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Psychotherapy Research : Journal of the... Jan 2019This study examined changes in depressed adolescents' reports of attachment anxiety and avoidance with interpersonal psychotherapy (IPT-A), and the relationship between... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE(S)
This study examined changes in depressed adolescents' reports of attachment anxiety and avoidance with interpersonal psychotherapy (IPT-A), and the relationship between attachment style and change in depression with IPT-A.
METHOD
Forty adolescents (aged 12-17) participated in a 16-week randomized clinical trial of 4 adaptive treatment strategies for adolescent depression that began with IPT-A and augmented treatment for insufficient responders (n = 22) by adding additional IPT-A sessions (n = 11) or the antidepressant medication, fluoxetine (n = 11). Adolescents were 77.5% female and 22.5% male (mean age = 14.8, SD = 1.8). Ten percent of adolescents were Latino. Racial composition was 7.5% Asian, 7.5% American Indian/Alaska Native, 80.0% white, and 5.0% biracial. Measures of attachment style (Experience in Close Relationships Scale-Revised [ECR-R]) and depression (Children's Depression Rating Scale-Revised [CDRS-R]) were administered at baseline and Weeks 8 and 16.
RESULTS
Attachment Anxiety and Avoidance (ECR-R) decreased significantly from baseline to Week 16. Baseline Avoidance positively predicted greater reductions in depression (CDRS-R), controlling for fluoxetine. Reductions in Anxiety and Avoidance were also significantly associated with reductions in CDRS-R, controlling for fluoxetine.
CONCLUSIONS
Adolescents' reports of attachment anxiety and avoidance are amenable to intervention with IPT-A. IPT-A may be particularly beneficial for adolescents who report a high level of avoidant attachment. Clinical or methodological significance of this article Our findings suggest that attachment anxiety and avoidance are constructs that are amenable to intervention during adolescence, and therefore viable targets of treatment. IPT-A was found to be an effective intervention for addressing problems in attachment style, and decreases in attachment anxiety and avoidance were associated with reductions in depression. This provides support for selecting IPT-A as a treatment option for adolescents who are depressed and describe difficulty with attachment security. IPT-A appears to be particularly effective for adolescents with an avoidant attachment style, who experience discomfort with and have a tendency to avoid intimacy.
Topics: Adaptation, Psychological; Adolescent; Adolescent Behavior; Anxiety; Child; Depression; Depressive Disorder; Female; Humans; Interpersonal Relations; Male; Object Attachment; Outcome Assessment, Health Care; Psychotherapy, Brief
PubMed: 28436756
DOI: 10.1080/10503307.2017.1315465 -
Clinical, Cosmetic and Investigational... Dec 2013The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of... (Review)
Review
BACKGROUND
The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase.
OBJECTIVE
To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance.
METHODS
Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors' extensive experience, recommendations for avoiding and managing complications are provided.
RESULTS
Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique.
CONCLUSION
For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications.
PubMed: 24363560
DOI: 10.2147/CCID.S50546 -
Ostomy/wound Management May 2018Little is known about the nutritional status and dietary habits of persons with an intestinal stoma, and no specific dietary guidelines have been established. A...
Little is known about the nutritional status and dietary habits of persons with an intestinal stoma, and no specific dietary guidelines have been established. A cross-sectional study was conducted among patients of a Stoma Patient Health Care Service in Juiz de Fora, Brazil, to compare the nutritional status of persons with an ileostomy or colostomy and to evaluate which foods are avoided most frequently and why. Anthropometric measurements (weight, height, arm circumference, and triceps and subscapular skinfold thickness) and body fat were assessed. Habitual dietary intake (energy, protein, carbohydrate, fiber, fat, calcium, iron, sodium, potassium, thiamin, riboflavin, vitamin B6, vitamin B3 [niacin], and vitamin B12) was assessed using a validated quantitative food frequency questionnaire. Foods avoided and reasons for avoidance (increased odor, increased gas, increased output, constipation, appliance leakage, and feelings regarding leaving home) were assessed. All data were collected without personal identifiers and stored in electronic files. Data were analyzed descriptively, and the Student's t test or Mann-Whitney test was used to compare the groups. Chi-squared analysis with Yates' continuity correction or Fisher's exact test was employed to examine the differences in the frequency of avoided foods by reasons for avoidance between the 2 groups. Of the 103 participants (52 [50.5%] men, 51 [49.5%] women; mean age 60.5 ± 12.9 years); 63 (61.2%) had a colostomy and 40 (38.8%) had an ileostomy. For both groups combined, time since surgery ranged from 1 to 360 months. Anthropometric measurements and body composition did not suggest nutritional deficiencies and did not differ significantly between groups. Persons with an ileostomy had a significantly lower fat and niacin intake than persons with a colostomy (P <.05). No other dietary intake differences were observed. Avoiding foods due to appliance leakage was more common among participants with an ileostomy (8, 20%) than a colostomy (3, 4.8%), and vegetables and fruits were reported as the most problematic foods. None of the other cited reasons was significantly different. The results of this study confirm that many persons with a stoma adjust their dietary intake and avoid certain foods which, especially in persons with an ileostomy, may increase their risk for nutritional deficiencies. Additional research to assess dietary intake and nutritional status variables as well as patient needs is needed to facilitate the development of specific nutritional status monitoring and dietary recommendations for persons with an ileostomy or colostomy.
Topics: Adult; Aged; Aged, 80 and over; Anthropometry; Brazil; Colostomy; Cross-Sectional Studies; Diet; Diet Therapy; Female; Humans; Ileostomy; Male; Middle Aged; Nutritional Status; Surveys and Questionnaires
PubMed: 29847308
DOI: No ID Found -
Computational Psychiatry (Cambridge,... 2020Anxiety disorders are characterized by a range of aberrations in the processing of and response to threat, but there is little clarity what core pathogenesis might...
Anxiety disorders are characterized by a range of aberrations in the processing of and response to threat, but there is little clarity what core pathogenesis might underlie these symptoms. Here we propose that a particular set of unrealistically pessimistic assumptions can distort an agent's behavior and underlie a host of seemingly disparate anxiety symptoms. We formalize this hypothesis in a decision theoretic analysis of maladaptive avoidance and a reinforcement learning model, which shows how a localized bias in beliefs can formally explain a range of phenomena related to anxiety. The core observation, implicit in standard decision theoretic accounts of sequential evaluation, is that the potential for avoidance should be protective: if danger can be avoided later, it poses less threat now. We show how a violation of this assumption - via a pessimistic, false belief that later avoidance will be unsuccessful - leads to a characteristic, excessive propagation of fear and avoidance to situations far antecedent of threat. This single deviation can explain a range of features of anxious behavior, including exaggerated threat appraisals, fear generalization, and persistent avoidance. Simulations of the model reproduce laboratory demonstrations of abnormal decision making in anxiety, including in situations of approach-avoid conflict and planning to avoid losses. The model also ties together a number of other seemingly disjoint phenomena in anxious disorders. For instance, learning under the pessimistic bias captures a hypothesis about the role of anxiety in the later development of depression. The bias itself offers a new formalization of classic insights from the psychiatric literature about the central role of maladaptive beliefs about control and self-efficacy in anxiety. This perspective also extends previous computational accounts of beliefs about control in mood disorders, which neglected the sequential aspects of choice.
PubMed: 34036174
DOI: 10.1162/cpsy_a_00026 -
Philosophical Transactions of the Royal... Jul 2018All free-living animals are subject to intense selection pressure from parasites and pathogens resulting in behavioural adaptations that can help potential hosts to...
All free-living animals are subject to intense selection pressure from parasites and pathogens resulting in behavioural adaptations that can help potential hosts to avoid falling prey to parasites. This special issue on the evolution of parasite avoidance behaviour was compiled following a Royal Society meeting in 2017. Here we have assembled contributions from a wide range of disciplines including genetics, ecology, parasitology, behavioural science, ecology, psychology and epidemiology on the disease avoidance behaviour of a wide range of species. Taking an interdisciplinary and cross-species perspective allows us to sketch out the strategies, mechanisms and consequences of parasite avoidance and to identify gaps and further questions. Parasite avoidance strategies must include avoiding parasites themselves and cues to their presence in conspecifics, heterospecifics, foods and habitat. Further, parasite avoidance behaviour can be directed at constructing parasite-retardant niches. Mechanisms of parasite avoidance behaviour are generally less well characterized, though nematodes, rodents and human studies are beginning to elucidate the genetic, hormonal and neural architecture that allows animals to recognize and respond to cues of parasite threat. While the consequences of infection are well characterized in humans, we still have much to learn about the epidemiology of parasites of other species, as well as the trade-offs that hosts make in parasite defence versus other beneficial investments like mating and foraging. Finally, in this overview we conclude that it is legitimate to use the word disgust' to describe parasite avoidance systems, in the same way that 'fear' is used to describe animal predator avoidance systems. Understanding disgust across species offers an excellent system for investigating the strategies, mechanisms and consequences of behaviour and could be a vital contribution towards the understanding and conservation of our planet's ecosystems.This article is part of the Theo Murphy meeting issue 'Evolution of pathogen and parasite avoidance behaviours'.
Topics: Animals; Avoidance Learning; Biological Evolution; Host-Parasite Interactions; Host-Pathogen Interactions; Humans; Invertebrates; Vertebrates
PubMed: 29866923
DOI: 10.1098/rstb.2017.0256 -
Neuropsychopharmacology : Official... Apr 2022Avoiding stimuli that predict danger is required for survival. However, avoidance can become maladaptive in individuals who overestimate threat and thus avoid safe... (Review)
Review
Avoiding stimuli that predict danger is required for survival. However, avoidance can become maladaptive in individuals who overestimate threat and thus avoid safe situations as well as dangerous ones. Excessive avoidance is a core feature of anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). This avoidance prevents patients from confronting maladaptive threat beliefs, thereby maintaining disordered anxiety. Avoidance is associated with high levels of psychosocial impairment yet is poorly understood at a mechanistic level. Many objective laboratory assessments of avoidance measure adaptive avoidance, in which an individual learns to successfully avoid a truly noxious stimulus. However, anxiety disorders are characterized by maladaptive avoidance, for which there are fewer objective laboratory measures. We posit that maladaptive avoidance behavior depends on a combination of three altered neurobehavioral processes: (1) threat appraisal, (2) habitual avoidance, and (3) trait avoidance tendency. This heterogeneity in underlying processes presents challenges to the objective measurement of maladaptive avoidance behavior. Here we first review existing paradigms for measuring avoidance behavior and its underlying neural mechanisms in both human and animal models, and identify how existing paradigms relate to these neurobehavioral processes. We then propose a new framework to improve the translational understanding of maladaptive avoidance behavior by adapting paradigms to better differentiate underlying processes and mechanisms and applying these paradigms in clinical populations across diagnoses with the goal of developing novel interventions to engage specific identified neurobehavioral targets.
Topics: Animals; Anxiety; Anxiety Disorders; Avoidance Learning; Humans; Models, Animal; Obsessive-Compulsive Disorder
PubMed: 35034097
DOI: 10.1038/s41386-021-01263-4 -
Frontiers in Psychology 2019Pedestrians are commonly engaged in other activities while walking. The current study assesses (1) whether pedestrians are sufficiently aware of their surroundings to...
Pedestrians are commonly engaged in other activities while walking. The current study assesses (1) whether pedestrians are sufficiently aware of their surroundings to successfully negotiate obstacles in a city, and (2) whether various common walking practices affect awareness of obstacles and, or, avoidance behavior. To this end, an obstacle, i.e., a signboard was placed on a pavement in the city centre of Utrecht, the Netherlands. The behavioral measure consisted of the distance to the signboard before pedestrians moved to avoid it. After passing, participants were interviewed to obtain thought samples, self-reported route familiarity, a confirmation of secondary task engagement, and to assess awareness through recall and recognition of the signboard and its text. In this study 234 pedestrians participated. More than half of the participants (53.8%) was unaware of the signboard, still none of them had bumped into it. Mind wandering, being engaged in secondary tasks such as talking with a companion or using a mobile phone, and being familiar with a route, did not affect awareness nor avoidance behavior. In conclusion, despite being very common there was no evidence that necessarily results in risk. The absence of awareness does not imply any absence of cognitive and perceptual processing. Pedestrians are still capable of successfully avoiding obstacles in their path, even in visually more challenging environments such as a city centre. It is argued that this is because walking consists of highly automated, skilled behavior.
PubMed: 31456719
DOI: 10.3389/fpsyg.2019.01846 -
Neurology India 2021To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ' 'neurosurgeon's time,... (Review)
Review
BACKGROUND AND OBJECTIVE
To analyze the common problems in shunt surgery and measures to avoid them. Management of hydrocephalus takes up as much as 50% of a pediatric ' 'neurosurgeon's time, and these are notoriously prone to complications. In this article, the author analysis his series of ventriculoperitoneal shunts and discusses his technique, nuances and avoidance of shunt complications.
METHODS AND MATERIALS
The author will review common issues related to hydrocephalus shunt management with a review of 549 procedures and associated complications.
RESULTS
Key features and basic principles of complication avoidance in shunt surgery is provided. The analysis looks into the complications and ways to avoid them based on the author's experience.
CONCLUSIONS
Specific measures may be adopted to minimize or avoid these complications. These will be discussed based on the author's series and experiences.
Topics: Child; Humans; Hydrocephalus; Prostheses and Implants; Ventriculoperitoneal Shunt
PubMed: 35103008
DOI: 10.4103/0028-3886.332256