TMS in combination with a pain directed intervention for the treatment of fibromyalgia - A randomized, double-blind, sham-controlled trial.

BACKGROUND: Fibromyalgia Syndrome (FMS) is a highly prevalent condition, that causes chronic pain and severe reduction in quality of life and productivity, as well as social isolation. Despite the significant morbidity and economic burden of FMS, current treatments are scarce. OBJECTIVE: To investigate whether stimulation of ACC -mPFC activity by dTMS enhances a pain-directed psychotherapeutic intervention. METHODS: 19 FMS patients were randomised to receive either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. With the H7 HAC coil or sham stimulation, we targeted the ACC -mPFC; specific brain areas that play a central role in pain processing. Clinical response to treatment was assessed with the McGill Pain Questionnaire Short Form (SF-MPQ), the Visual Analogue Fibromyalgia Impact Questionnaire, the Brief Pain Inventory questionnaire, and the Hamilton Depression Rating Scale. RESULTS: DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the combined sensory and affective pain dimensions was specifically demonstrated in the dTMS cohort, as measured by the SF-MPQ (Significant group × time interaction [F(2, 32) = 3.51, p < .05,ηp2 = 0.18]; No significant changes were found in depressive symptoms in both the dTMS and sham groups. CONCLUSION: Our results suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not dTMS alone, but rather dTMS-induced plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.

The effectiveness of post-disaster psychotherapeutic interventions: A systematic review and meta-analysis study.

OBJECTIVE: This study aimed to determine the level of impact of post-disaster psychotherapeutic interventions. MATERIAL METHOD: For this systematic review and meta-analysis study, the studies were accessed through the databases of PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center in July-September 2022 without any year limitation. As a result of the examinations, 27 studies were included in the study. The data were synthesized by meta-analysis and narrative methods. RESULTS: According to the results of this systematic review and meta-analysis, post-disaster psychotherapeutic interventions were found to be effective (SMD:-0838, %95 CI: -1,087- 0.588; Z = -6588, p = 0.000, I2 = %95,249). Individuals who have undergone psychotherapeutic interventions experience either no or fewer post-traumatic stress disorder symptoms. The country/continent of the research, the types of psychotherapeutic interventions, the type of disaster, and the measurement tool used influence the effectiveness of the psychotherapeutic interventions. Psychotherapeutic interventions applied especially after earthquakes, one of the types of disasters, were found to be effective. In addition, EMDR, cognitive behavioral therapy, psychotherapy, and exposure method were found to reduce posttraumatic stress disorder symptoms in individuals in the post-disaster period. CONCLUSION: Post-disaster psychotherapeutic interventions have positive impacts on people and improve their mental health.

Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial.

BACKGROUND: The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants. METHODS: A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox's proportional hazard regressions were used to estimate hazard ratios (HRs) for survival. RESULTS: The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41-1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53-1.11). CONCLUSIONS: We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.

Efectividad de una intervención psicoterapéutica grupal en la mejora del bienestar de personas cuidadoras de un familiar con enfermedad de Alzheimer: estudio CuiDem / Effectiveness of a psychotherapeutic intervention group program in the improvement of caregiver well-being in Alzheimer’s disease patients’ family caregivers: the CuiDem study

Introducción: Las personas cuidadoras de familiares con enfermedad de Alzheimer presentan agotamiento físico y emocional, que puede abordarse con intervención no farmacológica. Objetivo: Evaluar la efectividad de una intervención psicoterapéutica grupal cognitivo-conductual para mejorar la percepción de bienestar de personas cuidadoras, respecto a una intervención de acompañamiento, y su sostenibilidad tras un período de seguimiento activo de un año postintervención. Sujetos y métodos: Estudio multicéntrico, cuasi experimental, abierto y con grupo control. Se asignó de forma no aleatorizada a 221 personas cuidadoras de familiares con enfermedad de Alzheimer, con demencia leve a moderada-grave, a tres condiciones de intervención: grupo de intervención psicoterapéutica sin seguimiento activo (GI) (n = 80); grupo de intervención psicoterapéutica con seguimiento activo (GIS) (n = 78); y grupo control de acompañamiento con seguimiento activo (GC) (n = 63). La intervención psicoterapéutica grupal (GI y GIS) es un programa estructurado, cognitivo-conductual, de una sesión semanal durante cuatro meses. La del GC tenía la misma duración. Se evaluaron preintervención, postintervención y, al año, sobrecarga percibida, estado de ánimo, resiliencia, apoyo social funcional y calidad de vida. Resultados: Se observó una mejora significativa postintervención en el GI y el GIS respecto al GC en percepción de sobrecarga (p = 0,0216). Al año de seguimiento, se observaron mejoras significativas en el GIS respecto al GI en estado de ánimo (p = 0,0271), resiliencia (p = 0,0018), apoyo social percibido (p = 0,014), calidad de vida (p = 0,0001) y salud mental (p = 0,0002); y en el GC frente al GI en estado de ánimo y apoyo social (p < 0,05). Conclusiones: Los resultados respaldan la efectividad de esta intervención psicoterapéutica para mejorar la percepción de bienestar (sobrecarga) y el seguimiento de apoyo para incrementar su eficacia.(AU)

Introduction: Caregivers of patients with Alzheimer’s Disease experience physical and emotional burnout that can be treated with non-pharmacological interventions. Aim: Assess the efficacy of a group cognitive behavioural psychotherapeutic intervention, for improving well-being perception in caregivers, compared to a support group. Also, we assessed its efficacy after a follow-up period of 1-year post-intervention. Subjects and methods: A multicentre, open, quasi experimental study with control group was conducted. 221 caregivers of patients with Alzheimer’s Disease, with mild to moderate-severe dementia, were non-randomly assigned to either IG-intervention group: psychotherapeutic program without active follow-up period (n = 80); IGF-intervention group: psychotherapeutic program with active follow-up period (n = 78); or CG-control group: support program with active follow-up period (n = 63). The psychotherapeutic intervention (IG and IGF) is a structured cognitive behavioural group program, of one weekly session over four months. The CG had the same duration. Caregiver’s burden, mood disorders, resilience, perceived functional social support and quality of life were measured at baseline, post-intervention and after 1-year follow-up. Results: At post-intervention, statistically significant improvements were observed in the IG and IGF compared to CG in caregiver burden (p = 0,0216). After one year follow-up, significant improvements were found in IGF compared to IG in emotional state (p = 0,0271), resilience (p = 0,0018), perceived social support (p = 0,014); quality of life (p = 0,0001) and mental health (p = 0,0002); and in CG versus GI in emotional state and social support (p < 0,05). Conclusions: These results support the efficacy of this psychotherapeutic intervention for improving well-being (burden), and the supportive follow-up period for increasing its efficacy.(AU)

Comparability of Patients in Trials of eHealth and Face-to-Face Psychotherapeutic Interventions for Depression: Meta-synthesis.

BACKGROUND: Depressive disorders (DDs) are a public health problem. Face-to-face psychotherapeutic interventions are a first-line option for their treatment in adults. There is a growing interest in eHealth interventions to maximize accessibility for effective treatments. Thus, the number of randomized controlled trials (RCTs) of eHealth psychotherapeutic interventions has increased, and these interventions are being offered to patients. However, it is unknown whether patients with DDs differ in internet-based and face-to-face intervention trials. This information is essential to gain knowledge about eHealth trials' external validity. OBJECTIVE: We aimed to compare the baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions with a cognitive component. METHODS: In this meta-epidemiological study, we searched 5 databases between 1990 and November 2017 (MEDLINE, Embase, PsycINFO, Google Scholar, and the database of Cuijpers et al). We included RCTs of psychotherapeutic interventions with a cognitive component (eg, cognitive therapy, cognitive behavioral therapy [CBT], or interpersonal therapy) delivered face-to-face or via the internet to adults with DDs. Each included study had a matching study for predefined criteria to allow a valid comparison of characteristics and was classified as a face-to-face (CBT) or eHealth (internet CBT) intervention trial. Two authors selected the studies, extracted data, and resolved disagreements by discussion. We tested whether predefined baseline characteristics differed in face-to-face and internet-based trials using a mixed-effects model and testing for differences with z tests (statistical significance set at .05). For continuous outcomes, we also estimated the difference in means between subgroups with 95% CI. RESULTS: We included 58 RCTs (29 matching pairs) with 3846 participants (female: n=2803, 72.9%) and mean ages ranging from 20-74 years. White participants were the most frequent (from 63.6% to 100%). Other socioeconomic characteristics were poorly described. The participants presented DDs of different severity measured with heterogeneous instruments. Internet CBT trials had a longer depression duration at baseline (7.19 years higher, CI 95% 2.53-11.84; 10.0 vs 2.8 years; P=.002), but the proportion of patients with previous depression treatment was lower (24.8% vs 42%; P=.04). Subgroup analyses found no evidence of differences for the remaining baseline characteristics: age, gender, education, living area, depression severity, history of depression, actual antidepressant medication, actual physical comorbidity, actual mental comorbidity, study dropout, quality of life, having children, family status, and employment. We could not compare proficiency with computers due to the insufficient number of studies. CONCLUSIONS: The baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions are generally similar. However, patients in eHealth trials had a longer duration of depression, and a lower proportion had received previous depression treatment, which might indicate that eHealth trials attract patients who postpone earlier treatment attempts. TRIAL REGISTRATION: PROSPERO CRD42019085880; https://tinyurl.com/4xufwcyr.

Investigating the needs and concerns of older adults with multimorbidity and their healthcare professionals for conceivable digital psychotherapeutic interventions.

Multimorbidity, defined as the concurrent experience of more than one chronic health condition in an individual, affects ∼65% of people over 65 and 85% of those over 85 years old with 30% of those also experiencing mental health concerns. This can lead to reduced quality of life and functioning as well as poorer outcomes in terms of condition management, adherence to treatment, and ultimately disease prognosis and progression. Digital health interventions offer a viable means of condition self-management, as well as psychological support, particularly for those who may have difficulty accessing in-person services. To best meet the needs of older adults with multimorbidity, deeper insights are needed into their specific concerns and issues around condition management, particularly with regard to distress in relation to managing one's condition. The present study aimed to explore this using one-to-one qualitative interviews and focus groups with people with chronic health conditions and healthcare professionals. Participants were 11 older adults with multimorbidity (4 males; mean age: M = 72.7 years) and 14 healthcare professionals including five clinical nurse specialists, four pharmacists, two general practitioners, one occupational therapist, one speech and language therapist and one dietician. Thematic analysis was used to identify key themes, which included: patient feelings of anxiety or worry leading to an unwillingness to access essential information; the various mental health challenges faced by those with multimorbidity; the importance of personal values in providing motivation; and the importance of social support. Findings are discussed in relation to the potential development of transdiagnostically applicable digital interventions for the management of distress in those with multimorbidity.

Psychologic Impacts on Diabetic Neuropathic Pain.

PURPOSE OF REVIEW: Many Americans cope with painful diabetic neuropathy (DN) as a sequela of high rates of diabetes mellitus in the US population. Appropriate management of this complex, debilitating chronic pain condition requires thorough evaluation through a biopsychosocial framework. This review aims to synthesize findings from original research studies and analyze the psychological factors that influence the experience of, and treatments for, DN pain. RECENT FINDINGS: Existing clinical literature suggests a wide breadth of psychological factors impacting DN pain. One research study detailed the demographic characteristics of DN patients most likely to have significant anxiety or depressive symptoms, and have emotional distress adversely impacting their response to therapies. A retrospective study demonstrated a correlation between patients' mindfulness-based stress reduction and improvement in DN pain severity. In addtion, a small-scale, randomized controlled pilot study supported cognitive-behavioral therapy as a superior intervention to conventional medical treatments in reducing DN patients' pain severity and pain interference, even when not accompanied by significant improvement in depressive symptoms. This review of investigations into psychological factors implicated in DN pain suggests that diagnosable mental health conditions as well as discrete, adverse thinking processes both exert significant influences on DN pain. This review further brings attention to the beneficial impact that psychotherapeutic modalities can have on DN pain.

Effectiveness of digital psychotherapeutic intervention among perinatal women: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The perinatal period is a challenging time of substantial emotional, physiological, social, and relational changes. Depression, anxiety, and stress symptoms are common, and co-exist in the perinatal period. Digital technology continues to grow at an unprecedented pace with wide application, including psychotherapeutic intervention. A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations, but relatively few meta- and meta-regression analyses have concentrated on perinatal women. AIM: To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features. METHODS: Randomized controlled trials (RCTs) were obtained from eight databases, including Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, PsycINFO, PubMed, Web of Science, and ProQuest Dissertation and Theses from inception up until November 24, 2020. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The Cochrane risk-of-bias tool and the Grading of the Recommendation, Assessment, Development, and Evaluation system were adopted to assess the individual and overall qualities of the evidence, respectively. RESULTS: A total of 25 RCTs that included 3239 women were identified. Meta-analyses revealed that intervention significantly improved depression (Hedges's g = 0.49), anxiety (g = 0.25), and stress (g = 0.47) symptoms compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms. Egger's regression asymmetry tests suggested that no publication biases occurred, but the overall quality of the evidence was very low. CONCLUSION: This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women. Further high-quality RCTs with large sample sizes are needed.

Effectiveness of a Brief Psychotherapeutic Intervention for Employees With Psychosomatic and Psychosocial Complaints-Pilot Study of a Consultation Off the Workplace.

Employees' mental health impairments are a leading reason for sickness-leave and early retirement. This is why a large number of different intervention programmes have evolved in recent years with the aim of counteracting this development. Our study evaluates a short-term cognitive-behavioral psychotherapeutic intervention off the workplace. We investigated improvement of mental and physical health in psychologically strained employees of a white collar company. Depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), somatic symptoms (PHQ-15), and perceived stress (PSQ-20) were assessed at the beginning and after the intervention. Patient satisfaction (recommendation - likeliness) was also measured after the intervention. In a second step, we have looked at potential determinants of therapy outcome. Changes in the symptom measures were assessed using t-tests, MANOVA, and Chi²-tests. Cohen's d was computed as effect size measure. One-hundred twenty-seven participants completed the assessment before, and 66 participants post intervention. Mean age of the participants was 44.6 (SD = 9.8) years, 54% were men. 89.7% of the patients attended one to five sessions. Depressive, anxiety, somatic symptoms, and perceived stress significantly declined from baseline to end of intervention. Effect sizes ranged from d = 0.49 (perceived stress) to d = 0.72 (depressive symptoms). Moreover, 93% of the patients stated that they were satisfied with the intervention and would recommend it to a friend. Previous uptake of psychiatric/psychotherapeutic treatment moderated the effect of the intervention on depressive symptoms, i.e., patients without previous experience showed a stronger reduction in symptoms of depression. The results tentatively suggest that the intervention is effective in reducing a broad range of psychological symptoms. Future research could investigate preferences and different outcomes of on-site and off-site work place interventions.

Featured Counter-Trafficking Program: ARPAN.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes a long-term psychotherapeutic intervention started by Arpan in 2010, in an institution named Advait Foundation. Advait runs a rehabilitation home, Project Baharati, in Vasai, Mumbai, India. Project Bharati serves adolescent females who have experienced commercial sexual exploitation and sexual abuse. The psychotherapeutic intervention uses group and individual therapy, employing trauma-focused cognitive behavioral and arts-based therapeutic techniques.

No palco da psicoterapia: um adolescente, seu drama e o Psicodrama / On the stage of psychotherapy: a teenager, his drama and Psychodrama / En el escenario de la psicoterapia: un adolescente, su drama y el Psicodrama

Este artigo tem o objetivo de evidenciar as possibilidades do psicodrama bipessoal diante do drama de um adolescente, demonstrando sua evolução. A metodologia utilizada foi a pesquisa qualitativa nas modalidades pesquisa-ação e estudo de caso. O manuscrito expõe técnicas como psicodrama em cena aberta, concretização, jogo de papéis, átomo social e psicograma, além da atividade "autor e protagonista da própria história", a qual concretizou as conquistas do paciente. Este trabalho conclui que o psicodrama bipessoal possui um vasto arsenal de técnicas, por meio das quais um adolescente passou a se reconhecer como autor e protagonista de sua história, e que o psicodramatista pode validar "seu psicodrama", ancorado por sua teoria.

This article aims to highlight the possibilities of bipersonal psychodrama before the drama of a teenager, demonstrating his evolution. The methodology used was the qualitative research, in the action-research and case study modalities. The manuscript exposes techniques such as psychodrama in the open scene, concretization, role play, social atom and psychogram, in addition to the "author and protagonist of his own story" activity, which materialized the patient’s achievements. This paper concludes that bipersonal psychodrama has a vast arsenal of techniques, through which a teenager has come to recognize himself as the author and protagonist of his story, and the psychodramatist can validate "his psychodrama", anchored by its theory.

Este artículo pretende destacar las posibilidades del psicodrama bipersonal ante el drama de un adolescente, reflejando su evolución. La metodología utilizada fue la investigación cualitativa, en las modalidades de investigación-acción y estudio de caso. El manuscrito detalla las técnicas como el psicodrama con escena abierta, la concretización, la interpretación de roles, el átomo social y el psicograma, además de la actividad "autor y protagonista de su própria historia", que materializó los logros del paciente. Este artículo concluye que el psicodrama bipersonal presenta un amplio arsenal de técnicas, por las que un adolescente se reconoce a sí mismo como autor y protagonista de su historia, y que el psicodramatista puede validar "su psicodrama", anclado por su teoría.

Effects of a brief psychotherapeutic intervention on resilience and behavior in patients with drug-resistant mesial temporal lobe epilepsy and late seizure recurrence after surgery.

Seizure recurrence (SR) after epilepsy surgery in patients with medically resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) can compromise medical treatment and quality of life (QOL). However, there is a scarcity of interventions specifically addressing this issue in the literature. We aimed to evaluate the impact of a four-week psychotherapeutic intervention on the levels of resilience, behavioral symptoms, and QOL of patients with drug-resistant TLE-MTS who underwent corticoamygdalohippocampectomy (CAH) and who presented with late SR. Fifty patients who had been diagnosed with TLE-TMS, undergone CAH, and presented with late SR were included. The study instruments included a clinical and sociodemographic questionnaire and the Brazilian versions of the Connor-Davidson Resilience Scale (CD-RISC-10), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Interictal Dysphoric Disorder Inventory (IDDI), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Significant reductions in the IDDI (p < 0.001) and NDDI-E (p < 0.001) scores, improvements in the CD-RISC-10 (p < 0.001) and QOLIE-31 (p < 0.001) scores, and positive correlations between resilience levels and QOL (p < 0.01), as well as a negative correlation between depressive symptoms and resilience (p < 0.01) and QOL (p < 0.01), were observed after the psychotherapeutic intervention. Improvements in the resilience levels and QOL, with concomitant reductions in depressive symptoms, were observed in patients with TLE-MTS and late SR after a brief psychotherapeutic intervention. Since there is a lack of studies that measured the impact of interventions in this patient subpopulation, these results may support the development of treatment strategies for this specific group.

Psychodynamic Psychiatry for Patients with Cancer: Survivorship.

The psychodynamic treatment approach for patients newly diagnosed with cancer provides a uniquely effective model for understanding the onset of psychiatric symptoms and planning a psychotherapeutic intervention. The words "you have cancer" often disrupt the patient's usual customary defenses and can result in the onset of psychiatric symptoms. The psychiatric symptoms will depend on the patient's usual defenses, past history, and characteristic style of relating to others. Multiple case examples of the cancer patient's journey from diagnosis to survivorship will be offered in this article to demonstrate the value of including a psychodynamic point of view in any treatment of cancer patients. This article will concern itself with patients who achieve survivorship.

Introducing system of psychotherapeutic interventions for family caregivers of patients with endogenous mental disorders.

OBJECTIVE: Introduction: Providing care for patients with endogenous mental disorders is associated with significant psychosocial burden. The aim of this study was to introduce a system of psychotherapeutic interventions for family caregivers of patients with paranoid schizophrenia and bipolar disorder based on understanding their prevalent coping behavior patterns and communicative coping resources evaluation. PATIENTS AND METHODS: Materials and methods: A total of 273 family caregivers of patients with paranoid schizophrenia and bipolar disorder were involved into this survey under informed consent conditions. Control group included 55 mentally healthy respondents, in whose families there is no mentally sick family member. Test for psychological diagnostics of coping mechanisms (E. Heim) and emotional empathy test (А. Mehrabian) were chosen as psychological testing research tools. Values of p <0.05 were considered significant. RESULTS: Results: The study revealed prevalence of certain maladaptive coping strategies and lack of communicative coping resources in family caregivers of patients with paranoid schizophrenia and bipolar disorder. These data might be among significant predictors of communicative dysfunctions in families where one of the family members has endogenous mental disorder, and must be considered while developing appropriate psychotherapeutic programs. CONCLUSION: Conclusions: On the basis of revealed data, we have introduced an integrative system of psychotherapeutic interventions, aimed to develop adaptive forms of coping behavior in family caregivers, increase their empathetic and affiliative resources, create favorable conditions for activation of personal resources and adaptive potential of both family caregivers and patients with paranoid schizophrenia and bipolar disorder.

Alleviation of Psychological Distress and the Improvement of Quality of Life in Patients With Amyotrophic Lateral Sclerosis: Adaptation of a Short-Term Psychotherapeutic Intervention.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that is inevitably fatal. To be diagnosed with a terminal illness such as ALS deeply affects one's personal existence and goes along with significant changes regarding the physical, emotional, and social domains of the patients' life. ALS patients have to face a rapidly debilitating physical decline which restrains mobility and impairs all activities of daily living. This progressive loss of autonomy may lead to a sense of hopelessness and loss of quality of life, which in turn may even result in thoughts about physician-assisted suicide. Here, we would like to propose a psychotherapeutic manualized, individual, semi-structured intervention to relieve distress and promote psychological well-being in ALS patients. This short-term intervention was originally developed for advanced cancer patients. "Managing Cancer and Living Meaningfully (CALM)" focuses on the four dimensions: (i) symptom management and communication with healthcare providers, (ii) changes in self and relations with close others, (iii) spirituality, sense of meaning and purpose and (iv) thinking of the future, hope, and mortality. We suggest to supplement the concept by two additional dimensions which take into account specific issues of ALS patients: (v) communication skills, and (vi) emotional expression and control. This therapeutic concept named "ManagIng Burden in ALS and Living Meaningfully (mi-BALM)" may be a further treatment option to help improving quality of life of ALS patients.

Blocking Avoidance and Escape Responses: Relations With Clinically Relevant Behaviors / Bloqueio de Respostas de Evitação e Fuga: Relações com os Comportamentos Clinicamente Relevantes / El bloqueo de Respuestas de Escape y Evitación: Relaciones con las Conductas Clínicamente Relevantes

Abstract: The current study aims to evaluate the possible effects of interrupting problematic clinically relevant behaviors on the percentage of these responses and of clinical improvement-related responses. Two clients were treated with Functional Analytic Psychotherapy (FAP), alternating two conditions (ABAB). On condition A, procedures to the therapist consisted of responding to the clinical improvement responses, and to description of outside of therapeutic setting behaviors, but therapists were advised to ignore problem behaviors emitted in session. During condition B, therapists followed the same procedures, but they were oriented to block (interrupt) problematic responses emitted in session. Results suggest increase in the percentage of problem behaviors during condition B. Results are discussed, highlighting the viability of planning the contingent response the therapist emits to clinically relevant behaviors.

Resumo: O presente estudo visa avaliar possíveis efeitos de procedimentos de interrupção de comportamentos clinicamente relevantes problemáticos nas porcentagens de sua emissão e nas de comportamentos de melhora durante a sessão. Duas clientes foram tratadas com a Psicoterapia Analítica Funcional (FAP), alternando duas condições (ABAB). Na condição A, os procedimentos consistiam em responder aos comportamentos de melhora na interação com o terapeuta e aos relatos sobre os comportamentos na vida diária, ignorando os comportamentos problemáticos no contexto da sessão. Na condição B, os procedimentos foram mantidos, mas os comportamentos problemáticos foram interrompidos em vez de ignorados. Os resultados sugerem aumento na porcentagem de comportamentos problemáticos na condição B. Os resultados são discutidos destacando a viabilidade do planejamento de responder do terapeuta contingentemente ao comportamento do cliente.

Resumen: El estudio tiene como objetivo evaluar los posibles efectos de la interrupción de las conductas clínicamente relevantes problematicas en los porcentajes de emisión y de conductas de mejora durante la sesión. Dos clientes fueron tratados con la Psicoterapia Analítica Funcional (FAP), alternando dos condiciones (ABAB). En la condición A del tratamiento, los procedimientos consistían en responder a las conductas de mejora en la interacción con el terapeuta y a los informes sobre las conductas en la vida diaria, haciendo caso omiso de los problemas de comportamiento en el contexto de la sesión. En la condición B, los procedimientos se mantuvieron, pero los problemas de conducta fueron interrumpidos en lugar de ignorados. Los resultados sugieren un aumento en el porcentaje de comportamientos problemáticos en la condición B. Los resultados son discutidos, destacando la viabilidad de la planificación del terapeuta de responder de forma contingente al comportamiento del cliente.

Capacidade de mentalização materna e prematuridade: repercussões de uma intervenção em UTIN / Maternal mentalizing capacity and prematurity: effects of na intervention in NICU / Capacidad de mentalización materna y prematuridad: efectos de una intervención en UCIN

As interações mãe-bebê e suas repercussões na construção do psiquismo são abordadas pela Teoria do Apego, destacando-se a capacidade de mentalização materna como determinante na formação de um apego seguro. Este estudo objetivou compreender como uma intervenção psicoterápica, realizada com duplas mãe-bebê prematuro, durante a internação em UTIN, repercute na capacidade de mentalização materna, mediante pesquisa qualitativa de intervenção, exploratória e descritiva, de estudo de casos múltiplos, com avaliações antes e após a intervenção. Participaram duas díades mãe-bebê prematuro, internado em UTIN. Utilizaram-se como instrumentos antes da intervenção ficha de dados sociodemográficos e clínicos, entrevista de história de vida da mãe; e, após, entrevista de história da internação. Analisaram-se os dados por meio de dois eixos temáticos: a) Representações maternas sobre si mesma; b) Representações maternas sobre o bebê. Verificaram-se mudanças na capacidade de mentalização materna, o que favoreceu o vínculo mãe-bebê e a possível aplicação de intervenções voltadas às relações iniciais mãe-bebê prematuro em UTIN.

Mother-infant interactions and their impact on the formation of the psyche are studied by the Attachment Theory, highlighting the maternal mentalizing capacity as a determinant in the formation of a secure attachment. This study aimed to understand how a psychotherapeutic intervention performed with mother-premature baby pairs during hospitalization in NICU affects the maternal mentalizing capacity through a qualitative intervention research, with exploratory and descriptive character, which surveyed multiple cases and assessments before and after the intervention. The research included two mother-premature neonate dyads hospitalized in NICU. Before the intervention, the instruments used were: Socio-Demographic and Clinical Data Sheets and Live History Interview with the mother; after, the instrument used was the Hospitalization History Interview. Data were analyzed according to two themes: a) maternal representations of herself; b) maternal representations of the baby. There were changes in maternal mentalizing capacity, favoring the mother-baby bond and a possible implementation of interventions aimed at the early relationship mother-premature baby in NICU.

Las interacciones madre-hijo y su impacto en la formación de la psique son estudiados por la teoría del apego, destacando la capacidad de mentalización materna como factor determinante en la formación de una unión segura. Este estudio tuvo como objetivo comprender cómo una intervención psicoterapéutica realizada con doble materno-infantil temprana durante el ingreso en la UCIN, afecta la capacidad de mentalización materna por la intervención investigación cualitativa, estudio exploratorio y descriptivo de casos múltiples, con las evaluaciones antes y después de la intervención. Se incluyeron dos díadas madre-hijo temprana ingresados en UCIN. Se utiliza como instrumentos antes de la intervención: Hoja socio-demográficas y clínicas de datos, Entrevista Historia de la Madre de la Vida; y después de: Entrevista Historia de internamiento. los datos se analizaron a través de dos temas: a) las representaciones maternas de la misma; b) las representaciones maternas del bebé. No hubo cambio en la capacidad de mentalización materna, lo que favorece el vínculo madre-bebé y la posible implementación de las intervenciones dirigidas a las primeras relaciones temprana madre-bebé en la UCIN.

Strategies to manage patients with dental anxiety and dental phobia: literature review.

Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, "tell-show-do", and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought.

Psychiatric morbidity among disabled clients of the rehabilitation sheltered workshop- Department of Social Welfare and Development (DSWD)

OBJECTIVES: The aim of this study is to assess the psychosocial needs of persons with disability of the Rehabilitation Sheltered Workshop (RSW) of the DSWD as well as screen for psychiatric illness.METHODOLOGY: There were 38 persons with various disabilities enrolled at the RSW. They were interviewed and screened using the Self Reporting Questionnaire (SRQ).RESULTS: About a third (34.21%) were married and 28.94% were single. Fifty percent were physically disabled i.e. amputees or with deformities of the extremities; 34.21% were blind the remaining 15.78% had a variety of disabilities e.g. deafness, facial deformity or speech impairment. The mean age was 45.5 years old. Based on the SRQ 38.64% of the visually disabled clients scored positive for mood/anxiety while 53.84% scored positive for psychosis; while 52.63% of the orthopedic clients scored positive for mood/anxiety and an even higher 73.68% scored positive for psychosis. For the other handicapped clients,33.33% scored positive for mood/anxiety and 50.00% scored positive for psychosis.CONCLUSION: Majority (63.16%) of the 38 clients at the RSW were psychotic and only 44.73% were found to have mood/ anxiety symptoms, thus the need for psychiatric follow up as well as initiation of psychopharmacological and psychotherapeutic interventions for these clients.

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks.

OBJECTIVE: The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. METHODS: This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receiving four to six sessions by a consultation liaison psychiatrist, the first and last sessions adding a neurological consultation and a joint psychiatric and neurological consultation, and (b) a standard care group. After intervention, patients were assessed at 2, 6 and 12 months with the Somatoform Dissociation Questionnaire (SDQ-20), Clinical Global Impression scale, Rankin scale, use of medical care, global mental health [Montgomery and Asberg Depression Rating Scale, Beck Depression Inventory, mental health component of Short Form (SF)-36] and quality of life (SF-36). We calculated linear mixed models. RESULTS: Our intervention brought a statistically significant improvement of physical symptoms [as measured by the SDQ-20 (P<.02) and the Clinical Global Impression scale (P=.02)] and psychological symptoms [better scores on the mental health component of the SF-36 (P<.05) and on the Beck Depression Inventory (P<.05)] and a reduction in new hospital stays after intervention (P<.05). CONCLUSION: A brief psychotherapeutic intervention taking advantage of a close collaboration with neurology consultants in the setting of consultation liaison psychiatry appears effective.