Children's online care during COVID-19 / Atendimento on-line infantil em tempos de COVID-19

Objective: This study aims at shedding light on online child psychotherapy using cognitive-behavioral therapy as well as suggesting forms of psychological interventions during a pandemic. Method: Since the beginning of the recent coronavirus (SARS-CoV-2) outbreak, which causes COVID-19, there has been a great concern about a disease that has rapidly spread over the world, bringing about several different socio-economic issues. The fear of contracting the disease has led to safety measures and uncertainties with regard to the future, and it is believed that social isolation has had a direct and psychological impact on both adults and children. This way, we conducted a systematic search for literature review articles. Results: The clinical practice has led to observe that children had their routine interrupted and, consequently, prevented from basic activities such as going to school, being separated from friends, being apart from grandparents, spending the day with their parents, and not to mention, depending on their age, attending online classes in the most varied ways. Conclusion: It is clear that through the use of cognitive-behavioral therapy, forms of psychological interventions can be suggested in the face of the COVID-19 pandemic. Thus, it is clear that effective results are possible with online intervention.

Objetivo: O objetivo deste estudo é sistematizar conhecimentos sobre o atendimento online infantil através da terapia cognitivo-comportamental e sugerir formas de intervenções psicológicas diante da pandemia de COVID-19. Método: Desde o início do surto do coronavírus (SARS-CoV-2), causador da COVID-19, houve preocupação diante de uma doença que se alastrou rapidamente em várias regiões do mundo, com diferentes impactos. Além do medo de contrair a doença, dos cuidados com os familiares e das incertezas frente ao futuro, o isolamento causou impactos psicológicos diretamente relacionados à COVID-19 tanto em adultos como em crianças. Deste modo, foi feita uma busca sistemática por artigos. Resultados: A prática clínica levou ao entendimento de que as crianças passaram por mudanças, como a interrupção das idas à escola, o afastamento dos amigos e dos avós e a presença dos pais o dia todo em casa, além de, dependendo da idade, aulas online em diversos estilos, e a percepção de que os pais também não sabiam como lidar com a situação. Conclusão: Percebe-se que através do uso da terapia cognitivo-comportamental pode-se sugerir formas de intervenções psicológicas diante da pandemia de COVID-19. Assim, nota-se que resultados efetivos são possíveis com a intervenção on-line.

Intervención clínica cognitiva en paciente con trastorno esquizoide de personalidad: reporte de caso / Cognitive clinical intervention in a patient with schizoid personality disorder: Case report

El presente reporte de caso describe a un paciente varón de 19 años, que presentaba como principales síntomas frialdad emocional, ausencia de relaciones cercanas, problemas para experimentar placer con otras personas y carencia de motivación para trabajar o retomar sus estudios. Se diagnosticó un trastorno de personalidad esquizoide, producto de esquemas maladaptativos tempranos como inhibición, privación emocional, aislamiento social e inadecuación. Asimismo, se evidenció un contexto familiar rígido y fragmentado, con ausencia afectiva de padres y direccionado hacia normas estrictas en la conducta. El objetivo del estudio fue intervenir desde un enfoque clínico cognitivo los esquemas maladaptativos tempranos y síntomas que mantenían los rasgos de trastorno esquizoide de la personalidad en el paciente. Para esto se realizó una terapia cognitiva conductual, con técnicas como debates, imágenes para reparentalizar, asignación de tareas, uso del humor, entrenamiento de habilidades sociales, entre otros. Como conclusión se puede manifestar que los esquemas maladaptativos tempranos mantenían la sintomatología de personalidad esquizoide. Por último, se demostró a través de un criterio clínico y psicométrico que la terapia cognitiva conductual disminuyo las conductas de personalidad esquizoide en el paciente.

The present case report describes a 19-year-old male patient whose main symptoms were emotional coldness, absence of close relationships, difficulty experiencing pleasure with other people, and lack of motivation to work or to continue his studies. A schizoid personality disorder was diagnosed as a product of early maladaptive patterns such as inhibition, emotional deprivation, social isolation, and inadequacy. Likewise, a rigid and fragmented family context was evidenced, with an affective absence of parents and a focus on strict behavioral rules. The study aimed to intervene, from a cognitive clinical approach, the early maladaptive patterns and symptoms that maintained the features of schizoid personality disorder in the patient. For this purpose, cognitive behavioral therapy was carried out, with techniques such as debates, images to reparentalize, assignment of tasks, use of humor, and social skills training, among others. In conclusion, it can be stated that the early maladaptive patterns maintained the schizoid personality symptomatology. Finally, it was demonstrated through clinical and psychometric criteria that cognitive behavioral therapy decreased schizoid personality behaviors in the patient.

Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: cognitive-behavioral therapy

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Prolonged grief disorder treatment: An approach to COVID-19 grief / Tratamiento del trastorno de duelo prolongado: Una aproximación al duelo en tiempos de COVID-19

Abstract Background It has been estimated that COVID-19 grief will affect approximately sixteen million people worldwide, while the prevalence of prolonged grief disorder (PGD) could rise to 40%. Objective To review treatments that can be administered to patients with PGD due to COVID-19. Method PUBMED and Google Scholar were searched with the following keywords: prolonged grief disorder, complicated grief, grief and psychotherapy, and treatment of prolonged grief, complicated grief or persistent complex grief. Results Fifty articles were reviewed on the efficacy of interpersonal therapy, rational emotional-behavioral therapy, supportive therapy, humanistic therapy, systemic family therapy, group therapy, writing therapy, Internet-based intervention, and a modality of cognitive behavioral therapy used with prolonged grief, metacognitive therapy, and acceptance and commitment therapy. Discussion and conclusion There is no consensus on the psychotherapeutic treatment of choice for people with PGD due to the loss of a family member to COVID-19. Group therapy is effective in reducing the intensity of uncomplicated grief, cognitive-behavioral therapy is highly efficacious in reducing the severity of grief, metacognitive therapy specifically designed for PGD has a positive impact on depression, anxiety, stress, rumination, and quality of life while Acceptance and Commitment Therapy is helpful for restoring spirituality. Psychotherapy is most effective when combined with drug therapy. It is suggested that comparative studies be undertaken of psychotherapeutic techniques for managing patients with PGD associated with COVID-19 and the adaptation of these techniques to virtual settings.

Resumen Antecedentes Se estima que el duelo secundario a COVID-19 dejará cerca de 16 millones de personas afectadas mundialmente, y la prevalencia del Trastorno de Duelo Prolongado (TDP) pudiera incrementarse al 40%. Objetivo Revisar los tratamientos susceptibles de aplicar en pacientes con TDP por COVID-19. Método Se realizó la búsqueda en PUBMED y Scholar google con las palabras clave trastorno de duelo prolongado, duelo complicado, duelo y psicoterapia y tratamiento del duelo prolongado o complicado o complejo persistente. Resultados Se revisaron 50 artículos, se refirió la eficacia de la terapia interpersonal, la terapia racional emotiva del comportamiento, la terapia de apoyo, la terapia humanista, la terapia familiar sistémica, la terapia grupal, la terapia de escritura, la intervención basada en internet, y una modalidad de terapia cognitivo conductual aplicada al duelo prolongado, la terapia metacognitiva y la terapia de aceptación y compromiso. Discusión y conclusión No hay consenso sobre el uso preferencial de tratamientos psicoterapéuticos en personas con TDP por la pérdida de una familiar por COVID-19. La terapia grupal es efectiva en disminuir la intensidad del duelo no complicado, la terapia cognitivo conductual es altamente efectiva para disminuir la gravedad del duelo, la Terapia Metacognitiva diseñada específicamente para el TDP impacta positivamente en la depresión, ansiedad y calidad de vida; y la Terapia de Aceptación y Compromiso es útil en el restablecimiento de la espiritualidad. La psicoterapia es más eficaz cuando se combina con terapia farmacológica. Se sugiere la realización de estudios comparativos entre técnicas psicoterapéuticas para el manejo de pacientes con TDP asociado a COVID-19 y la adaptación de estas técnicas a ambientes virtuales.

O que Terapeutas Comportamentais Aprendem para sua Prática Clínica na Relação Terapêutica? / What Do the Behavioral Therapists Learn for their Clinical Practice in the Therapeutic Relationship? / ¿Qué Aprenden los Terapeutas Conductuales para su Práctica Clínica en la Relación Terapéutica?

De acordo com a visão vigente, aprende-se a ser psicoterapeuta comportamental em cursos, onde se ensinam teoria, intervenções e técnicas; e na supervisão, onde a atuação do terapeuta é aprimorada. O objetivo deste estudo foi examinar uma terceira via de aprendizagem. O que os terapeutas aprendem na relação com seus clientes? Foram entrevistados 14 terapeutas analítico-comportamentais, cognitivo comportamentais ou comportamentais contextuais, a respeito do que aprenderam com seus clientes para sua prática clínica. A análise das transcrições foi pautada nos preceitos da grounded theory analysis. Os resultados sugerem que os terapeutas aprendem sobre algumas coordenadas importantes do processo terapêutico: a singularidade de cada cliente, a responsabilidade do cliente e do terapeuta para o processo e sobre as suas limitações como terapeuta. Expandem suas competências clínicas: como enxergar além de rótulos e julgamentos, assumir uma postura terapêutica, flexibilidade e autenticidade. Adquirem estratégias clínicas, aprendem a ceder espaço para o cliente, a respeitar o tempo do cliente e responder às suas necessidades. Finalmente, aprendem a manejar riscos e contrariedades, a lidar com a proximidade no relacionamento, como usar dos seus equívocos a favor da terapia e conduzir aspectos burocráticos da sua profissão.

According to the current view, the role of a behavioral therapist is trained in courses which theory, interventions and techniques are taught and in clinical supervision supervision where the beginner's performance is shaped. The aim of this study was to explore a third learning pathway. What do therapists learn in their relationship with their clients? Fourteen behavioral and cognitive-behavioral therapists were interviewed about what they learned from their clients. The transcripts were examined according to the precepts of grounded theory analysis. The results suggest that therapists learn about important coordinates of the therapeutic process: the uniqueness of each client, the client's and therapist's responsibility in the process, and also about therapists limitations. They expand their clinical competencies: how to see beyond labels and evaluations, to assume a therapeutic stance, be flexible and authentic. They acquire clinical strategies, learning to allow due space to the client, to respect the client's time and to respond to their needs. Finally, they learn how to manage risks and setbacks, to deal with closeness in the relationship, take advantage of their errors in favor of therapy and how to manage bureaucratic aspects of their profession.

Según la visión actual, la profesión de psicoterapeuta se aprende de los profesores que imparten teoría, intervenciones y técnicas y de los supervisores que acompañan la actuación. El objetivo de este estudio fue identificar una tercera vía de aprendizaje: ¿qué aprenden los terapeutas con sus clientes? Se entrevistó a catorce terapeutas conductuales y cognitivo-conductuales sobre lo que aprendieron con sus clientes. El análisis de datos se basó en los preceptos del análisis de teoría fundamentada. Los resultados sugieren que los terapeutas aprenden sobre las coordenadas importantes del proceso terapéutico: la singularidad de cada cliente, la responsabilidad del cliente y del terapeuta por el proceso y sus limitaciones como terapeuta. Los terapeutas amplían sus competencias clínicas: cómo ver más allá de las etiquetas y los juicios, adoptar una postura terapéutica, desarrollar flexibilidad y autenticidad. Adquirir estrategias clínicas, aprender a darle espacio al cliente, respetar el tiempo del cliente y responder a sus necesidades. Finalmente, aprenden a gestionar los riesgos y contratiempos, a lidiar con la proximidad al cliente, a aprovechar los conceptos erróneos a favor de la terapia y a gestionar los aspectos burocráticos de su profesión.

Eficacia de las terapias online de activación conductual y cognitivo conductual para el tratamiento de la depresión en mujeres mexicanas víctimas de violencia / Efficacy of online behavioral activation and cognitive-behavioral therapies for the treatment of depression in Mexican women victims of violence

Antecedentes: La violencia contra la mujer (VCM) y la pandemia por COVID-19 son problemáticas que han afectado la salud mental de las mujeres, con secuelas como la depresión. Objetivo: Comparar la eficacia del tratamiento breve de activación conductual (BATD) y la terapia cognitiva conductual (TCC) con adaptaciones culturales administradas online (telesalud) para la depresión en víctimas de VCM durante la COVID-19 en México. Método: Se realizó un ensayo clínico aleatorizado con 20 mujeres mexicanas de 18-60 años con depresión que experimentaron VCM en los últimos seis meses durante la COVID-19. Las participantes fueron asignadas de manera aleatorizada 1:1 a los grupos BATD y TCC. Para el análisis de datos se aplicaron las pruebas Friedman y U de Mann-Whitney, y se estimó el Índice de Cambio Confiable. Resultados: Se encontró una disminución en síntomas depresivos (p < .001) e incremento en los niveles de activación (p < .001) a favor del grupo BATD, al término de la intervención y en el seguimiento en contraste con la TCC. Conclusiones: La BATD mostró ser eficaz en crisis de emergencia sanitaria en contextos de VCM. Aunar evidencia de intervenciones eficientes para esta población contribuye a mitigar las afecciones de salud mental.

Background: Violence against women (VAW) and the COVID-19 pandemic are issues that have affected women's mental health, with sequela such as depression. Objective: To compare the efficacy of brief behavioral activation therapy (BATD) and cognitive behavioral therapy (CBT) with cultural adaptations administered online by telehealth for depression in victims of VAW during COVID-19 in Mexico. Method: A randomized clinical trial was conducted with 20 Mexican women aged 18-60 years with depression who experienced VAW in the last six months during COVID-19. Participants were randomized 1:1 to the BATD and CBT groups. For data analysis, Friedman and Mann-Whitney U tests were applied, and the Reliable Change Index was estimated. Results: A decrease in depressive symptoms (p < .001) and an increase in activation levels (p < .001) were found in favor of the BATD group at the end of the intervention and at follow-up, in contrast to CBT. Conclusions: BATD was shown to be effective in health emergency crises in VAW contexts. Gathering evidence of efficient interventions for this population contributes to mitigating mental health conditions.

Revisão sistemática sobre resolução de problema e mediação de conflito pela terapia cognitivo-comportamental / Systematic review on problem solving and conflict mediation by cognitive-behavioral therapy

RESUMO Objetivo: Na prática clínica, é importante diferenciar problema e conflito, porque os passos sugeridos na técnica de resolução de problemas costumam não ser suficientes para auxiliar o cliente a lidar com conflitos. Esta revisão sistemática teve como objetivos: investigar como a terapia cognitivo-comportamental (TCC) pode auxiliar na resolução de problemas e na mediação de conflito; sugerir uma estratégia que favoreça a melhor capacidade de mediar conflitos (QPD). Métodos: Foi realizada uma busca nas bases de dados: PubMed, PsycINFO, Web of Science (ISI) e Scopus. O método prisma foi utilizado, e foram selecionados para leitura na íntegra artigos experimentais. Resultados: Trezentos e sessenta e quatro ensaios clínicos aplicaram a resolução de problemas, apontando a eficácia dessa técnica juntamente com outras estratégias/intervenções da TCC. Livros-guias de TCC: não diferenciam problema e conflito; descrevem detalhadamente passos para resolução de problemas, focando na perspectiva do cliente, no momento presente e no uso da razão lógica; não abordam a mediação de conflitos pela TCC. Sugerimos uma estratégia que pode ajudar na mediação de conflitos: auxiliando na coleta/organização de informações; melhorando a comunicação - empática e assertiva; favorecendo escolhas com o intuito de causar o menor dano possível a todas as partes envolvidas no conflito. Conclusões: Para treinar terapeutas para aplicarem a resolução de problemas, há descrição detalhada dos passos a serem seguidos. Entretanto, para capacitar os terapeutas para mediarem conflitos, práticas clínicas que têm sido frequentemente descritas/utilizadas nas terapias cognitivas contextuais podem ser necessárias: aceitação psicológica, mindfulness , entender valores individuais, vivenciar/considerar a emoção em tomadas de decisão, ativar a compaixão/autocompaixão.

ABSTRACT Objective: It is important to differentiate between problem and conflict in clinical practice, because the steps suggested in the problem-solving technique are usually not enough to help patients deal with conflicts. This systematic review aimed to: investigate how cognitive-behavioral therapy (CBT) can help in problem solving and conflict mediation; suggest a strategy that can improve conflict mediate skills (QPD). Methods: A search was performed in the following databases: PubMed, PsycINFO, Web of science (ISI) and Scopus. Prisma flow diagram was used and experimental articles were selected for full reading. Results: Three hundred and sixty four clinical trials applied problem solving, showing the effectiveness of this technique with other CBT strategies/interventions. CBT guide books: do not differentiate between problem and conflict; describe in detail problem solving steps, focusing on the customer's perspective, the present moment and the use of logical reason; do not explore conflict mediation in the CBT. We suggest a strategy that can help in the mediation of conflicts: assisting in the collection/organization of information; improving communication - empathic and assertive; favoring choices that can cause the least possible harm to all parties in the conflict. Conclusions: There is detailed description of the steps to train therapists to apply problem solving. However, to improve therapeutic skills to mediate conflicts, clinical practices that have been frequently described/used in the contextual cognitive behavioral therapies may be necessary: psychological acceptance, mindfulness, understanding personal values, experiencing/considering emotion in decision making, activating compassion/self-compassion.

Desenvolvimento de uma tecnologia digital de apoio à terapia cognitivo-comportamental / Development of a digital technology to support cognitive behavioral therapy / Desarrollo de una tecnología digital de apoyo a la terapia cognitivo-conductual

INTRODUÇÃO: Na atualidade, abordagens que se utilizam de aplicativos tecnológicos para solução de problemas psicológicos têm sido cada vez mais comuns, de modo que múltiplos estudos têm evidenciado eficácia bem estabelecida nessa modalidade de intervenção. OBJETIVO: O objetivo do presente trabalho é o de apresentar o projeto-piloto do desenvolvimento de uma ferramenta, com componentes mobile e web, de apoio ao tratamento psicológico via Terapia Cognitivo-Comportamental. De forma específica, será discorrido sobre a metodologia de desenvolvimento da pesquisa e projeto de software, apresentação da solução tecnológica desenvolvida, avaliação da solução e as considerações finais. METODOLOGIA: A metodologia adotada foi o Design Science Research (DSR), que propõe a resolução de problemas por meio de criação de artefatos. RESULTADOS: Como resultado obteve-se uma solução tecnológica centralizada e eficaz, por meio de um Software as a Service (SAAS), composto por um sistema web que permite ao psicoterapeuta gerenciar o tratamento psicológico pela Terapia Cognitivo-comportamental e um aplicativo móvel que possibilita ao paciente o registro preciso de funcionamento cognitivo-comportamental diário, frequência de sintomas, atividades gamificadas, e técnicas de manejo. CONCLUSÃO: A integração entre áreas da psicologia e da tecnologia tem sido cada vez mais comum, contudo é primordial a condução de estudos que descrevam desde sua concepção até a sua aplicação, com vistas a uma validação baseada em evidências científicas.

INTRODUCTION: Currently, psychological perspectives that use technological applications to solve mental health disorders have been increasingly common, in addition multiple studies have shown well-established effectiveness in this type of intervention. OBJECTIVE: The objective of the present work is to present the pilot project of the development of a tool, with mobile and web components, to support psychological treatment via Cognitive-Behavioral Therapy. Specifically, the research development methodology and software design, presentation of the developed technological solution, evaluation of the solution and final considerations will be discussed. METHODOLOGY: The methodology adopted was Design Science Research (DSR), which proposes the resolution of problems through the creation of artifacts. RESULTS: As a result, a centralized and effective technological solution was obtained, through a Software as a Service (SAAS), composed of a web system that allows the psychotherapist to manage psychological treatment through Cognitive-Behavioral Therapy and a mobile application that provide the patient with an accurate record of daily cognitive-behavioral functioning, symptom frequency, gamified activities, and management techniques. CONCLUSION: The integration between areas of psychology and technology has been increasin, however, it is essential to conduct studies that describe from its conception to its application, with the aim to a validation based on scientific evidence.

INTRODUCCIÓN: Actualmente, los enfoques que utilizan aplicaciones tecnológicas para solucionar transtornos mentales son cada vez más comunes, por lo que múltiples estudios han demostrado una efectividad bien establecida en este tipo de intervenciones. OBJETIVO: El objetivo del presente estudio es presentar el proyecto piloto del desarrollo de una herramienta, con componentes móviles y web, para apoyar el tratamiento psicológico a través del uso de Terapia Cognitivo-Conductual. Específicamente, se discutirá la metodología de desarrollo de la investigación y el diseño del software, presentación de la solución tecnológica desarrollada, evaluación de la solución y consideraciones finales. METODOLOGÍA: La metodología adoptada fue Design Science Research (DSR), que propone la resolución de problemas a través de la creación de artefactos. RESULTADOS: Como resultado se obtuvo una solución tecnológica centralizada y eficaz, a través de un Software como Servicio (SaaS), compuesta por un sistema web que permite al psicoterapeuta gestionar el tratamiento psicológico a través de la Terapia Cognitivo-Conductual y una aplicación móvil que permite al paciente un registro preciso del funcionamiento cognitivo-conductual diario, la frecuencia de los síntomas, las actividades gamificadas y las técnicas de manejo. CONCLUSIÓN: La integración entre áreas de la psicología y la tecnología han sido cada vez más comunes, sin embargo es fundamental realizar estudios que describan desde su concepción hasta su aplicación, buscando una validación basada en evidencia científica.

Trastorno de Acumulación: A propósito de un caso / Hoarding Disorder: A case report

El trastorno de acumulación se caracteriza por una extrema dificultad para deshacerse o descartar artículos, independientemente de su valor real, originando con ello múltiples síntomas y problemas cotidianos de todo tipo. Aunque la severidad es más marcada en adultos mayores, el cuadro es de instalación progresiva a lo largo de varias décadas. Se presenta el caso de un paciente varón de 49 años, con inicio de la enfermedad desde los 15 años, guardando libros y cuadernos usados con la idea de que podrían ser útiles en el futuro; además de manifestaciones significativas de ansiedad. La acumulación de otros objetos como herramientas, ropa y utensilios de cocina se fue intensificando junto con el incremento de la ansiedad tras varias pérdidas familiares. El paciente buscó atención médica en diferentes centros sin encontrar alivio. Finalmente, el diagnóstico, el tratamiento psicofarmacológico y psicoterapéutico fueron replanteados con resultados favorables.

SUMMARY Hoarding Disorder is characterized by an extreme difficulty to get rid of or discard objects, regardless of their real value and originating multiple symptoms and everyday life problems. The severity is major in old adults although the condition progresses throughout several decades of life. The case of a 49 years old man is presented: the illness started at age 15, keeping used books and notebooks with idea that they would be necessary in the future. This was associated with significant anxiety in some social situations; later, other objects such as tools, clothes and cookware beside were added with intensified anxiety relate to emotional and family losses. The patient sought medical attention in several centers without relief. Finally, his diagnosis, psychopharmacological and psychotherapeutic treatment were re-framed with favorable results.

Efficacy of bupropion and cognitive behavioral therapy in the treatment of methamphetamine use disorder: a systematic review and meta-analysis

Objectives: We assessed the efficacy of cognitive behavioral therapy and bupropion compared to cognitive behavioral therapy alone for methamphetamine use disorder. Methods: The selection criteria for this systematic review study with meta-analysis were randomized clinical trials on the efficacy of cognitive behavioral therapy and bupropion in the treatment for methamphetamine use disorder (assessed by urine metabolites). The search was conducted in PubMed, PubMed Central, LILACS, SciELO, Cochrane Library, SCOPUS, Google Scholar, Ovid Medline, Clinicaltrials.gov, and the International Clinical Trials Registry Platform. The primary outcome was relapse. Risk of bias was assessed with the RoB 2 tool. The results of each clinical trial were input into an Excel spreadsheet. We performed a meta-analysis using relative risk and a 95%CI. Results: Of the 597 initial articles (498 after removing duplicate records), five were included in the meta-analysis, with an aggregate sample of 539 patients. An overall relative risk of 0.91 (95%CI 0.78-1.05) was estimated for relapse. Conclusion: Our study limitations included publication bias and heterogeneous populations. We found no evidence that cognitive behavioral therapy and bupropion reduced the risk of relapse compared to cognitive behavioral therapy and placebo.

Testing the efficacy of group cognitive-behavioral therapy for pathological internet use among undergraduates in Nigeria

Abstract Introduction The aim of this study was to examine the effect of group cognitive-behavioral therapy (GCBT) on pathological internet use (PIU). Method The study applied a group randomized controlled trial design to assign participants to intervention and control groups. A total of 40 college students aged 18 to 30 who were pathological internet users (PIUs) participated in this study and were randomly assigned to treatment and control groups. Participants completed a self-report scale entitled the Problematic Internet Use Scale (PIUS) at three time points. The intervention lasted 8 weeks. The data collected were statistically analyzed using repeated-measures analysis of variance (ANOVA). Results The results showed that GCBT has significant efficacy, decreasing the symptoms of PIU among the GCBT participants compared to those in the control group and that the improvements were maintained at follow-up. We also found a significant interaction effect by time for PIU. Conclusion From the study findings, we can conclude that GCBT has significant benefit for mitigating the severity of PIU in college students. Therefore, mental health professionals are encouraged to explore the benefits of GCBT in treating symptoms associated with PIU in school settings and beyond.

Effect of self-help cognitive behavioral therapy for insomnia combined with trazodone hydrochloride on elderly patients with depression and insomnia / 中国医师杂志

Objective:To observe the efficacy of self-help cognitive behavioral therapy for insomnia (CBTI), trazodone hydrochloride and their combination in the treatment of depression and insomnia comorbidity in the elderly.Methods:90 elderly patients with insomnia and depression admitted to the 901th Hospital of the Joint Logistic Support Force from October 2019 to October 2021 were selected as the study subjects. They were divided into trazodone group, CBTI group and trazodone combined with CBTI group(combination group), with 30 cases in each group. Trazodone group was treated with oral trazodone hydrochloride, CBTI group was treated with self-help CBTI, and the combination group was treated with oral trazodone hydrochloride combined with self-help CBTI. All three groups were treated for 4 weeks. The sleep latency, total sleep time and sleep efficiency of each group were compared at the time of admission and after 4 weeks of treatment. Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used for sleep assessment before and after treatment, and Self-Rating Depression Scale (SDS) was used for depression assessment.Results:Before treatment, there was no significant difference among the three groups in terms of sleep latency, total sleep time, sleep efficiency, PSQI, ESS and SDS (all P>0.05). After treatment, the sleep latency of the three groups was shorter than that before treatment, and the total sleep time was longer than that before treatment (all P<0.05). The sleep efficiency of the trazodone group and the combination group was higher than that before treatment, with statistically significant difference (both P<0.05). The indexes of the combined group were better than those of the trazodone group and the CBTI group (all P<0.05). The sleep latency of the trazodone group was shorter than that of the CBTI group, and the total sleep time was longer than that of the CBTI group (all P<0.05), with statistically significant difference (all P<0.05). After treatment, the PSQI, except for the SDS of CBTI group, the ESS and SDS of the three groups were lower than those before treatment (all P<0.05). The PSQI, ESS and SDS of the combined group were lower than those of the trazodone group and the CBTI group, and the ESS and SDS of the trazodone group were lower than those of the CBTI group, with statistically significant difference (all P<0.05). Conclusions:For the elderly patients with depression and insomnia, the combination of self-help CBTI and trazodone can not only improve insomnia but also relieve depression symptoms, and the effect is better than that of trazodone and self -help CBTI alone.

Qualitative research on digital cognitive behavioral therapy for insomnia in patients with insomnia combined with depressive and/or anxious symptoms / 中华行为医学与脑科学杂志

Objective:To investigate the physical and mental experience, treatment compliance and use barriers of patients with insomnia in using digital cognitive behavioral therapy for insomnia (dCBT-I) in order to provide qualitative evidence for the development and application optimization of the dCBT-I technology paradigm.Methods:From July to November 2021, a semi-structured interview outline was used to conduct in-depth interviews with the dCBT-I users ( n=10) to record their original feelings about the use of dCBT-I. Interpretative phenomenology's text analysis was used to explore the participants' experience and cognition of dCBT-I. Results:Text analysis and key information calibration were carried out on the verbatim transcripts of semi-structured interview recordings, and three core themes were extracted, namely stickiness factor, use barrier and optimization direction, as well as eight sub-themes, namely professionalism, accessibility, benefit experience, difficulty in task execution, instruction generalization, difficulty in software operation, enrich treatment content and personalized guidance.Conclusion:The present study showed that participants were receptive to the dCBT-I intervention and would be benefited from it.However, dCBT-I still needs to be optimized and improved to reduce the operating difficulty and explore more appropriate timing of manual intervention.

Effects of cognitive intervention in an attribution study on psychological resilience and cancer-related fatigue in older adult patients with lung cancer / 中国基层医药

Objective:To investigate the effects of cognitive intervention in an attribution study on psychological resilience and cancer-related fatigue in older adult patients with lung cancer.Methods:A total of 88 older adult patients with lung cancer who received treatment in Ningbo Ninth Hospital between January 2018 and January 2020 were included in this study. These patients were randomly divided into a study group ( n = 44) and a control group ( n = 44). The control group was given routine nursing intervention, and the study group was given cognitive intervention under an attribution study. All patients were treated for 6 consecutive months. After the intervention, the changes in psychological resilience and improvements in cancer-related fatigue symptoms compared with before intervention were observed. The Coping Style Questionnaire (CSQ) was applied to evaluate the change in coping styles after intervention relative to before intervention. Before and after intervention, patient compliance was compared between the two groups. Results:After 6 months of intervention, the scores of various dimensions of the Chinese version of Connor–Davidson Resilience Scale (CD-RISC) in the study group were (7.74 ± 1.36) points, (23.67 ± 1.94) points, and (41.28 ± 1.47) points, respectively, which were significantly higher than (6.92 ± 1.12) points, (12.45 ± 2.76) points, and (32.34 ± 1.69) points respectively in the control group ( t = 3.08, 22.06, 26.47, all P < 0.05). The scores of various dimensions of Piper Fatigue Scale-Revised (PFS) in the study group were (4.85 ± 1.15) points, (4.71 ± 1.05) points, (4.85 ± 1.05) points, (5.24 ± 1.05) points, respectively, which were significantly lower than (6.33 ± 1.25) points, (6.21 ± 1.52) points, (6.39 ± 1.17) points, (6.72 ± 1.23) points respectively in the control group ( t = 5.78, 5.38, 6.49, 6.07, all P < 0.05). The score of positive coping style in the study group was (28.51 ± 2.65) points, which was significantly higher than (24.84 ± 2.52) points in the control group ( t = 6.65, P < 0.05). The score of negative coping style was (12.39 ± 2.53) points, which was significantly lower than (14.81 ± 2.12) points in the control group ( t = 4.86, P < 0.05). The patient compliance with medication, review, diet, and physical exercise in the study group were 100.00%, 90.91%, 90.91%, and 81.82%, respectively, which were significantly higher than 81.81%, 68.18%, 75.00%, and 61.36%, respectively in the control group ( χ2 = 6.73, 6.98, 3.93, 4.52, all P < 0.05). Conclusion:Cognitive intervention in an attribution study can enhance psychological resilience, improve the symptoms of cancer-related fatigue, promote a positive change of coping style, and enhance treatment compliance in older adult patients with lung cancer.

Effect of cognitive behavioral therapy on quality of life in patients with Parkinson's disease： a Meta-analysis / 四川精神卫生

BackgroundDepression， anxiety， impulse control disorders， insomnia are prevalent non-motor symptoms of Parkinson's disease， severely impairing the quality of life of patients. Cognitive behavioral therapy （CBT） is a common psychological intervention for various clinical psychological conditions， which can improve anxiety， insomnia and depression in patients with Parkinson's disease. However， the current research evidence on the effects of CBT in improving quality of life in patients with Parkinson's disease remains inconsistent. ObjectiveTo assess the effects of CBT on the quality of life among patients with Parkinson's disease， so as to provide references for the clinical application of CBT in this population. MethodsOn May 25， 2023， a systematic search was conducted across PubMed， PsycINFO， Embase， CNKI， Wanfang Database and VIP Database to identify randomized controlled trials investigating the impact of CBT on the quality of life in patients with Parkinson's disease. Literature screening， quality evaluation and data extraction were performed， focusing on variables related to quality of life， anxiety， and depression. Meta-analysis was performed using Stata 13.0 and RevMan 5.3. ResultsA total of 11 studies with 456 participants were included， comprising 241 in the CBT group and 215 in the control group. The CBT group exhibited significantly higher quality of life compared with the control group （SMD=0.47， 95% CI： 0.27~0.67， P<0.01）. Anxiety and depression scores in CBT group were significantly lower than those in the control group （SMD=-0.63，95% CI：-0.84~-0.43， P<0.01； SMD=-0.83， 95% CI： -1.15~-0.51， P<0.01）. Among the 11 studies， 6 studies delivered CBT remotely and 5 studies implemented CBT face-to-face. Meta-analysis results revealed that remote CBT group yielded significantly higher quality of life （SMD=0.43， 95% CI： 0.17~0.70， P<0.01）， and lower anxiety and depression scores （SMD=-0.62， 95% CI： -0.91~-0.34， P<0.01； SMD=-0.78， 95% CI： -1.34~-0.21， P<0.01） compared with the control group. Similarly， face-to-face CBT group showed better outcomes than the control group in terms of quality of life， anxiety and depression （SMD=0.51， 95% CI： 0.22~0.81， P<0.01； SMD=-0.64， 95% CI： -0.93~-0.35， P<0.01； SMD=-0.90， 95% CI： -1.20~-0.60， P<0.01）. ConclusionCBT may contribute to alleviating anxiety and depression levels of patients with Parkinson's disease， and improving their quality of life.｛Funded by Shanghai 13th Five-Year Key Specialty Construction Project （number， shslczdzk04901）； Nature Fund Project of Shanghai Science and Technology Commission （number， 22ZR1459300）； Shanghai Municipal Health Commission Traditional Chinese Medical Science Non-drug Therapy Demonstration Center Project ［number， ZY（2021-2023） -0204-03］｝

Internet-based group cognitive behavioral therapy for depression and anxiety symptoms / 四川精神卫生

This paper presents a systematic review of extant research investigating the effectiveness of Internet-based group cognitive behavioral therapy （IGCBT） for depression and anxiety symptoms with an emphasis on the treatment modalities， treatment protocols， efficacy and mechanism， together with a summary of research limitations and suggestions for future research. Cognitive behavioral therapy （CBT） is a structured， short-term and present-oriented psychotherapeutic treatment， its Internet- and group-delivered modalities have led to its wider application， and has proven to be clinically effective in alleviating depression and anxiety symptoms caused by different diseases， whereas some drawbacks have been reported. Thus this paper elaborates the clinical application， therapeutic effect and underlying mechanisms of IGCBT intervention for depression and anxiety symptoms， so as to provide references for its future application. ［Funded by the Natural Science Foundation of the Inner Mongolia Autonomous Region （number， 2019MS03038）

Effect of Gandouling Decoction Combined with Cognitive Behavioral Therapy on Impulse Control Disorders in Wilson's Disease with Syndrome of Combined Phlegm and Stasis / 中国实验方剂学杂志

ObjectiveTo observe the clinical efficacy of Gandouling decoction combined with cognitive behavioral therapy （CBT） in the treatment of impulse control disorders in patients with Wilson's disease （WD， syndrome of combined phlegm and stasis）. MethodA prospective study was conducted on 90 WD patients with the syndrome of combined phlegm and stasis and impulse control disorders （ICD） treated in the Department of Encephalopathy of the First Affiliated Hospital of Anhui University of Chinese Medicine from August 2018 to February 2023. They were randomized into a control group， a CBT group， and a treatment group， with 30 patients in each group. The control group received routine Western medicine treatment （basic copper removal）. The CBT group received cognitive behavioral therapy in addition to the therapy in the control group， and the treatment group received Gandouling decoction in addition to the therapy in the CBT group. Each course of treatment was 8 days， and the patients were treated for 4 courses. Before and after treatment， the 24-hour urine copper （24 h U-Cu）， non-ceruloplasmin-bound copper （NCC）， traditional Chinese medicine （TCM） syndrome score， unified WD rating scale part Ⅲ （UWDRS Ⅲ） score， Barratt Impulse Scale Version 11 （BIS-11） score， Buss-Perry aggression questionnaire （BPAQ） score， modified overt aggression scale （MOAS） score， and treatment emergent symptom scale （TESS） score of three groups of patients were determined and statistically analyzed. ResultBefore treatment， there was no statistically significant difference in the level of 24 h U-Cu or NCC among the three groups. After treatment， all the three groups showed an increase in 24 h U-Cu （P<0.01） and a decrease in the NCC level （P<0.05， P<0.01）. There was no significant difference in the 24 h U-Cu level among the three groups after treatment. After treatment， the NCC level showed no significant difference between the control group and the CBT group， while the NCC level in the treatment group was lower than that in the control group and CBT group （P<0.05）. Before treatment， there was no statistically significant difference in the TCM syndrome score among the three groups. After treatment， the TCM syndrome scores of all the three groups decreased （P<0.01）. Moreover， the treatment group had lower TCM syndrome score than the control group and CBT group （P<0.05）. Before treatment， the UWDRS Ⅲ， BIS-11， BPAQ， and MOAS scores had no statistically significant differences among the three groups. After treatment， the UWDRS Ⅲ， BIS-11， BPAQ， and MOAS in all the three groups declined （P<0.05）. Moreover， the CBT group and treatment group had lower UWDRS Ⅲ， BIS-11， BPAQ， and MOAS scores than the control group （P<0.05）， and the treatment group had lower BIS-11 and BPAQ scores than the CBT group （P<0.05）. ConclusionThe combination of Gandouling decoction and CBT can ameliorate impulse control disorders in the WD patients with combined phlegm and stasis.

Construction of intervention program for physical and mental adjustment for primary caregivers of cancer patients based on network cognitive behavior therapy / 中国实用护理杂志

Objective:Based on cognitive behavioral therapy, to construct a physical and mental adjustment intervention plan for the main caregiver of cancer patients through the network platform.Methods:Through evidence-based literature published from July 2012 to July 2022 screening and evaluation, combined with qualitative interviews for 10 primary caregivers of cancer patients, the intervention plan for physical and mental adjustment of the main caregivers of cancer patients was preliminarily formulated. After consultation with Delphi experts (15 cases) through two rounds, the intervention plan was finally determined.Results:In the two rounds of expert letter inquiries, 15 questionnaires were distributed and 15 valid questionnaires were recovered. The effective recovery rate was 100.00% and the expert authority coefficient were 0.89 and 0.90 in the two rounds of expert letter inquiries respectively, the Kendall harmony coefficients were 0.279 and 0.323 respectively, and the differences were all statistically significant ( P<0.01). The intervention plan for physical and mental adjustment ofthe main caregivers of cancer patients included 5 first-level indicators (basic knowledge, symptom education, home care knowledge, relaxation training, social support), 27 second-level indicatorsand 54 third-level indicators. Conclusions:The method of the psychosomatic regulation intervention program is scientific and practical, which can be initially applied to the psychological adjustment of the main caregivers of cancer patients, so as to provide a reference for improving their negative emotions.

Internet-based cognitive behavioral therapy for distress， depression， anxiety and quality of life in cancer patients： a Meta-analysis / 四川精神卫生

BackgroundInternet-based cognitive behavioral therapy （ICBT） is progressively emerging as an efficacious alternative to alleviate anxiety and depression in cancer patients. To date， no Meta-analysis has been conducted specific to the effect of ICBT on anxiety， depression， distress and quality of life in cancer patients. ObjectiveTo assess the effect of ICBT on distress， depression， anxiety and quality of life in cancer patients through a systematic review of the literature. MethodsOn March 28， 2022， PubMed， PsycINFO， Embase， Cochrane Library， Web of Science， CNKI， VIP， Wanfang Data and CBM were retrieved for the randomized controlled trials （RCTs） involving ICBT targeting either distress， depression， anxiety， quality of life or all in cancer patients. After the risk of bias assessment， Stata 17.0 software was used for Meta-analysis. ResultsA total of 12 RCTs with a total sample size of 1 686 patients were included. Meta-analysis revealed that the superiority of ICBT over controls was evident for interventions targeting distress in cancer patients （SMD=-0.547， 95% CI： -1.090~-0.145， P<0.01）， while appeared to be less evident for the interventions targeting depression （SMD=-0.652， 95% CI： -1.734~0.002， P=0.051）， anxiety （SMD=-1.045， 95% CI： -3.656~0.101， P=0.088） and quality of life （SMD=0.234， 95% CI： -0.064~0.449， P=0.112） in cancer patients，and dropout rate was higher in ICBT group than that in control group （OR=1.795， 95% CI：1.358~2.374， P<0.01）. ConclusionICBT is reported to be effective in alleviating distress in cancer patients， whereas results inconsiderable improvements over depression， anxiety and quality of life in cancer patients.