Effectiveness of mindfulness-integrated cognitive behavior therapy on anxiety, depression and hope in multiple sclerosis patients: a randomized clinical trial

Abstract Introduction Multiple sclerosis (MS) is a chronic medical condition that attracts particular attention because of the high risks associated with it. MS patients suffer from medical problems, depression, anxiety, and reduced hopefulness. These issues can increase the severity of the disease and treatment resistance and reduce patients' individual and social efficacy. Mindfulness-integrated cognitive behavior therapy (MICBT) is a new approach that is being applied in chronic diseases and can be used in combination with existing treatments. Therefore, the present study investigated the efficacy of MICBT in terms of anxiety, depression, and hope in MS patients. Methods A sample of 20 patients with MS was randomly selected at Shafa Hospital in Kerman City, Iran. Patients were then assigned to one of two groups of 10 people using a random number table. The experimental group received MICBT. The control group also received the same therapy after study completion. The assessment tools used in this study included the Beck Depression Inventory-Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and Miller Hope Scale (MHS). Measurements were conducted at three stages: pre-test, post-test, and follow-up. For data analysis, means and standard deviations were calculated and one-way analysis of covariance was conducted using SPSS 24. Results Compared with controls, MICBT was effective for reducing depression (P < 0.001, F = 72.55), anxiety (P < 0.001, F = 100.75). Additionally, MICBT was effective in improving hope (P < 0.001, F = 45.36). Changes were maintained in the follow-up phase. Conclusion The MICBT affects depression, anxiety and hope of MS patients. Therefore, mental health professionals can benefit from the results obtained in the present study to reduce depression and anxiety and increase hope in this group of patients. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT201601030258N4.

Efectividad del tratamiento temprano de niños con mutismo selectivo en los centros educativos / Effectiveness of early treatment of children with selective mutism in educational centers

Resumen El mutismo selectivo (MS) es un trastorno de ansiedad de baja prevalencia, lo que dificulta su investigación. Pese a su inicio temprano su diagnóstico no suele hacerse antes del acceso a la escolaridad obligatoria. El objetivo de este estudio fue valorar la eficiencia de un protocolo cognitivo-conductual para la intervención psicológica en el contexto educativo (ipmsce), siguiendo los criterios de la Task Force in Promotion and Dissemination of Psychological Procedures. Participaron 10 niños que presentaban una demora inferior a dos años entre el inicio del MS y su diagnóstico (1.00 ± 0.54). La edad media fue de 4.94 años y el 80% fueron niñas. Se utilizó un diseño de acumulación de casos, con medidas del tratamiento antes de su aplicación, al finalizar y en un seguimiento a los 12 meses, obtenidas a través de los padres, los profesores y un test situacional. Los resultados muestran la efectividad de la intervención.

Abstract Selective mutism (SM) is an anxiety disorder of low prevalence, which makes its investigation difficult. Despite its early start, its diagnosis is not usually made before access to compulsory schooling. The objective of this study was to assess the efficiency of a cognitive-behavioral protocol for psychological intervention in the educational context (ipmsce), following the criteria of the Task Force in Promotion and Dissemination of Psychological Procedures. Ten children with a delay of less than two years between the onset of SM and its diagnosis (1.00 ± 0.54) participated. The average age was 4.94 years and 80 % were girls. A case accumulation design was used, with measures of treatment before its application, at the end and in a followup at 12 months, obtained through parents, teachers and a situational test. The results show the effectiveness of the intervention.

Terapia cognitivo-comportamental em cefaleia crônica / Cognitive behavioral treatment in chronic headache

A terapia cognitivo-comportamental (TCC) é a abordagem psicoterápica mais pesquisada atualmente. Seus fundamentos procuram identificar pensamentos e comportamentos inadequados ou disfuncionais automáticos. Ajuda o paciente a desenvolver habilidades e empregar as técnicas cognitivas para rebater as crenças que destroem sua aceitação da responsabilidade no emprego de técnicas de enfrentamento e autogerenciamento da dor. Também são administradas técnicas de relaxamento para alívio de alguns sintomas da dor crônica.

Eating Disorders

Therapist competency is fundamental to the success in treating most psychological disorders. However, the skills required to effectively treat eating disorders may be more demanding than many other problems, because competency requires mastery of considerable educational information about physical complications associated with eating-disorder symptoms and chronic weight suppression. The cognitive-behavioral model of treatment has become well-defined in recent years; however, the mark for therapist competency continues to rise as the knowledge base has expanded with the high level of clinical and research interest in eating disorders. The guidelines provided in this paper are intended to provide a springboard for the training and supervision to improve patient care.

La competencia del terapeuta es fundamental para el éxito en el tratamiento de los Trastornos Psicológicos. Sin embargo, las habilidades que se requieren para tratar eficazmente los Trastornos del Comportamiento Alimentarios pueden ser más demandantes que para otros problemas, porque la competencia requiere del dominio de considerable información educativa acerca de las complicaciones físicas asociadas con los síntomas de los Trastornos Alimentarios y la supresión crónica de peso. El modelo de tratamiento cognitivo-conductual se ha convertido en el mejor definido en recientes años, sin embargo, el marco de la competencia del terapeuta continúa aumentando, dado que, la base de conocimientos se ha ampliado con el alto nivel de interés en la investigación clínica y en los trastornos alimentarios. Las directrices que proporciona este artículo tiene objetivo servir de trampolín para la formación y supervisión para mejorar la atención al paciente.

Treatment Relationships in Cognitive-Behavioral Treatment of Children and Adolescents / 신경정신의학

This article reviewed the literatures which demonstrated correlations between therapeutic relationship variables and treatment outcomes in children and adolescents, and also examined factors which affect a positive therapeutic relationship. Results from this review revealed that a positive therapeutic relationship is essential for cognitive-behavioral treatment (CBT) with children and adolescents, and also indicated that the therapeutic effect is the most powerful when a therapist maintains a collaborative relationship. Finally, basic strategies for maintaining a collaborative relationship have been suggested. These include strategies such as ; 1) setting a goal for therapy focusing on enhanced motivation for therapy ; 2) facilitating the engagement of parents in the treatment process ; 3) creating a collaborative atmosphere ; 4) educating the client about therapy ; 5) liciting feedback ; 6) making creative and innovate modifications of traditional CBT methods ; and, 7) providing choices for the client.

Stress, Sleep Physiology, and Related Insomnia Disorders

Excessive stress gives rise to disturbances in various systems in humans and activates defense mechanisms to maintain homeostasis in the body. Sleep is an essential biological process of which the underlying regulating mechanism involves numerous anatomical structures and biochemical substances that can be compromised by stress and the immune system. Immune sub-stances such as interleukin-1beta and tumor necrosis factor are related to the homeostatic process of sleep. Interleukin-1beta interacts by being involved in an immune regulating feedback chain that activates the hypothalamo-pituitary-adrenal axis which, in turn, is related to the circadian process. Moreover, stress-induced insomnia activates the hypothalamo-pituitary-adrenal axis further to bring about a vicious cycle of stress and insomnia. The pathophysiological theory responsible for chronic insomnia is that of stressdiathesis, which is a series of processes consisting of predisposition, precipitating, and perpetuating factors. In clinical practice, as the process in which stressinduced insomnia passes into a chronic course is directly related to treatment, the understanding of perpetuating factors is indispensable. Sleep disturbance is a very common complaint among pa-tients with posttraumatic stress disorder. Increased noradrenergic activity and REM sleep dysregul-ation seem to have a role in mediating sleep disturbances of this disorder. Sleep disturbance must always be taken into account as an important clinical variable whenever evaluating or managing stress.

Resultados preliminares del Programa de Intervención Breve para Adolescentes que Inician el Consumo de Alcohol y otras Drogas / Preliminary study of a brief intervention program for adolescents who initiate alcohol and other drugs consumption

During the last two decades, alcohol, tobacco and illicit drug consumption among young people has come to be regarded as a serious public health problem, both in Mexico and internationally. This recognition has resulted from a trend toward higher levels of use, greater diversification of the types of drugs used and abused, and increased drug marketing. Epidemiological data show that most users initiate drug use when they are about 16 years old. However, the age of first drug experimentation appears to be decreasing, with recent reports indicating an average age 12 or 13 years at present. The societal costs of adolescent drug use cut across different domains including physical and mental health, car crashes, and morbidity and mortality related to substance misuse. The personal costs of teen drug use include school failure, drop-out, and truancy. Moreover, aggressive behavior and crime, risky sexual behaviour, and many other behavioural problems have been shown to be associated with adolescent drug use. Research from many different disciplines has increased knowledge about (a) important dimensions of adolescent substance use and (b) the processes and variables related to the origin and maintenance of addictive behavior among teenagers. Despite this growing body of knowledge, few current prevention and treatment programs are based on empirical investigation. Moreover, many current intervention programs have not been adequately evaluated in regard to effectiveness. A recent development in the addiction field is brief intervention (BI). BIs have been demonstrated to be effective in the treatment of addictive behavior among adult problem drinkers, with the most successful programs based on the Theory of the Social Learning. Only recently have BIs been tried with adolescent populations. While promising, little empirical research exists about the effectiveness of brief treatment with adolescents. The primary goals of BIs are to (a) reduce or eliminate substance consumption and (b) to mitigate the adverse effects of using alcohol or other drugs (i.e., harm reduction). While the goals of BIs are clear, the effectiveness of such programs with adolescents, despite their promise, is not well researched. For this reason, it is important to develop and empirically test BI programs for adolescents demonstrating problematic alcohol or other drug consumption. Schools represent a particularly good place to access adolescents who would benefit from BIs, and BIs represent an attractive alternative to the typical strategies used by school to address student substance use (i.e., suspension or expulsion). The main goal of this investigation was to develop and to evaluate a brief intervention program for teenagers with substance abuse (but who have not developed substance dependence) between 14 and 18 years old. The intervention program tries to: (a) promote a change in drug consumption through establishing consumption goals (in the case of the alcohol, moderation or abstinence; in the case of illegal drugs, abstinence); (b) identify high-risk situations in which use is probable; and (c) develop alternative strategies to these situations. The theorical bases of the intervention include Self-control Theory, Motivational Interviewing, Relapse Prevention and <>. Our brief intervention program consisted of six steps: 1. case detection, which involved the identification of adolescents who abuse alcohol or another drugs, by means of teacher's reports, legal and psychology personnel, trained by the investigators; 2. screening, which involved determining whether adolescents met inclusion criteria; 3. assessment, which addressed the frequency and amount of consumption and self-confidence to suitably face situation of probable drug; 4. induction to the program, the objective of which was to sensitize the adolescents about the importance of attending treatment; 5. intervention; and, 6. one, three and six months follow-up assessments. The intervention program consisted of four individual sessions with the participants in which they chose their own substance reduction goals, identified their high risk situations, developed coping plans for each high risk situation, and appraised the impact of their substance use on their own life-goals success. The researchers used a single-case design with 25 participants, 17 of whom had alcohol problems and eight of whom had marijuana problems. The age average of participants was 16 years (SD = 1.8), and 19 were male and six were female. The average age of first consumption was 14 years old (SD = 1.72); the average duration of substance use was 18 months. From the complete sample, 45% reported consumption one or twice per week, 22% reported daily consumption, and the remainder consumed once a month. Results indicated that from the 25 participants, 24 demonstrated changes from the baseline in their consumption pattern (measured by frequency and quantity) during intervention and at follow-up assessments. Self-efficacy levels (self-perceptions about the capability to abstain or use moderately in high risk situations) changed as well. Specifically, among the adolescents who consumed alcohol a one-way ANOVA revealed significant changes in average consumption between the baseline, treatment, and follow-up phases F(2.48) = 17.691, p < .001. Bonferroni's post-hoc tests showed differences between baseline ( = 8.89, SD = 3.55) and treatment ( = 4.46, SD = 3.27), and between baseline and the follow-up ( = 3.29, SD = 1.35). Student's t tests for each subject showed that 16 adolescents significantly reduced their alcohol consumption from the baseline to the follow-up. Only one participant demonstrated increased use (from five standard drinks per drinking occasion at the baseline to 5.90 standard drinks at the follow-up). Regarding consumers of marijuana, a one-way ANOVA showed significant changes in consumption across the baseline, treatment and follow-up phases F(2.21) = 8.219, p = .002. Bonferroni's post-hoc tests showed significant differences between the baseline ( = 18.23, SD = 16.62) treatment phases ( = 1.07, SD = 0.77), and between the baseline and the follow-up phases ( = 1.59, SD = 1.06). An additional one-way ANOVA revealed significant changes in self-efficacy. Specifically, participants demonstrated increased self-efficacy in situations including: Unpleasant emotions, Pleasant emotions, Testing personal control, Conflict with others, Social pressure, and Pleasant time with others (all p < .01), F(2.78) = 24.30, 12.47, 11.34, 11.02, 16.91 and 25.62, respectively. Self-efficacy in regard to Physical discomfort and Urges and temptations to drink also showed significant changes, but at p < .05 F(2.78) = 3.97 and 3.26, respectively. Finally, in order to evaluate the impact of the intervention on problems that participants associated with their alcohol use (or other drugs), seven areas were examined: School, Health, Cognitive, Interpersonal, Family, Legal and Economic. At the end of the treatment, there was a reduction in the number of problems related to these seven areas, compared with the baseline.

En las últimas décadas, el abuso de drogas legales e ilegales en los jóvenes ha sido considerado como un serio problema de salud pública, tanto en el ámbito internacional como en nuestro país. Los estudios epidemiológicos indican que la mayoría de los consumidores experimentan por primera vez con drogas alrededor de los 16 años, pero esta experimentación continúa disminuyendo presentándose en promedio a los 12 o 13 años. Esto representa altos costos para la sociedad y el individuo. Por ejemplo, en áreas de la salud se incrementan los costos de la atención médica, los servicios de salud mental y los tratamientos especializados, además de aumentar la probabilidad de accidentes y muertes relacionadas con el abuso; en el área escolar se presenta el fracaso y/o la deserción escolar, y la expulsión de los estudiantes por parte de las instituciones; y en el área social se pueden presentar conductas agresivas y/o delictivas, contacto sexual de riesgo y otros problemas de conducta relacionados con el consumo de sustancias. De los diferentes programas existentes, resaltan las intervenciones breves en el tratamiento de usuarios que abusan pero que no dependen de las sustancias. Este tipo de intervenciones se basan en la Teoría del Aprendizaje Social y están diseñadas para reducir los patrones de abuso de alcohol u otras drogas. Sin embargo, la aplicación de las intervenciones breves se ha realizado principalmente en adultos, y es hasta últimas fechas que éstas se han adaptado a población adolescente que abusa de las sustancias, sin tenerse todavía resultados concluyentes. Es por esto que es fundamental desarrollar programas de intervención breve como una alternativa para adolescentes que inician el abuso de alcohol u otras drogas. Otro punto que requiere atención es el desarrollo de estrategias para detectar los casos en las escuelas, con la finalidad de ofrecer los servicios de atención en las propias instituciones educativas sin que el adolescente tenga consecuencias como la suspensión o la expulsión. Ante este fenómeno se ha recomendado fortalecer acciones que se basan en la identificación temprana de patrones de consumo que ponen en riesgo al adolescente a diferentes problemas relacionados con el abuso de las drogas. Estos programas se deben caracterizar por ser costo-eficientes, breves y capaces de instrumentarse en una variedad de escenarios, así como de aplicarse a una variedad de culturas. Por lo tanto, el objetivo de esta investigación fue desarrollar y evaluar un programa de intervención breve para adolescentes de entre 14 y 18 años de edad, estudiantes de nivel medio y medio superior, que consumen alcohol en exceso u otras drogas, y que presentan problemas relacionados con este patrón de consumo pero sin cubrir los síntomas físicos de la dependencia. Para realizar la evaluación se utilizó un diseño de caso único con 25 réplicas, 17 casos de consumo de alcohol y 8 casos de consumo de mariguana. De los 25 adolescentes que participaron en el estudio, 24 mostraron una disminución en el patrón de consumo (cantidad y frecuencia de consumo), al comparar las mediciones de los datos recabados en las fases de línea base, tratamiento y seguimiento. Así mismo, se dieron cambios en el nivel de auto-eficacia (percepción de la capacidad de los sujetos para controlar sus situaciones de consumo), es decir, al finalizar el tratamiento los adolescentes se percibieron a sí mismos con mayor capacidad para controlar la cantidad de consumo en situaciones de riesgo. Además, al final del tratamiento los sujetos reportaron una reducción del número de problemas relacionados con su consumo. Esta investigación es uno de los primeros esfuerzos por demostrar el impacto de las intervenciones breves en el patrón de consumo de los adolescentes. Las limitaciones del estudio fueron que no se determinó el efecto específico de cada uno de los componentes del programa ni tampoco se evaluó la presencia de otras conductas problemáticas (comorbilidad). Sin embargo, esta investigación ofrece un apoyo empírico a los programas de intervención breve en población adolescente de nuestro país.

Repensando las adicciones: el paradigma cognitivo y el trastorno por dependencia / Rethinking addictions: the cognitive paradigm and substance dependence disorder

El objetivo del siguiente trabajo es revisar algunas estrategias psicoterapéuticas utilizadas para el trastorno por dependencia de sustancias. Desde el paradigma cognitivo se estudian diferentes creencias distorsionadas frecuentes en nuestro medio. Éstas denotan la dificultad de abordar el problema de las drogas desde el conocimiento científico basado en la evidencia. Se plantean problemáticas como el modelo de enfermedad, la alianza terapéutica, la ilegalidad, el objetivo del tratamiento, la medicación, las ideologías y las implicancias para las intervenciones sociales. Se repasan estrategias que han demostrado eficacia: Estrategias Motivacionales, Prevención de Recaídas, Manejo de Contingencias, Terapia Cognitiva Estándar y Reducción del Daño. Se concluye con la importancia de aplicar el conocimiento científico actual en los programas de tratamiento y en las políticas preventivas

The aim of this task is to review some psychotherapeutic strategies used for the treatment of Substance Dependence Disorder. Different distorted beliefs, from the cognitive paradigm, which are usually assumed in our society, are studied here. These beliefs reveal difficulty in facing the drug problem, from the scientific knowledge based on evidence. Different problems are set up, such us the illness pattern, therapeutic alliance, treatment aims, unlawful acts, medication, ideologies and implications for the social interventions. Different strategies that have proved effectiveness are reviewed. Motivational Interview, Contingencies Management, Standard Cognitive Therapy and Harm Reduction have been pointed out. We come to an end with the recommendation to use the scientific knowledge for the treatment programs and preventive policies

Cognitive-Behavioral Treatment of Late-Life Anxiety Disorder

This paper reviews the Cognitive-Behavioral Treatment (CBT) of late-life anxiety disorders, mainly focused on generalized anxiety disorder. CBT for late-life anxiety disorder is usually based on the same programs with demonstrated efficacy in younger adults, with specific treatment components included relaxation training, cognitive restructuring, and exposure. CBT for late-life anxiety disorders was proved to be more effective than no treatment. But, the existing body of work does not clearly indicate the superiority of CBT over alternative psychosocial interventions. Another serious limitation of CBT is that the rates of attrition in many trials are higher among older adults than among younger adults. Those limitations are strongly suggested that augmented CBT to meet the late-life adult's characteristics and needs, like as execute function, should be developed. Enhanced CBT is the one of the example, it includes the standard CBT elements, as well as additional attention to at-home practice assignments, reminder telephone call and weekly reviews of concepts and techniques. In conclusion, this review suggested the potential value of CBT for late-life anxiety disorders. Based on the current literature, nonstandard and augmented therapies appear to produce best results.

Cognitive and Group Treatment of Internet Addiction in Adolescents

A review of the literature and the authors' recent researches on the treatment of internet addiction among adolescents based on a cognitive behavioral approach suggest that most severely addicted adolescents have various co-morbid psychiatric problems and that the cognitive behavioral approach in a group setting is effective in the improvement of not only addictive behavior but also emotional and general behavioral problems including insight, depression, anxiety, and impulsiveness. Adolescents with internet addiction, especially who are severely affected, need a comprehensive psychiatric treatment of co-morbid problems and other behavioral problems.

Treatment of Sleep Disorders

Sleep medicine is a relatively new field to which medical practitioners have a limited exposure. During the last 20 years, many categories of sleep disorders have been defined. Sleep disorders produce various, sometimes serious, symptoms that cause physical, neuropsychological, and psychiatric problems. Medical doctors should recognize what symptoms are related to sleep disorders and make a first step to establish treatment plans that can help the patients. Based on sleep pharmacology we can understand the mechanisms of sleep physiology and ultimately can make appropriate prescriptions for patients. In Korea, actually, the physicians usually prescribe hypnotics indiscriminately for sleep problems, without considering any various sleep disorders and precise diagnostic procedures. Insomnia is not a simple homogenous disease entity, thus the exact diagnosis is essential for appropriate treatment. Especially, primary insomnia has a psychophysiological origin. Hypnotic medication is just one of the several treatment modalities for insomnia. To certain patients, behavioral modifications, rather than hypnotics, are effective. In fact, antidepressants and benzodiazepines can aggravate certain sleep disorders. In this article, the author reviews nonpharmacological treatment of insomnia, the medication specific to different sleep disorders, and treatment guidelines of hypnotics.

Pharmacological and Behavioral Approaches in the Treatment of Pathological Gambling / 대한정신약물학회지

Pathological gambling is classified as impulse control disorder in DSM-IV, but in clinical aspects it is similar with addictive disorder. Hence some pharmacological agents which are used to addictive disorders could be effective to pathological gambling. The author summarizes and discusses the treatment study results of mood stabilizers, serotonin reuptake inhibitors, naltrexone and other potentially promising agents. Recent double-blind, placebo-controlled studies show SSRIs and naltrexone effective to reduce urges of gamblers. However further studies with large patient population and longer treatment duration are required. The author also discusses cognitive behavioral treatment, family education and Gamblers Anony-mous (GA). Western cognitive behavioral treatment consists of cognitive correction, problem solving technique, social skill training and relapse prevention, but we need to modify these rechnics to fit to our clinical population.