Effects of Caregiver-Focused Programs on Psychosocial Outcomes in Caregivers of Individuals with ASD: A Meta-analysis.

The current meta-analysis comprehensively reviewed group-design studies of interventions designed to improve ASD caregiver psychosocial outcomes and explored potential moderators of effectiveness. Forty-one unique studies targeting 1771 caregivers met inclusion criteria. Overall, the interventions had a small positive effect in improving psychosocial outcomes in caregivers of individuals with ASD (within-subjects: Hedges' g = .44; between-subjects: Hedges' g = .28). Most intervention approaches demonstrated some evidence of effectiveness. Acceptance and commitment therapy, mindfulness-based interventions, and cognitive behavioral treatments demonstrated the strongest impact in improving caregiver psychosocial outcomes in pre-post comparisons. Although the results provide preliminary support for the effectiveness of caregiver-focused interventions, more studies with larger sample sizes, rigorous research designs, and long-term follow-up assessments are needed.

Acceptance and Commitment Therapy in Cancer: Review of Applications and Findings.

This study aimed to analyze published studies regarding the usefulness of Acceptance and Commitment Therapy in the treatment of oncological patients. A systematic review of the literature was conducted using the Web of Science, Google Scholar and Dialnet (2000-2016). Nineteen articles fulfilled the inclusion criteria. Those patients who received interventions based on Acceptance and Commitment Therapy showed a better emotional state and quality of life and greater psychological flexibility. Acceptance and Commitment Therapy proved to be useful in the psychological treatment of oncological patients. However, the heterogeneity and limitations of the studies, principally with regard to sample characteristics, study design and manner in which mechanisms responsible for changes are evaluated, make further studies necessary with a view to ascertaining what patient and/or intervention characteristics might improve results. Randomized controlled trials comparing the efficacy of Acceptance and Commitment Therapy with no treatment, with treatment with placebo and with other efficacious therapies, including a study of medium- and long-term results, would be of particular interest.

The frequency and management of seizures during psychological treatment among patients with psychogenic nonepileptic seizures and epilepsy.

OBJECTIVE: Growing evidence suggests that psychological treatments are effective for improving outcomes in both epilepsy and psychogenic nonepileptic seizures (PNES). However, the risk of in-session seizures may cause concerns about safety and about seizures disrupting treatment. This study explores the risk of in-session seizures in patients with epilepsy and those with PNES, the timings of seizures during psychological therapy, and the responses of therapists to seizures. METHODS: Consecutive patients with epilepsy or PNES attending 2 neurology centers in the United Kingdom for psychological treatment to help with their seizure disorders were studied. Information about seizures during outpatient psychological therapy sessions was gathered using a 12-item pro forma. RESULTS: Ninety-seven patients with epilepsy and 195 with PNES were evaluated. One in 32 patients with epilepsy and 1 in 8 with PNES had at least 1 in-session seizure. A seizure occurred in 1 in 136 treatment sessions provided to patients with epilepsy, and 1 in 36 sessions provided to those with PNES. The risk of in-session seizures was significantly greater in patients with PNES than in patients with epilepsy (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.3-15.2). Seizures tended to occur in the first half of treatment programs and individual sessions and only disrupted sessions briefly. Only one patient with PNES required in-patient observation not involving overnight admission. SIGNIFICANCE: In-session seizures do occur and are much more common in patients with PNES than in those with epilepsy. Seizures rarely caused major disruption to psychological treatment, and could almost invariably be managed by the treating therapist without help from additional medical staff. Nonetheless, this research suggests that psychological therapy providers should anticipate the occurrence of in-session seizures and have safe management plans in place. The greater frequency of in-session seizures in PNES may add to our understanding of the mechanisms triggering these seizures.

New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT)

The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than attention placebo control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome (AU)

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Terapia de aceptación y compromiso en un caso de trastorno mixto de ansiedad y depresión en una paciente con cáncer / Acceptance and commitment therapy in a case of adjustment disorder with mixed anxiety and depressed mood in a patient with cancer

Se expone el caso de una paciente con diagnóstico de cáncer de mama quien había desarrollado un trastorno mixto de ansiedad y depresión con conductas de evitación. La paciente presentaba síntomas clínicos importantes relacionados con estados depresivos (anhedonia, insomnio, llanto, aislamiento, des- órdenes alimenticios, pensamientos de desesperanza y minusvalía), así como síntomas de ansiedad tales como activación fisiológica, sensación de intranquilidad y pensamientos catastróficos. Sumado a esto presentaba un patrón de evitación conductual hacia todos los estímulos que ella consideraba podían alterarla. Desde el enfoque de la terapia de aceptación y compromiso se propuso como objetivo terapéutico la aceptación de la enfermedad y del malestar emocional que ella estaba experimentando; también se planteó la recuperación de las esferas vitales, siguiendo como punto de partida sus propios valores. El tratamiento se llevó a cabo en 14 sesiones y se diseñó implementando las técnicas de la amTerapia de Aceptación y Compromiso dentro de las cuales se incluyeron la desesperanza creativa, la desactivación de las funciones verbales, la clarificación de valores y la pérdida de control sobre los eventos privados. En los resultados se observó un cambio positivo en las conductas de la paciente, así como una disminución del malestar emocional que constituía su motivo de consulta inicial

This paper introduces the case of a woman with breast cancer who had developed a mixed depressive-anxiety disorder with avoidance behaviors. The patient presented depressive symptoms like listlessness, insomnia, weeping, food disorders and hopelessness though. Also, she exhibited physiological arousal and restlessness feelings. Additionally, the patient had an avoidance patron behavior in relation with all stimulus she believed could hurt her. Based on the Acceptance and Commitment Therapy (ACT) the intervention planted the following objectives: the patient will learn to accept her illness and the emotional distress that she was experiencing, also, the patient will recover the other areas of her life that she had abandoned. The treatment was developed in 14 sessions. The therapist used these techniques: creative hopelessness, disabling verbal functions, values clarification and loss of control over private events. In the results, it was observed a positive change in the behavior of the patient as well as a decrease in emotional distress that was his reason for initial consultation

Terapia de aceptación y compromiso en el tratamiento del Trastorno Obsesivo-Compulsivo / Acceptance and commitment therapy in the treatment of Obsessive-Compulsive Disorder

El tratamiento psicológico de elección del Trastorno Obsesivo-Compulsivo (TOC) es la Exposición con Prevención de Respuesta (EPR). El objetivo de este trabajo es llevar a cabo un análisis funcional de los procedimientos de EPR y Terapia de Aceptación y Compromiso (ACT) en el tratamiento del TOC, y comparar la eficacia de ambas formas de terapia. Para ello, se realizó una revisión sistemática de la literatura disponible hasta el momento. Los resultados obtenidos indican que estas formas de intervención se basan en diferentes procesos de cambio, pudiendo constituir la ACT una buena alternativa para aquellas personas que no se beneficien de un tratamiento con EPR, además de para lograr una prevención de recaídas en el futuro (AU)

The psychological treatment of obsessive-compulsive disorder (OCD) is the exposure with response prevention (ERP). The aim of this work is to perform a functional analysis of the EPR and Acceptance and Commitment Therapy (ACT) procedures in the treatment of OCD, and to compare the efficacy of both forms of intervention. A systematic review of the literature was performed. The results indicate that these interventions are based on different processes of change; the ACT may be a good alternative for those who do not have access to treatment with EPR and in the relapse prevention (AU)