and meta-analysis found that mindfulness is effective for improving the mental health of college students.
SYSTEMATIC REVIEW REGISTRATION
identifier: CRD42023441453.
Topics: Humans; Mindfulness; Mental Health; Universities; Depression; Students
PubMed: 38111480
DOI: 10.3389/fpubh.2023.1284632