The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review.

BACKGROUND: Social Anxiety Disorder (SAD) or Social Phobia is characterized by fear and anxiety of social circumstances that negatively impact an individual's occupational and relational life. There are several treatment options for this disorder ranging from pharmacological therapy to psychotherapies. In particular, the Acceptance and Commitment Therapy (ACT), a form of cognitive-behavioral therapy that practices acceptance and awareness strategies with behavior change strategies in order to increase an individual's mental flexibility, has been found to be effective. In this review, we aimed to provide an overview of recent studies that examined ACT's efficacy in SAD, also taking into consideration the comparison with traditional Cognitive-behavioral Therapy (CBT) interventions. METHODS: A bibliographic search on PubMed, EMBASE and Scopus was conducted from inception to the 3rd of February 2022 of all studies investigating the effect of ACT in SAD individuals without any comorbidity. Among the articles retrieved, 11 met the inclusion criteria. RESULTS: From the reviewed studies, ACT may be considered a promising treatment of social phobia by improving attentional bias, awareness, emotion regulation, and safety/avoidance behaviors; however, the results have not yet demonstrated a valid alternative to the CBT. LIMITATIONS: Only four studies considered a follow-up evaluation, which is paramount to exploring the effectiveness of ACT and several studies have a very small sample size. Concerning the review itself we only considered original English articles and we did not measure the risk of publication bias and the risk of bias between studies. CONCLUSIONS: The results of this study suggest that ACT can be a promising treatment for improving selective psychological problems often observed in SAD. However, larger longitudinal studies further exploring the effectiveness of the behavioral and cognitive "third-wave" psychotherapies, based mainly on acceptance of SAD, are necessary.

Introspective Meditation before Seeking Pleasurable Activities as a Stress Reduction Tool among College Students: A Multi-Theory Model-Based Pilot Study.

In the realm of behavioral interventions, a combined approach of yoga and a cognitive-behavioral strategy in the form of introspective meditation (manan-dhyana) may offer benefits as a stress management tool. This pilot study focuses on introspective meditation performed before seeking pleasurable activities, which is a self-reflection about whether to pursue a goal that will bring sensory pleasure in life. A non-probability sample of college students was recruited from a mid-sized Southern University of the United States using a 52-items web-based survey built in Qualtrics. Univariate, bivariate, and multivariate statistics were used to analyze data. Of total 65 students, only 21.5% students reported being engaged in the introspective meditation. The sample constituted predominantly females (75.4%), White (64.6%), and undergraduate students (87.7%). The proportions of anxiety, depression, and moderate/high stress were 50.8%, 40.0%, 86.1% respectively. In the hierarchical regression for initiation, the final model explained nearly 21.1% of variance in initiating introspective meditation among participants (n = 51) who had not been practicing it. With each unit increment in subscales of initiation (i.e., changes in physical environment), the conditional mean for initiating introspective meditation behavior increased by 0.373 units. In the hierarchical regression for sustenance, the final model explained nearly 50.5% of variance in sustaining introspective meditation behavior among participants (n = 51) who had not been practicing it. With each unit increment in subscales of sustenance (i.e., emotional transformation), the conditional mean for sustaining introspective meditation behavior increased by 0.330 units. This study can pave a way for designing interventions for college students to promote introspective meditation directed toward seeking pleasurable activities before engaging in them. This has implications for the reduction of stress as well as a preemptive measure for sexual risk-taking, indulgence in maladaptive behaviors such as smoking, vaping, alcohol, and substance use.

Applying Psychological and Educational Health Models to Determine the Effect of a Pharmacist-led Cognitive and Behavioral Intervention on Tuberculosis Treatment Outcomes in Plateau State, Nigeria.

Background: The prolonged multi-drug treatment regimen for tuberculosis (TB) can lead to non-adherence and unsuccessful treatment outcomes. Educational and psychological health models can be used to design cognitive and behavioral interventions to improve adherence and treatment outcomes. Objective: To determine the effect of cognitive and behavioral interventions on TB treatment outcomes. Methods: The quasi-experimental study conducted in six TB treatment centers involved reinforced medication education and adherence counseling (MEAC), designed from a structured validated psychometric scale. Data were collected three different times during the intensive and continuation phases of treatment from 463 TB patients (232 in the control and 231 in the intervention group). Baseline demographic and clinical characteristics were compared between the groups. The generalized estimating equation model was used to analyze the repeated measures by determining if treatment success was associated with the cognitive and behavioral interventions and medication adherence. Results: The males made up 290(62.6 %) of the population. The mean age was 36.75±13.9. Most of the TB patients were newly diagnosed 413(89.2%) and HIV negative 315(68%), with secondary level of education 216(46.6%). There was no significant difference in baseline characteristics between the groups. The intervention group was four times more likely to have treatment success (p<0.01; CI=1.5-8.4), compared to the control group. Medication-adherent TB patients were 24 times more likely to have treatment success than patients who did not adhere (p<0.001; 10.8-52.1). TB patients' emotions, attitudes, and perceptions of their medicines were predictors of treatment success (p<0.05; 1.0 - 1.1). Conclusion: The cognitive and behavioral interventions administered to TB patients improved successful treatment outcomes.

CBT-Informed Interventions for Essential Workers During the COVID-19 Pandemic.

Essential workers during the COVID-19 pandemic face heightened levels of anxiety and depression due to increased work demands, lack of adequate personal protective equipment, fear of contracting the virus, and fear of spreading it to loved ones. This is a time of urgent need for mental health support for workers affected by the pandemic crisis. Clinicians may employ empirically supported interventions derived from cognitive behavioral therapy (CBT) and related therapies. Psychological First Aid, an evidence-based crisis intervention, may be utilized to emphasize basic needs and support, but is intended as an acute disaster intervention. Given that a pandemic is an ongoing and prolonged stressor, additional CBT-informed interventions are likely needed to fully support essential workers during these times. It is recommended that clinicians help essential worker clients meet their basic needs by modifying health and sleep habits where possible and helping them advocate for their needs using interpersonal effectiveness skills. Empathic listening, validation of the crisis at hand, and values clarification can aid the therapeutic relationship, help them feel a renewed sense of purpose and meaning in their careers and with their families, and facilitate behavior change consistent with chosen values. Self-monitoring through a daily diary can help clients focus their thoughts and recognize maladaptive patterns in their thoughts and behaviors. In tandem with these techniques, behavioral activation and coping strategies including relaxation, distress tolerance, and acceptance promote engaging in positive and adaptive activities. Finally, therapists can help clients reduce anxiety related to the pandemic by helping them limit information intake.

[Early recognition and prevention of schizophrenia and other psychoses]. / Früherkennung und Prävention von Schizophrenie und anderen Psychosen.

The last two decades of clinical research have clearly demonstrated the comprehensive benefits of the early recognition and treatment of psychotic disorders. The attenuated and transient positive symptoms according to the ultrahigh risk criteria and the basic symptom criterion "Cognitive disturbances" are the main approaches for an indicated prevention. They have recently been recommended as criteria for a clinical high-risk (CHR) state of psychosis by the European Psychiatric Association (EPA) and, following these, in the German S3 guidelines for the treatment of schizophrenia by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN); however, the efficacy of early treatment of patients with a CHR for psychoses critically depends on the development of prognostic instruments, which enable healthcare professionals to reliably identify these patients based on the individual objective risk profiles. An important goal is the treatment of functional deficits, which can be identified by an individual risk profile. The treatment of existing comorbid mental disorders, psychosocial problems and the prevention of potential future disorders also characterizes the recommendations of the EPA and DGPPN for early treatment, which favor psychotherapeutic, especially cognitive behavioral interventions over pharmacological treatment. The close interdisciplinary cross-sectoral cooperation between the disciplines of child and adolescent psychiatry, and adult psychiatry is of outstanding importance in this context.

Lowering Risk for Significant Behavior Problems Through Cognitive-Behavioral Intervention: Effects of the Tools for Getting Along Curriculum 2 Years Following Implementation.

To address the needs of students at risk for significant behavior problems, educators need efficient, effective, and feasible preventive classroom interventions that increase students' ability to regulate their own behavior. Tools for Getting Along is a universally delivered cognitive-behavioral curriculum designed to address early emotional and behavioral risk among fourth and fifth grade students within the general classroom setting. We used latent growth model statistical methodology to investigate the effects of Tools for Getting Along 2 years following treatment cessation on students who evidenced baseline risk relative to peers. We followed an average of 455 students across measure-specific baseline risk groups at pretest, posttest, 1-year post-treatment, and 2-years post-treatment. Growth models fit data for four (behavior regulation, metacognition, aggression, and behavioral adjustment) of the eight factors used to assess emotional and behavioral outcomes. Findings indicated a long-term positive treatment effect for students at baseline risk on behavior regulation and general behavioral adjustment. We discuss how findings related to long-term treatment benefits add to prior research on Tools for Getting Along and to the evaluation of preventive treatment effects on emotional and behavioral risk over time.

The Food Addiction Construct May Do More Harm Than Good: Weight Controllers Are Athletes, Not Addicts.

Food addiction has become a popular notion in the media and scientific community, with many proposing that an addiction to food causes obesity. An article published in this journal in December 2017 by Tompkins et al. asserted that food addiction poses a barrier to the treatment of adolescent obesity. This review questions some of the methods, results, and perspectives offered by Tompkins et al. It also considers the extant evidence overall about this construct. The data about food addiction provide minimal support for the discriminant validity of this conceptualization relative to depressed binge eating. We believe that the evidence suggests that the potential harm outweighs the benefits of encouraging researchers, clinicians, and especially obese people to view food addiction as a cause of obesity or a barrier to effective weight management. Ultimately, this review concludes that the construct of food addiction does not serve the interests of those striving to lose weight permanently (i.e., weight controllers) nearly as well as an alternative perspective: weight controllers are athletes, not food addicts.

Alleviation of Side Effects and Distress in Breast Cancer Patients by Cognitive-Behavioral Interventions: A Systematic Review and Meta-analysis.

Cognitive and behavioral interventions (CBI) have been used for breast cancer patients with various stages of the disease or undergoing different treatments. However, no quantitative review has summarized their efficacy on the side effects of treatment, distress, and quality of life in the acute treatment setting after diagnosis. This meta-analysis synthesizes data from 19 randomized clinical trials in order to: (a) provide an estimation of overall effect of CBI in breast cancer patients during treatment for breast cancer, i.e., neo-adjuvant and adjuvant treatment; (b) provide average effect sizes on side effects of treatment, distress, and quality of life; and (c) test possible moderators of effect size. The results show that CBI yielded a small effect size overall, specifically on general side effects of treatment, nausea, vomiting, distress, and quality of life. Individual and behavioral interventions seem to elicit better results on distress and on general side effects of treatment, respectively. While more studies are needed with regard to specific side effects (i.e., fatigue, pain, and sleep disturbance), the overall results clearly support the use of CBI in breast cancer patients during treatment.

Assistive technology to promote occupation and reduce mouthing by three boys with fragile X syndrome.

OBJECTIVES: To extend the use of assistive technology (AT) for promoting a new adaptive response and to reduce hand mouthing, by three boys with fragile X syndrome. To monitor the effects of the intervention program on the positive mood. To carry out a three month follow-up phases. To conduct a social validation assessment involving 30 parents of children who presented multiple disabilities as raters. METHODS: The study was implemented according to an ABAB experimental design, where A represented baseline phases (technology available but inactive) and B represented intervention phases (the technology ensured 7 s of positive stimulation). RESULTS: All participants improved and consolidated their performance. Parents involved in the social validation assessment rated positively the use of such technology. CONCLUSION: AT-based program was useful, affordable, and effective for enhancing constructive engagement, self-determination, and for improving quality of life by children with fragile X syndrome and severe to profound developmental disabilities.

Behavioral Modification for the Management of Obesity.

This article provides behavioral strategies for working with obese patients and families within a primary care context. A multifactorial model for the etiology of obesity from which to adopt treatment strategies is provided. Optimal views to set up effective patient encounters and specific recommendations to motivate and support patients are discussed. Multicomponent programs include a combination of nutritional, physical activity, and cognitive behavioral approaches to target overweight/obesity. The focus is on behavioral approaches and practical applications, such as motivational interviewing techniques.

System Level spatial-frequency EEG changes coincident with a 90-day cognitive-behavioral therapy program for couples in relationship distress.

Evaluating relationship intervention programs traditionally involves the use of self-report surveys or observational studies to assess changes in behavior. Instead, to investigate intervention-related changes in behavior, our study evaluates spatial-frequency electroencephalography (EEG) patterns from the brains of couples participating in an Imago Relationship workshop and 12 weeks of group counseling sessions lasting approximately 90 days. This explorative study recorded 32-channel EEGs from nine committed distressed couples prior to, during and immediately following the Imago Relationship Therapy program. A repeated measures t-Test approach was applied to investigate if significant group level brain pattern changes could be identified in key resting state networks in the brains of the participants that could be correlated with changes in relationship outcome. The study results show that significant reductions in EEG power in the alpha2, beta3 and gamma bands were evident in the averaged brain activity in the pre-frontal, frontal and temporal-parietal cortices that are anatomically associated with the frontal executive, default mode and salience networks of the human brain. Our current understanding of system level neural connectivity and network dynamics strongly indicates that each of these systems is integrally required in learning and implementing a complex communication process taught in the Imago intervention. Thus, a high degree of hemispheric lateralization is consistent with our understanding of language function and mood regulation in the brain and is consistent with recent research into the use of resting frontal EEG asymmetry as an indicator of behavioral changes in distressed couples undergoing a program for relationship improvement. Although preliminary, these results further indicate that the EEG is an inexpensive and easily quantifiable measure, and possibly predictor, of behavioral changes in response to a cognitive behavioral intervention.

Efeitos de um programa de intervenção cognitivo-comportamental para mães de crianças com paralisia cerebral / Effects of an cognitive-behavioral intervention program for mothers of children with cerebral palsy

Este artigo descreve um modelo de intervenção cognitivo-comportamental que foi adaptado para um grupo de mães de crianças com paralisia cerebral (PC). O objetivo da intervenção foi diminuir os problemas emocionais das mães e capacitá-las a lidar com os problemas comportamentais das crianças. O programa teve duração de 12 sessões e baseou-se em manejo de contingências e enfrentamento do estresse. Participaram do programa 25 mães que responderam a escalas avaliando seu estado psicológico e o comportamento das suas crianças. Os resultados apresentaram diminuição significativa nos problemas emocionais das mães, sem diferenças significativas nas percepções do comportamento das crianças. O programa teve um efeito significativo sobre o estado emocional das mães, demonstrando aplicabilidade clínica.(AU)

This article describes a model of cognitive-behavioral intervention model was adapted for use with a group of mothers of children with cerebral palsy (CP). The objective of the intervention was to diminish the emotional problems of the mothers and to enable them to deal it with their children’s behavioral problems. The program was based on contingency and stress management approaches. A group of 25 mothers participated in the study. In the pre-test mothers answered scales assessing their psychological status as well as their perceptions on children’s behaviors. A post-test was applied after 12 intervention sessions. Mothers reported significantly reduced stress and depressive symptoms levels, but no significant changes were observed for children’s behavioral problems. The program had a significant effect on the emotional state of the mothers, demonstrating clinical applicability.(AU)