Are behavioral interventions a better choice for atopic dermatitis patients? A meta-analysis of 6 randomized controlled trials

Abstract Background The treatment for atopic dermatitis (AD) has been the focus of clinical research, and behavioral intervention is considered an indispensable treatment method. To our knowledge, no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis. Objectives To evaluate the effects of behavioral interventions on atopic dermatitis. Methods The authors searched PubMed, EMBASE, and Cochrane CENTRAL to retrieve relevant RCTs (up to Feb 2022). The search strategy involved a combination of related keywords. The Cochrane Q and I2 statistics were used to assess heterogeneity. Results Six RCTs involving seven reports with 246 patients were included. The results suggested that behavioral interventions could relieve eczema severity (correlation coefficient [r = −0.39]; p < 0.001) and scratching severity significantly (r = −0.19; p = 0.017), while not affect itching intensity (r = −0.02; p = 0.840). A sensitivity analysis confirmed the robustness of the results. Study limitations An important limitation of this study was the insufficient number of RCTs and the limited sample size. In addition, the study lacked a control group receiving a type of intervention other than the experimental protocol. Another limitation was the short duration of follow-up. Conclusions This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity. Additionally, habit-reversal behavioral therapy may be more effective for treating atopic dermatitis.

Tokophobia: a fear of childbirth and pregnancy - an overview

Tokophobia is a mental disorder that affects women of all ages and varies from a mild to severe dread of delivery. Knauer first reported in the literature in 1897 that between 20% to 78% of pregnant women experience dread connected to pregnancy and delivery. The International Journal of Reproduction, Contraception, Obstetrics and Gynaecology published a study that found that the prevalence of tokophobia was 30.7% on Levin's scale and 55.3% on Areskog's score. Tokophobia is a multifaceted fear of labor that can be further classified into primary tokophobia and secondary tokophobia. People who have tokophobia may have extreme anxiety that manifests as nightmares, insomnia, panic attacks, and avoidance of situations involving pregnancy or childbirth. The most prevalent type of tokophobia is called secondary tokophobia, and it usually affects women who have already given birth and have experienced a traumatic delivery previously. A 20-item questionnaire called the fear of childbirth questionnaire (FCQ) is used to scale people's fear of giving birth. Cognitive-behavioral therapy (CBT) is mostly used as a non-pharmacological treatment.

Atenção psicológica às puérperas na maternidade: relato de experiência / Psychological care for postpartum women in the maternity ward: experience report / Atención psicológica a la puérpera en la maternidad: relato de experiencia

OBJETIVO: Relatar a experiência de realizar intervenções em saúde mental desenvolvidas com puérperas internadas por razão de pósparto imediato. MÉTODO: Relato de prática profissional sobre a criação e implantação do Programa de Saúde Mental da Recém-mamãe, realizado no período de fevereiro de 2019 a fevereiro de 2024 com mulheres hospitalizadas após o parto, independente da via (cesárea ou normal) em uma maternidade pública do interior paulista. Fundamentada pela Terapia Cognitivo Comportamental (TCC), as ações do programa foram organizadas em um Protocolo de Conduta, para a psicóloga da instituição e elaboração de questionário intitulado "Escala Perceptiva de Experiência do Parto", objetivando abordar sobre a percepção da mulher com relação à sua vivência de parir, bem como, emoções e sentimentos envolvidos no momento, viabilizando um acolhimento mais assertivo de acordo com a demanda da participante. RESULTADOS: As ações do programa basearam-se em escuta qualificada, dando ênfase à narrativa da participante. A atenção à recém-mãe seguiu as seguintes diretrizes de atuação: abordagem com o questionário desenvolvido; atendimento psicológico de acordo com a demanda da participante; interconsulta com médico para tratamento medicamentoso, avaliação com instrumentos de saúde mental; encaminhamentos para serviço de psicologia externo; orientações sobre os aspectos emocionais do pós-parto; entrega de relatório à diretoria da instituição buscando fomentar ações de melhoria no que tange a gestão em saúde. CONSIDERAÇÕES FINAIS: A implantação do Programa permitiu um cuidado mais sensível, personalizado e assertivo, promovendo nova dinâmica de atenção à saúde mental materna no ambiente hospitalar.

OBJECTIVE: To report the experience of carrying out mental health interventions developed with postpartum women hospitalized for immediate postpartum reasons. METHOD: Professional practice report on the creation and implementation of the Programa de Saúde Mental da Recém-mamãe (New Mother's Mental Health Program), carried out from February 2019 to February 2024 with women hospitalized after childbirth, regardless of the route (cesarean section or normal) in a maternity ward public sector in the interior of São Paulo. Based on Cognitive Behavioral Therapy (CBT), the program's actions were organized into a Conduct Protocol, for the institution's psychologist and preparation of a questionnaire entitled "Escala Perceptiva de Experiência do Parto" ("Perceptual Scale of Childbirth Experience"), aiming to address the woman's perception in relation to their experience of giving birth, as well as the emotions and feelings involved in the moment, enabling a more assertive reception according to the participant's demands. RESULTS: The program's actions were based on qualified listening, placing emphasis on the participant's narrative. Care for the new mother followed the following guidelines: approach with the developed questionnaire; psychological care according to the participant's demand; consultation with a doctor for drug treatment, assessment with mental health instruments; referrals to external psychology services; guidance on the emotional aspects of postpartum; delivery of a report to the institution's board of directors seeking to encourage improvement actions regarding health management. FINAL CONSIDERATIONS: The implementation of this program allowed for more sensitive, personalized and assertive care, promoting new dynamics of maternal mental health care in the hospital environment.

OBJETIVO: Relatar la experiencia de realización de intervenciones en salud mental desarrolladas con puérperas hospitalizadas por motivos de posparto inmediato. MÉTODO: Informe de práctica profesional sobre la creación e implementación del Programa de Salud Mental de la Nueva Madre, realizado de febrero de 2019 a febrero de 2024 con mujeres hospitalizadas después del parto, independientemente de la vía (cesárea o normal) en una maternidad del sector público del interior de São Paulo. Con base en la Terapia Cognitivo Conductual (TCC), las acciones del programa se organizaron en un Protocolo de Conducta, para el psicólogo de la institución y la elaboración de un cuestionario denominado "Escala Perceptual de la Experiencia del Parto", con el objetivo de abordar la percepción de la mujer en relación con su experiencia de dar nacimiento, así como las emociones y sentimientos involucrados en el momento, posibilitando una recepción más asertiva de acuerdo con las demandas del participante. RESULTADOS: Las acciones del programa se basaron en la escucha calificada, poniendo énfasis en la narrativa de los participantes. El cuidado de la nueva madre siguió las siguientes pautas: abordaje con el cuestionario desarrollado; atención psicológica según la demanda del participante; consulta con médico para tratamiento de drogas, valoración con instrumentos de salud mental; derivaciones a servicios externos de psicología; orientación sobre los aspectos emocionales del posparto; entrega de un informe al directorio de la institución buscando incentivar acciones de mejora en materia de gestión en salud. CONSIDERACIONES FINALES: La implementación del Programa permitió una atención más sensible, personalizada y asertiva, promoviendo nuevas dinámicas de atención a la salud mental materna en el ambiente hospitalario.

Effects of chest physiotherapy and cognitive behavioral therapy in preventing post-operative complications in a patient who has undergone double barrel ileostomy: a case study

Bowel obstruction is a common complication in advanced ovarian cancer with a reported obstruction rate between 5�%, which is treated with resection and anastomosis. Post-operative complications (PPCs) generally occur due to immobility, decreased chest expansion, reduced thoracic mobility, weakness of respiratory muscles, severe pain at the suture site, and bandaging, making it difficult for the patient to cough. Thick and sticky mucus and depressed mucociliary clearance as an effect of anesthesia, cause accumulation of secretions in the lungs and can lead to PPCs. All this leads to prolonged hospital stays for the patient and delays recovery. Hence, our study aims to study the effects of chest physiotherapy and cognitive behavioral therapy in preventing post-operative complications in a patient who has undergone double barrel ileostomy. A 47-year-old female presented with the chief complaint of pain in the abdomen, for 2 months, which was dull aching and did not relieve with medication. She underwent double barrel ileostomy surgery. Following surgery, a 1- week exercise program was designed for the patient, which included the combination of chest PT and cognitive behavioral therapy with pre- and post-assessment of 3 scales, HAM-A, MGS-2, and POP DST, which showed remarkable differences in the pre and post values of the patient. Our present study concluded that post-operative physiotherapy intervention of chest PT and cognitive behavioral therapy was effective in preventing post-operative complications in the patient and promoted her early discharge from the hospital.

Application of trauma-focused cognitive behavioral therapy among children and adolescents with childhood household dysfunction / 中南大学学报(医学版)

Childhood household dysfunction(CHD)is a common adverse childhood experience,which brings the heavy physical and mental afflictions to children and adolescents.Trauma-focused cognitive behavioral therapy(TF-CBT)is an evidence-based psychotherapy that helps children and adolescents who have experienced childhood trauma with traumatic memories.It aims to enhance the coping abilities of CHD children and adolescents,thereby improving the negative effects caused by trauma and effectively reducing psychological burden.TF-CBT can effectively improve post-traumatic stress disorder,emotional and behavioral problems,and family function in children and adolescents with CHD.It is recommended to conduct high-quality original research in the future,develop targeted TF-CBT intervention plans based on potential predictive factors,adopt a combination of online and offline methods,and construct TF-CBT interventions suitable for the Chinese CHD population to meet the mental health service needs of CHD children and adolescents.

SWOT analysis of internet-based cognitive behavioral therapy application in improving negative emotions in patients with coronary heart disease / 中国实用护理杂志

Objective:With the help of SWOT(S: internal strengths, W: internal weaknesses, O: external opportunities, T: external threats)analysis, to explore the internal and external conditions of internet-based cognitive behavioral therapy applied to improve the negative emotions of patients with coronary heart disease, and to propose development strategies.Methods:SWOT analysis was used to analyze and sort out the internal strengths and internal weaknesses, external opportunities and external threats of internet-based cognitive behavioral therapy in improving the negative emotions of patients with coronary heart disease.Results:The internal strengths of internet-based cognitive behavioral therapy in improving the negative emotions of patients with coronary heart disease were significant therapeutic effect, strong operability and high cost-effectiveness. The internal weaknesses included excessive dependence on patients′ treatment enthusiasm, and a lack of psychological training among nurses. The external opportunities included demand support, technical support, and theoretical support. The external threats were the lack of large-scale empirical research and the risk of patient personal information leakage.Conclusions:In the clinical application of internet-based cognitive behavioral therapy to improve the negative emotions of patients with coronary heart disease, both strengths and weaknesses coexist, and opportunities and threats coexist. Only by taking strengths of opportunities to overcome weaknesses, improve the autonomy and enthusiasm of patients in treatment, and increase the psychological training of medical staff, can internet-based cognitive behavioral therapy be further promoted in the clinical application of improving the negative emotions of patients with coronary heart disease.

Efficacy of rTMS and CBT-I on patients with chronic insomnia disorder： a randomized controlled study / 四川精神卫生

BackgroundTo date， pharmacologic therapy is considered the standard first-line treatment for insomnia disorder， but there are still some concerns over the adverse reactions. Repetitive transcranial magnetic stimulation （rTMS） and cognitive behavioral therapy for insomnia （CBT-I） as an alternative to pharmacologic therapy have the advantages of fewer side effects and better patient tolerance in the treatment of chronic insomnia disorder. ObjectiveTo explore the clinical efficacy of rTMS and CBT-I on chronic insomnia disorder， so as to provide a novel therapeutic option for the treatment of chronic insomnia disorder. MethodsA total of 50 patients with chronic insomnia disorder attending the outpatient clinic of Inner Mongolia Autonomous Region Mental Health Center or community hospital from September 21， 2020 to December 16， 2021 and fulfilling the International Classification of Sleep Disorders， third edition （ICSD-3） diagnostic criteria were enrolled. Additionally， 16 age- and sex-matched healthy controls recruited from the community were set as control group. Patients were randomly divided into rTMS group and CBT-I group， 25 cases in each group， and received rTMS or CBT-I intervention for 6 weeks respectively. At enrollment and completion of intervention， patients were subjected to Polysomnography （PSG）， Pittsburgh Sleep Quality Index （PSQI）， Insomnia Severity Index （ISI） and Repeatable Battery for the Assessment of Neuropsychological Status （RBANS）. All participants underwent resting-state functional magnetic resonance imaging （rs-fMRI） scans， and amplitude of low-frequency fluctuation （ALFF） was calculated. The brain regions with statistically different ALFF values between patient group and control group were chosen as regions of interest （ROIs）， and whole-brain seed-based functional connectivity analyses were conducted. ResultsAfter a 6-week intervention in the two groups， the main effect of time was significant for PSQI （F=41.160， P<0.05）， ISI （F=69.615， P<0.05） and RBANS immediate memory （F=47.923， P<0.05）， language （F=12.090， P<0.05） and delayed memory indices （F=28.193， P<0.05）. A significant main effect of time for total sleep time （F=8.995， P<0.05）， a significant main effect of time for sleep efficiency （F=12.414， P<0.05）， a significant main effect of group for sleep efficiency （F=4.342， P<0.05） and a significant main effect of time for N1% （F=7.806， P<0.05） were observed. Sleep efficacy in CBT-I group improved significantly from pre- to post-test （t=-2.785， P<0.05）. Patients in rTMS group showed increased functional connectivity between the orbital superior frontal gyrus and other regions including left lentiform nucleus putamen （t=4.991， P<0.05）， right median cingulate and paracingulate gyri （t=4.471， P<0.05） and right postcentral gyrus （t=4.922， P<0.05）， and increased functional connectivity between the orbital superior frontal gyrus and left middle frontal gyrus was found in CBT-I group （t=6.586， P<0.05）. ConclusionrTMS and CBT-I may help alleviate insomnia and improve cognitive function of patients with chronic insomnia disorder. [Funded by Science and Technology Planning Projects in Inner Mongolia Autonomous Region （number， 201802142）］

Efficacy of brief cognitive behavioral therapy on improving quality of life improvement in patients with schizophrenia / 四川精神卫生

BackgroundThe course of schizophrenia is prolonged， and patients have impaired social function and significantly reduced quality of life. Drug therapy combined with psychological therapy is particularly important for improving the quality of life of patients. Brief cognitive behavioral therapy （BCBT） has been widely applied in clinical practice， but current research on BCBT focuses more on improving patients' symptoms and lacks relevant reports on improving quality of life. ObjectiveTo evaluate the efficacy and influencing factors of BCBT combined with conventional treatment on improving the quality of life in patients with schizophrenia. MethodsA total of 210 patients who met the diagnostic criteria for schizophrenia in the International Classification of Diseases （10th edition） （ICD-10） and were followed up at the outpatient department of Beijing Anding Hospital Capital Medical University from August 2011 to December 2016 were selected. Using a random number table method， patients were divided into study group and control group， with 105 cases in each group. Both groups received routine treatment， and the research group received a total of 8 BCBT sessions for 12 weeks on this basis. At the baseline period and 12 weeks of treatment， 26 weeks of follow-up and 52 weeks of follow-up， Positive and Negative Syndrome Scale （PANSS）， Personal and Social Performance Scale （PSP） and World Health Organization Quality of Life Brief （WHOQOL-BREF） were used for evaluation. ResultsThe results of repeated measures analysis of variance showed that the time point effect and interaction effect of PANSS total score were statistically significant （F=118.783， 8.083， P<0.01）.The time point effect， inter group effect and interaction effect of PSP total score were statistically significant （F=94.358， 4.048， 5.490， P<0.05 or 0.01）. The time point effect， inter group effect and interaction effect of the total score of WHOQOL-BREF were all statistically significant （F=12.330， 4.168， 4.142， P<0.05 or 0.01） Binary Logistic regression analysis showed that the study group （OR=1.861， 95% CI： 1.004~3.448） and young age （OR=1.044， 95% CI： 1.001~1.088） were protective factors for improving quality of life of patients， while high PANSS baseline score （OR=0.972， 95% CI： 0.945~0.999） was a risk factor for improving quality of life of patients. ConclusionThe combination of BCBT and conventional treatment has an earlier onset of improvement in the quality of life of patients with schizophrenia， and long-term efficacy is superior to conventional treatment.［Funded by Research Projects Supported by Beijing Municipal Commission of Science and Technology （number， Z111107058811078）； Capital Medical Development Fund Joint Research Project （number， 2009-1050）； Beijing Hygienism and Health Science and Technology Achievements and Appropriate Technology Promotion Project （number， TG-2017-38）； www.chictr.org.cn number： ChiCTR-TRC-13003709］

Intervention efficacy of cognitive behavioral therapy on prolonged grief disorder： a Meta-analysis / 四川精神卫生

BackgroundProlonged grief disorder （PGD） has serious impact on the quality of patients' work and life. Previous relevant studies have explored the intervention effect of cognitive behavioral therapy（CBT） on PGD， but their conclusions remain controversial due to differences in frequency， time and content of intervention. ObjectiveTo explore the intervention effects of CBT on the PGD through Meta-analysis， so as to provide references for clinical treatment. MethodsOn October 22， 2022， the database of VIP， China Biomedical Literature Database， Wanfang， CNKI， Embase， Cochrane Library， PubMed and Web of Science were searched systematically， and randomized controlled trials （RCTs） of CBT in treating PGD was collected. Outcome indicators include sadness， depression， anxiety and somatization symptoms. RevMan 5.3 was used for Meta-analysis. ResultsA total of 7 articles were included with a total sample size of 528 cases. Meta-analysis results showed that the study group had lower scores than the control group for grief （SMD=-0.78，95% CI：-1.27~-0.29）， depression （SMD=-0.45，95% CI：-0.73~-0.17） and anxiety symptom （SMD=-0.38，95% CI：-0.59~-0.18） with statistically significant differences. However， the difference of scores for somatization symptom between two groups was not significant （SMD=-0.01，95% CI：-0.26~0.25）. ConclusionCBT may contribute to improving the symptoms of grief， depression and anxiety in PGD patients but unsatisfactory efficacy on somatization symptom.

Effects of group cognitive behavioral therapy on clinical efficacy and executive function in patients with generalized anxiety disorder / 四川精神卫生

BackgroundPrevious studies have found that patients with generalized anxiety disorder （GAD） have impaired performance in executive function， and group cognitive behavioral therapy （CBT） has been shown to be effective in alleviating negative affect in patients with GAD， while its efficacy on executive function remains unclear. ObjectiveTo explore the efficacy of group CBT on anxiety symptom and executive function in GAD patients， so as to provide references for the rehabilitation program for GAD. MethodsA total of 80 consecutive patients with GAD who were hospitalized in Sleep and Psychosomatic Medical Center of Shiyan Taihe Hospital from March 2021 to August 2022 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for GAD were enrolled， and they were assigned into study group （n=40） and control group （n=40） using random number table methods. All patients were subjected to routine medication treatment and regular health education， based on this， study group received group CBT once a week （6 weeks， 60 to 90 minutes per session）. At the enrollment and after 6 weeks of treatment， patients were assessed using Hamilton Anxiety Scale （HAMA） and Frontal Assessment Battery （FAB）. ResultsANOVA with repeated measures on HAMA score revealed a significant time effect （F=1 870.320， P<0.01）， no significant group effect and no significant time×group interaction effect （F=1.254， 0.293， P>0.05）. Significant time effect， group effect and time×group interaction effect were reported on FAB scores （F=311.190， 4.399， 7.021， P<0.05 or 0.01）. Further analysis indicated that FAB scores of both groups after treatment were higher than those at baseline （t=200.569， 115.401， P<0.01）.And the FAB score of study group was higher than that of control group after treatment （t=-3.211， P<0.01）. ConclusionGroup CBT combined with medication treatment for GAD may alleviate the anxiety symptoms and improve executive function in GAD patients. ［Funded by Shiyan Science and Technology Bureau Pilot Scientific Research Project （number， 21Y21）］

Application of digital delivery of cognitive behavioral therapy for insomnia in patients with generalized anxiety disorder / 中国现代医生

Objective To explore the effect of digital delivery of cognitive behavioral therapy for insomnia(dCBT-I)based on internet technology on anxiety and sleep quality in patients with generalized anxiety disorder(GAD).Methods A total of 82 GAD patients treated in Huzhou Third Municipal Hospital from April to October 2023 were selected as study objects,and were divided into intervention group and control group according to random number table method,with 41 cases in each group.The intervention group received dCBT-I based on internet technology,and the control group received offline cognitive behavioral therapy for insomnia.The anxiety and sleep quality of two groups were compared.Results After the intervention,the scores of Hamilton anxiety scale and Pittsburgh sleep quality index in intervention group were significantly lower than those in control group,and the score of dysfunctional beliefs and attitudes about sleep was significantly higher than those in control group(P<0.05).Conclusion dCBT-I based on internet technology can effectively relieve the anxiety of GAD patients and improve the quality of sleep.

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.

Effectiveness of online group cognitive behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study

Objective: To evaluate the effectiveness of online group cognitive behavioral therapy (CBT) based on the CAMALEO TOC manual in the treatment of adolescents with obsessive-compulsive disorder (OCD). Methods: This is a quasi-experimental study with a single-group pretest-posttest intervention. Over a 12-week period, 11 adolescents aged 11 to 17 years with OCD participated in weekly online group CBT sessions based on the CAMALEO TOC manual. We used several assessment tools, including the Children's Yale-Brown Obsessive-Compulsive Scale to assess the severity of OCD symptoms, the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated to measure family accommodation, the Children's Depression Inventory to assess depression symptoms, the Revised Children's Manifest Anxiety Scale to assess anxiety, and the Multidimensional Students' Life Satisfaction Scale to measure satisfaction with life. Results: OCD symptoms decreased significantly (d = -1.55) after online group CBT, and a strong effect size (d = -1.03) was found for family accommodation. After controlling for variables (e.g., engagement in psychotherapeutic treatment, medication use, or psychiatric comorbidities), no significant differences were found for OCD symptoms and family accommodation scores. In addition, there was insufficient evidence to support the effectiveness of online group CBT in reducing symptoms of depression or anxiety or improving overall quality of life. Conclusion: Our study demonstrates the feasibility of short-term online group CBT as an effective therapeutic approach for adolescents with OCD.

Additional cognitive behavior therapy for persistent postural-perceptual dizziness: a meta-analysis

Abstract Objective To investigate whether additional Cognitive Behavior Therapy (CBT) combined with conventional therapy improves outcomes for patients with Persistent Postural-Perceptual Dizziness (PPPD) compared with conventional therapy alone. Methods Two reviewers independently searched PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant Randomized Controlled Trials (RCTs) examining CBT for PPPD which were conducted and published in English from January 2002 to November 2022. RCTs reporting any indicators for assessing corresponding symptoms of PPPD were included, such as Dizziness Handicap Inventory (DHI), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Two independent reviewers conducted extraction of relevant information and evaluation of risk of bias. The Cochrane Collaboration risk of bias tool version 1.0 was used to evaluate risks and assess the quality of the included studies, and Cochrane Review Manager 5.3 software (RevMan 5.3) was used to perform meta-analyses. Results The results of six RCTs indicated that combining additional CBT with conventional therapy significantly improved outcomes for PPPD patients compared with conventional therapy alone, especially in DHI-Total scores (Mean Difference [MD = −8.17], 95% Confidence Interval [95% CI: −10.26, −6.09], p< 0.00001), HAMA scores (MD = −2.76, 95% CI: [−3.57, −1.94], p< 0.00001), GAD-7 scores (MD = −2.50, 95% CI [−3.29, −1.70], p< 0.00001), and PHQ-9 scores (MD = −2.29, 95% CI [−3.04, −1.55], p< 0.00001). Subgroup analysis revealed a significant benefit of additional CBT compared with conventional therapies alone, including Vestibular Rehabilitation Therapy (VRT) (MD = −8.70, 95% CI: [−12.17, −5.22], p< 0.00001), Selective Serotonin Reuptake Inhibitor (SSRI) (with controlled SSRI: MD = −10.70, 95% CI: [−14.97, −6.43], p< 0.00001), and VRT combined with SSRI (MD = −6.08, 95% CI [−9.49, −2.67], p= 0.0005) in DHI-Total scores. Conclusion Additional CBT combined with conventional therapy may provide additional improvement for patients with PPPD compared with conventional therapy alone. However, more RCTs are needed to support and guide the application of CBT in treating PPPD. Level of evidence: I; Systematic review of RCTs.

Can cognitive behavioral therapy improve vasomotor symptoms and recurrent depression in postmenopausal women?

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in the treatment of vasomotor, sexual dysfunction, and recurrent depression in postmenopausal women. METHODS: This prospective, open study evaluated 112 postmenopausal women with vasomotor symptoms. Sexual dysfunction has cultural, social, biological, and emotional issues and divided into two groups: G1, without depression (n=65) and G2, with recurrent depression (n=47). The subjects underwent 12 sessions of in-person cognitive behavioral therapy and 12 sessions of home-based activity over a period of 6 months. They were evaluated at 3 months following the completion of therapy. Depression, memory, and attention-related functions, as well as climactic symptoms, were assessed using a questionnaire. RESULTS: In the depression questionnaire, the G1 group had a lower initial score than the G2 group (p<0.01). Following 6 months of therapy, both groups had similar improved scores. In the depression questionnaire, the women in group G1 had higher baseline values. In the assessment of vasomotor symptoms, the values in both groups were similar and showed an improvement in vasomotor symptoms after 24 weeks of treatment, but these effects disappeared after the follow-up of 48 weeks in the G2 group. Both groups improved the sexual dysfunction after 24 weeks. CONCLUSION: Cognitive behavioral therapy may be effective in reducing vasomotor symptoms and ameliorate the sexual dysfunction and recurrent depression in postmenopausal women after 24 weeks of treatment.

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.

Awareness, Beliefs and Practice of Cognitive Behavioral Therapy (CBT) Strategies for Chronic Pain Management Among Physiotherapists

Purpose: To evaluate the awareness, practice and beliefs about CBT strategies for chronic pain management among Physiotherapists. Relevance: Chronic pain can be defined as pain that persists for 3 months or longer and, while not necessarily maladaptive, often leads to physical decline, limited functional ability and emotional distress. CBT has been increasingly used as an effective tool by psychologists in the management of chronic pain that is delivered through individual or group counselling sessions. Cognitive restructuring, relaxation techniques, activity pacing and good sleep hygiene are a few strategies of cognitive behavioral pain management therapies. There is also increasing evidence that supports the use of CBT strategies by Physiotherapists during their treatment for obtaining a positive outcome for chronic pain patients. Method and Analysis: A Google Form was formulated with relevant questions about awareness, practice and beliefs about CBT strategies for chronic pain. The questionnaire was face validated by 3 independent psychologists who practice CBT for chronic pain in their regular practice. This form was then distributed through various Physiotherapy groups in Bangalore via snowball sampling method. The data obtained from the responses were then complied, decoded and quantitatively analysed through content analysis using the SPSS-22.Result: The result showed strikingly contrasting responses from the Physiotherapists, as even though the majority of them were aware of CBT (34.1%), they applied it relatively less (15.3%). Of 63.5% Physiotherapists believed that pain perception is affected by automatic thoughts, while 52.9% agreed that negative thoughts need to be changed into positive coping thoughts. Around 49.4% of Physiotherapists believe in teaching relaxation techniques to their patients with chronic pain. Activity pacing and good sleep hygiene are important, as believed by 25.9% and 47.1% respectively. Physiotherapists (56.5%) accepted that patient needs to be mindful while exercising. Conclusion Majority of Physiotherapists are aware and have positive beliefs about CBT strategies for chronic pain management. However, comparatively, we can see variations in the application of CBT strategies in their treatment plan.

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.

Percepções de pacientes sobre a Terapia Cognitivo Comportamental em Grupo para a obesidade / Patients' perceptions on group cognitive behavioral therapy for obesity

Resumo. Objetivo. Analisar os feedback de indivíduos com diagnóstico de obesidade que realizaram 8 sessões de Terapia Cognitivo Comportamental em Grupo (TCCG). Método. Participaram 13 pacientes com diagnóstico prévio de obesidade. O instrumento foi uma entrevista conduzida no último encontro da TCCG e, posteriormente, foi realizada a análise de conteúdo de Bardin. Resultados. Foram organizadas quatro categorias: benefícios da participação da intervenção, emagrecimento e autoestima, melhora na qualidade da alimentação, melhora na saúde física e qualidade de vida. Além do emagrecimento, houve uma melhora na qualidade da alimentação, perda de peso, bem-estar e autoestima e, consequentemente, na qualidade de vida. Além de sua aplicação no tratamento da obesidade, a TCCG pode ser uma abordagem promissora no tratamento de outros transtornos.

Abstract. Objective. The aim of this study was to analyze the feedback of individuals with obesity diagnosis after 8 Group Cognitive-Behavioral Therapy (GCBT) sessions. Method. 13 patients with previous obesity diagnosis participated. The instrument was an interview conducted at the last meeting of the GCBT; subsequently, a Bardin's content analysis was carried out. Results. The obtained data was organized into four categories: benefits of participation in the intervention; weight loss and self-esteem; improvement in nutrition quality; and improvement in physical health and life quality. Beyond weight loss, there was an improvement in the quality of nutrition, weight loss, well-being, self-esteem, and, consequently, in the quality of life. Aside from its application in obesity treatment, GCBT can be a promising approach in the treatment of other disorders.