-
Journal of General Internal Medicine Sep 2023Improving access to evidence-based psychotherapies (EBPs) is a Veterans Health Administration (VHA) priority. Cognitive behavioral therapy (CBT), acceptance and...
Evaluation of Implementation Strategies for Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-Based Stress Reduction (MBSR): a Systematic Review.
BACKGROUND
Improving access to evidence-based psychotherapies (EBPs) is a Veterans Health Administration (VHA) priority. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) are effective for chronic pain and several mental health conditions. We synthesized evidence on implementation strategies to increase EBP access and use.
METHODS
We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception until March 2021 for articles on EBP implementation within integrated health systems to treat chronic pain or chronic mental health conditions. Reviewers independently screened articles, extracted results, coded qualitative findings, and rated quality using modified criteria from Newcastle-Ottawa (quantitative results) or Critical Appraisal Skills Programme (qualitative results). We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework and classified outcomes using RE-AIM domains (Reach, Effectiveness, Adoption, Implementation, Maintenance).
RESULTS
Twelve articles (reporting results from 10 studies) evaluated CBT (k = 11) and ACT (k = 1) implementation strategies in large integrated healthcare systems. No studies evaluated MBSR implementation. Eight articles evaluated strategies within VHA. Six articles reported on national VHA EBP implementation programs; all involved training/education, facilitation, and audit/feedback. CBT and ACT implementation demonstrated moderate to large improvements in patient symptoms and quality of life. Trainings increased mental health provider self-efficacy in delivering EBPs, improved provider EBP perceptions, and increased provider EBP use during programs, but had unclear impacts on Reach. It was unclear whether external facilitation added benefit. Provider EBP maintenance was modest; barriers included competing professional time demands and patient barriers.
DISCUSSION
Multi-faceted CBT and ACT implementation programs increased provider EBP Adoption but had unclear impacts on Reach. Future implementation efforts should further evaluate Reach, Adoption, and Maintenance; assess the added value of external facilitation; and consider strategies targeting patient barriers. Future work should use implementation frameworks to guide evaluations of barriers and facilitators, processes of change, and outcomes.
REGISTRATION
PROSPERO registration number CRD42021252038.
Topics: Humans; Acceptance and Commitment Therapy; Mindfulness; Chronic Pain; Quality of Life; Cognitive Behavioral Therapy
PubMed: 37012538
DOI: 10.1007/s11606-023-08140-4 -
Journal of Affective Disorders Jul 2021Social functioning impairment has been described in several psychiatric illness, including depressive disorders. It is associated with a deterioration in global... (Review)
Review
BACKGROUND
Social functioning impairment has been described in several psychiatric illness, including depressive disorders. It is associated with a deterioration in global functioning and quality of life, thus there is a growing interest in psychosocial functioning remediation interventions. This systematic review aims to review all psychotherapeutic, pharmacological and biological social functioning interventions in depressive disorders.
METHODS
A systematic search was conducted on PubMed, PsycINFO and Scopus from the first articles to 2019 following the PRISMA guidelines. 72 original papers were extracted from an initial number of 1827, based on the selected eligibility criteria.
RESULTS
A growing body of research was observed in the last 10 years, with most studies showing a low level of scientific evidence. The main diagnosis found was major depressive disorder and the principal social cognition domains assessed were emotional processing and attributional style. The type of intervention most found was the pharmacological one, followed by psychotherapeutic interventions classified as "non-specific. The efficacy of treatments showed an improvement in depressive symptoms and positive results for emotional processing and attributional style.
LIMITATIONS
Because there is a lack of well-controlled designs and really few interventions focusing on its remediation, and low homogeneity on the assessment of social aspects across, a comparison of results and the extraction of general conclusions is quite difficult.
CONCLUSIONS
Although a promising body of literature has been developed in recent years on the improvement of psychosocial functioning in patients with depressive disorders, more studies are needed to clarify relevant aspects in this area.
Topics: Cognition; Depressive Disorder, Major; Humans; Quality of Life; Social Perception
PubMed: 33991945
DOI: 10.1016/j.jad.2021.04.052 -
European Geriatric Medicine Dec 2023The primary objective of this study was to identify the barriers and enablers to deprescribing from the viewpoint of community-dwelling older adults and their caregivers. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The primary objective of this study was to identify the barriers and enablers to deprescribing from the viewpoint of community-dwelling older adults and their caregivers.
METHODS
This meta-synthesis included a systematic review of the literature and an inductive thematic synthesis. Medline and EMBASE were searched for studies that qualitatively explored the perspectives of older adults or their caregivers on deprescribing. Studies had to use qualitative methodologies and include community-dwelling adults (or their caregivers) aged 60 years or older who were taking one or more chronic medications. The quality of studies was assessed using the CASP tool.
RESULTS
Fourteen studies were included in the meta-synthesis. All studies included older adults, and 3 included caregivers or companions. Four barriers were identified: favorable perceptions of medications, fear of medication discontinuation, the complexity of the healthcare system and discouragement from healthcare professionals; and seven enablers were identified: medication safety concerns, patient autonomy and confidence, education, follow-up, deprescribing strategies, relationships with physicians, and patient-perceived benefits of deprescribing.
CONCLUSION
Multiple barriers and enablers to deprescribing exist within the older adult population. Health system complexity and direct discouragement from healthcare providers were barriers uniquely identified in the older adult population. This population would benefit from interventions to increase their medication literacy, confidence, and autonomy in the deprescribing journey.
Topics: Aged; Humans; Caregivers; Deprescriptions; Health Personnel; Mental Processes; Physicians
PubMed: 37874489
DOI: 10.1007/s41999-023-00879-7 -
Neuroscience and Biobehavioral Reviews Nov 2020Just as happy people see the proverbial glass as half-full, 'optimistic' or 'pessimistic' responses to ambiguity might also reflect affective states in animals.... (Meta-Analysis)
Meta-Analysis Review
Just as happy people see the proverbial glass as half-full, 'optimistic' or 'pessimistic' responses to ambiguity might also reflect affective states in animals. Judgement bias tests, designed to measure these responses, are an increasingly popular way of assessing animal affect and there is now a substantial, but heterogeneous, literature on their use across different species, affect manipulations, and study designs. By conducting a systematic review and meta-analysis of 459 effect sizes from 71 studies of non-pharmacological affect manipulations on 22 non-human species, we show that animals in relatively better conditions, assumed to generate more positive affect, show more 'optimistic' judgements of ambiguity than those in relatively worse conditions. Overall effects are small when considering responses to all cues, but become more pronounced when non-ambiguous training cues are excluded from analyses or when focusing only on the most divergent responses between treatment groups. Task type (go/no-go; go/go active choice), training cue reinforcement (reward-punishment; reward-null; reward-reward) and sex of animals emerge as potential moderators of effect sizes in judgement bias tests.
Topics: Animals; Behavior, Animal; Cognition; Cues; Judgment; Optimism; Pessimism
PubMed: 32682742
DOI: 10.1016/j.neubiorev.2020.07.012 -
Clinical Psychology Review Jun 2024In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to... (Review)
Review
BACKGROUND
In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to characterise the nature and effectiveness of existing imagery-related interventions in treatment of worry.
METHODS
PsycInfo, CENTRAL, EMBASE, Medline, Medline Epub, and PubMed were searched for studies examining the relationship between worry/GAD and mental imagery, or interventions using imagery in treatment of worry/GAD. We assessed study quality and used qualitative narrative synthesis to comprehensively map study results.
RESULTS
The search yielded 2589 abstracts that were assessed for eligibility independently by two authors. From this, 183 full texts were screened and 50 qualitatively synthesised. Twenty-seven reported an association between worry/GAD and an aspect of mental imagery. Here, overactive negative and worry imagery, and diminished positive future imagining, were associated with worry/GAD. Twenty-three studies reported an intervention. This literature suggested mixed findings regarding efficacy, including for imaginal exposure as an independent technique for GAD.
CONCLUSIONS
Findings support dysfunctional negative imagining and diminished positive prospective imagery in GAD. General imagining abilities remain intact, which is promising for efforts to utilise imagery in treatment. Further research is warranted to develop innovative clinical applications of imagery in treatment of GAD.
Topics: Humans; Imagery, Psychotherapy; Anxiety Disorders; Imagination; Anxiety
PubMed: 38640775
DOI: 10.1016/j.cpr.2024.102427 -
Neuroscience and Biobehavioral Reviews Dec 2022In recent years, an increasing number of studies employed the full body illusion paradigm (i.e., the experimentally induced illusory ownership over a fake/virtual body)... (Review)
Review
In recent years, an increasing number of studies employed the full body illusion paradigm (i.e., the experimentally induced illusory ownership over a fake/virtual body) to investigate the role of body ownership in higher-level cognition. However, to date, no systematic review of this topic is present. To fill this gap, here we identified 102 papers classifiable in 4 cognitive domains and 12 subdomains. Overall, they manipulated the identity of the fake body, and/or its spatial perspective, and/or the kind of multisensory stimulation, and/or its spatiotemporal congruency. The effects were measured through implicit and/or explicit indices. In summary, results showed that participants' behavior shifted away from the self and/or towards that of the embodied fake/virtual body. The findings have been interpreted within various exploratory frameworks, with the most common being the Proteus effect, the cortical body matrix and the inverse model of motor control. Future studies should focus on building a unitary theoretical explanation of the effects, gaining solid neural evidence, creating standard experimental procedures, and exploring the practical applications.
Topics: Humans; Illusions; Cognition; Body Image; Visual Perception; Touch Perception
PubMed: 36341941
DOI: 10.1016/j.neubiorev.2022.104926 -
The Journals of Gerontology. Series B,... Jun 2023The goal of this preregistered study was to synthesize empirical findings on age differences in motivated cognition using a meta-analytic approach, with a focus on the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The goal of this preregistered study was to synthesize empirical findings on age differences in motivated cognition using a meta-analytic approach, with a focus on the domains of cognitive control and episodic memory.
METHODS
A systematic search of articles published before July 2022 yielded 27 studies of cognitive control (N = 1,908) and 73 studies of memory (N = 5,837). Studies had to include healthy younger and older adults, a within-subjects or between-subjects comparison of motivation (high vs low), and a measure of cognitive control or memory. The Age × Motivation effect size was meta-analyzed using random-effects models, and moderators were examined using meta-regressions and subgroup analyses.
RESULTS
Overall, the Age × Motivation interaction was not significant in either cognitive domain, but the effect sizes in both domains were significantly heterogeneous, indicating a possible role of moderating factors in accounting for effect size differences. Moderator analyses revealed significant moderation by incentive type for episodic memory, but not for cognitive control. Older adults' memory was more sensitive to socioemotional rewards, whereas younger adults' memory was more sensitive to financial gains.
DISCUSSION
Findings are discussed with reference to the dopamine hypothesis of cognitive aging and to life-span theories of motivational orientation. None of these theories is fully supported by the meta-analysis findings, highlighting the need for an integration of neurobiological, cognitive process, and life-span-motivational perspectives.
Topics: Aged; Humans; Cognition; Health Status; Memory, Episodic; Motivation; Reward
PubMed: 36933188
DOI: 10.1093/geronb/gbad049 -
Behavioural Brain Research Sep 2019The adapted Autobiographical Interview (AI) is one of the most commonly used and widely cited measures of prospection in adult humans. The use of this instrument... (Review)
Review
The adapted Autobiographical Interview (AI) is one of the most commonly used and widely cited measures of prospection in adult humans. The use of this instrument requires investigators to make many decisions that can influence the outcomes of studies. Here, we performed a systematic review of studies utilizing the adapted AI. We assessed and characterized the studies on various aspects of methodological quality and reporting. We then investigated and reported on several properties of adapted AI scores that have implications for their interpretation. We conclude by proposing Conduct and Reporting of Autobiographical Interview (CRAI) guidelines to contribute to the improvement of the reporting quality for studies that use the adapted AI, and hope that this will contribute to future efforts to validate this influential measurement instrument of prospection in humans.
Topics: Executive Function; Female; Humans; Imagination; Interview, Psychological; Male; Memory Disorders; Memory, Episodic; Mental Recall; Neuropsychological Tests
PubMed: 30935946
DOI: 10.1016/j.bbr.2019.03.050 -
International Journal of Environmental... Sep 2022The main purpose of this study was to investigate the effects of neurofeedback training (NFT) of theta activity on working memory (WM) and episodic memory (EM) in... (Meta-Analysis)
Meta-Analysis Review
The main purpose of this study was to investigate the effects of neurofeedback training (NFT) of theta activity on working memory (WM) and episodic memory (EM) in healthy participants via a systematic review and meta-analysis. A total of 337 articles obtained from electronic databases were assessed; however, only 11 articles met the criteria for meta-analysis after manually screening and eliminating unnecessary studies. A meta-analysis calculating the Hedges' g effect size metric with 95% confidence intervals using random effects models was employed. Heterogeneity was estimated using I statistics. Theta NFT is effective in improving memory outcomes, including WM with a Hedges' g of 0.56 [0.10; 1.02] (I = 62.9% and = 0.02), and EM with a Hedges' g of 0.62 [0.13; 1.10] (I = 42.04% and = 0.01). Overall, the results suggest that theta NFT seems to be useful as nonpharmacological/adjunct training to improve WM and EM in healthy participants.
Topics: Health Status; Healthy Volunteers; Humans; Memory, Episodic; Memory, Short-Term; Neurofeedback
PubMed: 36078752
DOI: 10.3390/ijerph191711037 -
Neuroscience and Biobehavioral Reviews Mar 2023Pain-induced gamma-band oscillations (GBOs) are one of the most promising biomarkers of the pain experience. Although GBOs reliably encode pain perception across... (Meta-Analysis)
Meta-Analysis Review
Pain-induced gamma-band oscillations (GBOs) are one of the most promising biomarkers of the pain experience. Although GBOs reliably encode pain perception across different individuals and species, considerable heterogeneity could be observed in the characteristics and functions of GBOs. However, such heterogeneity of GBOs and its underlying sources have rarely been detailed previously. Here, we conducted a systematic review and meta-analysis to characterize the temporal, frequential, and spatial characteristics of GBOs and summarize the functional significance of distinct GBOs. We found that GBO heterogeneity was mainly related to pain types, with a higher frequency (∼66 Hz) GBOs at the sensorimotor cortex elicited by phasic pain and a lower frequency (∼55 Hz) GBOs at the prefrontal cortex associated with tonic and chronic pains. Positive correlations between GBO magnitudes and pain intensity were observed in healthy participants. Notably, the characteristics and functions of GBOs seemed to be phylogenetically conserved across humans and rodents. Altogether, we provided a comprehensive description of heterogeneous GBOs in pain and nociception, laying the foundation for clinical applications of GBOs.
Topics: Animals; Humans; Nociception; Rodentia; Electroencephalography; Pain Perception; Chronic Pain
PubMed: 36682424
DOI: 10.1016/j.neubiorev.2023.105062