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Journal of Autism and Developmental... Jun 2022For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for...
For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for autistics/individuals diagnosed with autism spectrum disorder (ASD). Despite the plethora of evidence for the effectiveness of ABA-based interventions, some autism rights and neurodiversity activists have expressed concerns with ABA-based interventions. Concerns have included discontent with historical events and possible harm from the procedures and goals targeted. The purpose of this manuscript is to examine some expressed concerns about ABA-based intervention and suggest productive ways of moving forward to provide the best outcomes for autistics/individuals diagnosed with ASD. The authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD.
Topics: Applied Behavior Analysis; Autism Spectrum Disorder; Autistic Disorder; Behavior Therapy; Humans; Parents
PubMed: 34132968
DOI: 10.1007/s10803-021-05137-y -
Health Psychology Review 2015Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to... (Review)
Review
Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to public health interventions tend to emphasise individual capabilities and motivation, with limited reference to context and social factors. Intervention effectiveness may be increased by drawing on a wider range of theories incorporating social, cultural and economic factors that influence behaviour. The primary aim of this paper is to identify theories of behaviour and behaviour change of potential relevance to public health interventions across four scientific disciplines: psychology, sociology, anthropology and economics. We report in detail the methodology of our scoping review used to identify these theories including which involved a systematic search of electronic databases, consultation with a multidisciplinary advisory group, web searching, searching of reference lists and hand searching of key behavioural science journals. Of secondary interest we developed a list of agreed criteria for judging the quality of the theories. We identified 82 theories and 9 criteria for assessing theory quality. The potential relevance of this wide-ranging number of theories to public health interventions and the ease and usefulness of evaluating the theories in terms of the quality criteria are however yet to be determined.
Topics: Behavior Control; Behavior Therapy; Health Behavior; Humans; Motivation; Psychological Theory; Public Health
PubMed: 25104107
DOI: 10.1080/17437199.2014.941722 -
Current Psychiatry Reports May 2020This review provides an overview of current methods and important aspects to consider when applying virtual worlds in the treatment of social anxiety disorder (SAD). (Review)
Review
PURPOSE OF REVIEW
This review provides an overview of current methods and important aspects to consider when applying virtual worlds in the treatment of social anxiety disorder (SAD).
RECENT FINDINGS
Different aspects such as dialogs between avatars and patients have been investigated as well as virtual audiences, emotional facial expression, and verbal interaction with avatars. Results of these studies are promising. Few randomized controlled trials (RCTs) have investigated the efficacy of virtual reality exposure therapy (VRET) in SAD. Unfortunately, most RCTs into the efficacy of VRET in comparison with exposure in vivo in SAD have been conducted with a combination of cognitive interventions and VRET. No differences between these conditions were found, but the pure effect of VRET as a stand-alone treatment has only been investigated in one RCT, wherein VRET was not superior to exposure in vivo. Current research into different facets of SAD and VRET has produced promising results with respect to technological aspects. No differences in efficacy between cognitive behavior therapy and VRET were found, but there is a clear need for studies investigating the efficacy of VRET as a stand-alone treatment and the therapeutic processes involved before this therapy can be disseminated in routine clinical practice.
Topics: Cognitive Behavioral Therapy; Emotions; Fear; Humans; Phobia, Social; Virtual Reality Exposure Therapy
PubMed: 32405657
DOI: 10.1007/s11920-020-01156-1 -
Psychological Medicine Sep 2019Dialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a... (Comparative Study)
Comparative Study
BACKGROUND
Dialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a head-to-head comparison of outcomes has never been conducted. The present study therefore aimed to compare the clinical outcomes of DBT v. MBT in patients with BPD.
METHODS
A non-randomised comparison of clinical outcomes in N = 90 patients with BPD receiving either DBT or MBT over a 12-month period.
RESULTS
After adjusting for potentially confounding differences between participants, participants receiving DBT reported a significantly steeper decline over time in incidents of self-harm (adjusted IRR = 0.93, 95% CI 0.87-0.99, p = 0.02) and in emotional dysregulation (adjusted β = -1.94, 95% CI -3.37 to -0.51, p < 0.01) than participants receiving MBT. Differences in treatment dropout and use of crisis services were no longer significant after adjusting for confounding, and there were no significant differences in BPD symptoms or interpersonal problems.
CONCLUSIONS
Within this sample of people using specialist personality disorder treatment services, reductions in self-harm and improvements in emotional regulation at 12 months were greater amongst those receiving DBT than amongst those receiving MBT. Experimental studies assessing outcomes beyond 12 months are needed to examine whether these findings represent differences in the clinical effectiveness of these therapies.
Topics: Adolescent; Adult; Behavior Control; Borderline Personality Disorder; Dialectical Behavior Therapy; Emotional Regulation; Female; Humans; Linear Models; Male; Mentalization; Middle Aged; Psychotherapy, Group; Self-Injurious Behavior; Treatment Outcome; United Kingdom; Young Adult
PubMed: 30303061
DOI: 10.1017/S0033291718002878 -
Health Psychology Review Sep 2016In this paper, we introduce the Intervention Mapping (IM) taxonomy of behaviour change methods and its potential to be developed into a coding taxonomy. That is,... (Review)
Review
In this paper, we introduce the Intervention Mapping (IM) taxonomy of behaviour change methods and its potential to be developed into a coding taxonomy. That is, although IM and its taxonomy of behaviour change methods are not in fact new, because IM was originally developed as a tool for intervention development, this potential was not immediately apparent. Second, in explaining the IM taxonomy and defining the relevant constructs, we call attention to the existence of parameters for effectiveness of methods, and explicate the related distinction between theory-based methods and practical applications and the probability that poor translation of methods may lead to erroneous conclusions as to method-effectiveness. Third, we recommend a minimal set of intervention characteristics that may be reported when intervention descriptions and evaluations are published. Specifying these characteristics can greatly enhance the quality of our meta-analyses and other literature syntheses. In conclusion, the dynamics of behaviour change are such that any taxonomy of methods of behaviour change needs to acknowledge the importance of, and provide instruments for dealing with, three conditions for effectiveness for behaviour change methods. For a behaviour change method to be effective: (1) it must target a determinant that predicts behaviour; (2) it must be able to change that determinant; (3) it must be translated into a practical application in a way that preserves the parameters for effectiveness and fits with the target population, culture, and context. Thus, taxonomies of methods of behaviour change must distinguish the specific determinants that are targeted, practical, specific applications, and the theory-based methods they embody. In addition, taxonomies should acknowledge that the lists of behaviour change methods will be used by, and should be used by, intervention developers. Ideally, the taxonomy should be readily usable for this goal; but alternatively, it should be clear how the information in the taxonomy can be used in practice. The IM taxonomy satisfies these requirements, and it would be beneficial if other taxonomies would be extended to also meet these needs.
Topics: Behavior Therapy; Health Behavior; Humans; Research Design
PubMed: 26262912
DOI: 10.1080/17437199.2015.1077155 -
International Journal of Environmental... Dec 2022This meta-analysis review compared eye movement desensitization and reprocessing and cognitive behavior therapy efficacy in reducing post-traumatic stress disorder... (Meta-Analysis)
Meta-Analysis Review
This meta-analysis review compared eye movement desensitization and reprocessing and cognitive behavior therapy efficacy in reducing post-traumatic stress disorder (PTSD), anxiety, and depression symptoms. A systematic search for articles published between 2010 and 2020 was conducted using five databases. The RevMan software version 5 was used. Out of 671 studies, 8 fulfilled the inclusion criteria and were included in this meta-analysis. Three studies reported that eye movement desensitization and reprocessing reduced depression symptoms better than cognitive behavior therapy in both children, adolescents, and adults (SDM (95% CI) = -2.43 (-3.93--0.94), = 0.001). In three other studies, eye movement desensitization and reprocessing were shown to reduce anxiety in children and adolescents better than cognitive behavior therapy (SDM (95% CI) = -3.99 (-5.47--2.52), < 0.001). In terms of reducing PTSD symptoms, eye movement desensitization and reprocessing and cognitive behavior therapy did not demonstrate any statistically significant differences (SDM (95% CI) = -0.14 (-0.48-0.21), = 0.44). There was no statistically significant difference at the three-month follow-up and at the six-month follow-up for depression ( = 0.31), anxiety ( = 0.59), and PTSD ( = 0.55). We recommend randomized trials with larger samples and longer follow-up times in the future.
Topics: Child; Adult; Adolescent; Humans; Stress Disorders, Post-Traumatic; Eye Movements; Cognitive Behavioral Therapy; Anxiety Disorders; Eye Movement Desensitization Reprocessing; Treatment Outcome
PubMed: 36554717
DOI: 10.3390/ijerph192416836 -
Psychological Medicine May 2021Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.
METHODS
We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.
RESULTS
Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63).
CONCLUSIONS
DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.
Topics: Adolescent; Borderline Personality Disorder; Dialectical Behavior Therapy; Female; Humans; Male; Self-Injurious Behavior; Suicidal Ideation; Young Adult
PubMed: 33875025
DOI: 10.1017/S0033291721001355 -
Journal of Clinical Psychology Mar 2018Rational emotive behavior therapy (REBT), introduced by Albert Ellis in the late 1950s, is one of the main pillars of cognitive-behavioral therapy. Existing reviews on... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Rational emotive behavior therapy (REBT), introduced by Albert Ellis in the late 1950s, is one of the main pillars of cognitive-behavioral therapy. Existing reviews on REBT are overdue by 10 years or more. We aimed to summarize the effectiveness and efficacy of REBT since its beginnings and investigate the alleged mechanisms of change.
METHOD
Systematic search identified 84 articles, out of which 68 provided data for between-group analyses and 39 for within-group analyses.
RESULTS
We found a medium effect size of REBT compared to other interventions on outcomes (d = 0.58) and on irrational beliefs (d = 0.70), at posttest. For the within-group analyses, we obtained medium effects for both outcomes (d = 0.56) and irrational beliefs (d = 0.61). Several significant moderators emerged.
CONCLUSION
REBT is a sound psychological intervention. Directions for future studies are outlined, stemming from the limitations of existing ones.
Topics: Cognitive Behavioral Therapy; Emotions; History, 20th Century; History, 21st Century; Humans; Outcome Assessment, Health Care
PubMed: 28898411
DOI: 10.1002/jclp.22514 -
Annals of Behavioral Medicine : a... Jul 2019Despite advances in behavioral science, there is no widely shared understanding of the "mechanisms of action" (MoAs) through which individual behavior change techniques... (Review)
Review
BACKGROUND
Despite advances in behavioral science, there is no widely shared understanding of the "mechanisms of action" (MoAs) through which individual behavior change techniques (BCTs) have their effects. Cumulative progress in the development, evaluation, and synthesis of behavioral interventions could be improved by identifying the MoAs through which BCTs are believed to bring about change.
PURPOSE
This study aimed to identify the links between BCTs and MoAs described by authors of a corpus of published literature.
METHODS
Hypothesized links between BCTs and MoAs were extracted by two coders from 277 behavior change intervention articles. Binomial tests were conducted to provide an indication of the relative frequency of each link.
RESULTS
Of 77 BCTs coded, 70 were linked to at least one MoA. Of 26 MoAs, all but one were linked to at least one BCT. We identified 2,636 BCT-MoA links in total (mean number of links per article = 9.56, SD = 13.80). The most frequently linked MoAs were "Beliefs about Capabilities" and "Intention." Binomial test results identified up to five MoAs linked to each of the BCTs (M = 1.71, range: 1-5) and up to eight BCTs for each of the MoAs (M = 3.63, range: 1-8).
CONCLUSIONS
The BCT-MoA links described by intervention authors and identified in this extensive review present intervention developers and reviewers with a first level of systematically collated evidence. These findings provide a resource for the development of theory-based interventions, and for theoretical understanding of intervention evaluations. The extent to which these links are empirically supported requires systematic investigation.
Topics: Behavior Therapy; Humans; Psychological Theory
PubMed: 30304386
DOI: 10.1093/abm/kay078 -
Health Technology Assessment... Jun 2016Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. (Meta-Analysis)
Meta-Analysis Review
A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults.
BACKGROUND
Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition.
OBJECTIVES
To determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults.
DATA SOURCES
We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014.
REVIEW METHODS
We undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes for effectiveness included mean differences in the total scores of the Yale-Brown Obsessive-Compulsive Scale or its children's version and total dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; see www.openbugs.net ).
RESULTS
We included 86 randomised controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis, respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive-behavioural therapy (CBT) did not. BT and CT, but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at high risk of bias.
LIMITATIONS
The majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents.
CONCLUSIONS
In adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective, whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions.
STUDY REGISTRATION
The study is registered as PROSPERO CRD42012002441.
FUNDING DETAILS
The National Institute for Health Research Health Technology Assessment programme.
Topics: Adolescent; Adult; Antidepressive Agents; Behavior Therapy; Child; Cognitive Behavioral Therapy; Cost-Benefit Analysis; Humans; Interatrial Block; Models, Econometric; Network Meta-Analysis; Obsessive-Compulsive Disorder; Quality-Adjusted Life Years; State Medicine; United Kingdom
PubMed: 27306503
DOI: 10.3310/hta20430