Psychotherapy for depression among advanced,incurable cancer patients: A systematic review and meta-analysis

BackgroundThere is a high prevalence of depressive disorder and depressive symptoms among advanced, incurable cancer patients. Patients commonly report a preference for non-pharmacological treatments such as psychotherapy over pharmacological treatments for depression. The objective of this review was to investigate the effectiveness of psychotherapy for the treatment of depression in people with advanced, incurable cancer via a meta-analysis of randomized controlled trials (RCTs).MethodsWe searched research databases and clinical trial registries for studies published prior to June 2015. No language restrictions were applied when selecting studies. Cochrane Collaboration meta-analysis review methodology was used. All relevant RCTs comparing psychotherapy with control conditions on depression outcomes for adults with advanced cancer were eligible for inclusion. We calculated pooled effect sizes using Hedges g and a standardized mean difference (SMD) of change between baseline and post-treatment scores. Quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsOf 13 studies included in the review, 12 reported data suitable for meta-analysis. Psychotherapy was associated with moderate decrease in depression score (SMD −0.67, 95% confidence interval −1.06 to −0.29, P = 0.0005). Few studies focused on people with clinically diagnosed depression. Overall, quality of evidence across the included studies was rated as low, and heterogeneity was high.ConclusionsLow quality evidence suggests that psychotherapy is moderately more effective for the amelioration of symptoms of depression among advanced, incurable cancer patients than the control conditions. There is insufficient high-quality evidence supporting the effectiveness of psychotherapy for patients with clinically diagnosed depression.     

Specific and non-specific effects of psychotherapeutic interventions for depression: Results from a meta-analysis of 84 studies

There is a long-standing and very active debate regarding which psychotherapeutic intervention should be used in depressive disorders. However, the effects of psychotherapies may result majorly from non-specific factors rather than from specific factors related to the type of psychotherapeutic intervention. We performed a systematic review and meta-analysis on aggregated data to understand how the effects of different psychotherapies are impacted by non-specific factors. We included randomized controlled trials that assessed the efficacy of psychotherapeutic interventions in the treatment of adult depressive disorders. The primary outcome was the change in depression score from baseline to the latest follow-up visit (i.e. response). A meta-regression was performed to predict response according to the type of intervention and non-specific factors (e.g. number of treatment sessions, length of follow-up, therapeutic allegiance of the investigator). The main analysis included 214 study arms from 84 trials. The effects of psychotherapies compared to the waiting list control condition failed to remain significant after adjusting for non-specific factors. Response increased with the number of treatment sessions (β = 0.03, 95% CI [0.01; 0.04]) and the length of follow-up (β = 0.01, 95% CI [0.00; 0.02]). Response also improved in case of presumed therapeutic allegiances among investigators (β = 0.29, 95% CI [0.07; 0.52]). Response to psychotherapies seems to be closely related to non-specific effects. The development of a well-designed trial that controls for non-specific factors might help disentangle the effects of psychotherapies.     

两种方法治疗磨牙症的有效性对比研究

目的通过对两种不同方法治疗磨牙症的患者康复情况进行对比,分析并探讨治疗磨牙症的最佳方案。方法收集我校2010级学生愿意佩戴牙合垫治疗磨牙症的患者100例,分为A、B两组,各50例;A组单纯采用牙合垫治疗磨牙症,B组牙合垫联合心理疗法治疗磨牙症,治疗6个月后,对两组的康复情况进行统计学分析。结果对A、B两组患者之间的康复率进行χ2检验,P〈0.05,有统计学意义,两组之间存在差异。结论牙合垫联合心理疗法治疗磨牙症的方法优于单纯采用牙合垫治疗磨牙症。     

The burden of relatives of psychiatric patients: Comparisons between parents,spouses, and grown-up children of voluntarily and compulsorily admitted psychiatric patients

As part of an ongoing study of the quality of the mental health services in two Swedish county councils, relatives of both voluntarily and compulsorily admitted patients were interviewed with regard to family burden. The aims of this part of the study were to investigate differences in burden between subgroups of relatives, differences in family burden between 1986 and 1991, and differences between relatives of voluntarily and compulsorily admitted patients. The relatives investigated consisted of 79 spouses, 118 parents, and 31 grown-up children. The results showed that relatives of severely mentally ill persons have a considerable amount of burden, of both an external and a psychologic internal nature. Subjective burden was generally more pronounced than objective external burden. Spouses had to a greater extent external burdens. Relatives experienced more internal burden in 1986 and more external burden in 1991. There were no differences between relatives of voluntarily and compulsorily admitted patients. It is concluded that the psychiatric services in their work with relatives have to consider the specific burden of different subgroups of relatives.     

Drug refusal skills training does not enhance outcomes of African American adolescents with substance use problems

In prior research by Witkiewitz and colleagues, African American adults receiving refusal skills training (RST) had fewer heavy drinking days and were categorized as having more successful outcomes. This study extends findings to adolescents receiving the Adolescent Community Reinforcement Approach (A-CRA). Propensity score matching was used to create three groups equivalent on baseline characteristics, including: African Americans receiving refusal skills training (AA + RST; n = 214), African Americans not receiving RST (AA-RST; n = 212), and Caucasians receiving RST (CA + RST; n = 214). In propensity weighted regression models that controlled for overall A-CRA exposure, racial group by RST status was not a significant predictor of substance use frequency or abstinence/early remission outcomes. Higher exposure to A-CRA, however, was a significant predictor of both outcomes. Universal receipt of RST may not improve the outcomes of African American adolescents with substance use problems, and outcomes may be driven more by the overall number of A-CRA procedures received.     

心理治疗对创伤骨折患者心理状况的效果研究

目的 探讨心理治疗对创伤骨折患者心理状态的影响,以便为骨折患者心理干预治疗提供科学依据.方法 将符合条件的创伤骨折患者分为干预组和非干预组.非干预组行常规治疗,干预组在常规治疗的基础上进行心理治疗,应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量评定问卷(SF-36)对两组患者在心理治疗前后进行测查.结果 与常模比较创伤骨折患者的SAS、SDS的总分高于常模(t=4.88,3.57;P＜0.01);心理治疗后,干预组SAS、SDS总分低于非干预组(t＝ 2.54,P＜0.05;t=2.65,P＜0.01);SF-36除生理机能外各因子分高于非干预组(P＜0.05).结论 创伤骨折患者存在明显的焦虑、抑郁情绪,心理治疗可以明显的改善患者的心理健康状况及其生活质量.     

The rationale behind a Dance Movement Psychotherapy intervention used in a small research pilot in a further education context to develop awareness about young people's body image

This study includes some of the comments from a small piece of quantitative research conducted in a British Further Education College. It was designed to investigate young people's experience of a Dance and Movement Psychotherapy intervention in relation to their body awareness and their body image.     

多发性创伤患者急性应激障碍的联合干预

目的:联合临床心理科与创伤外科对外科多发性创伤伴发急性应激障碍(ASD)患者进行研究,探寻综合医院ASD患者合理有效易操作的联合干预方法。方法:对多发性创伤后符合美国精神疾病诊断标准(DSM-IV-TR)ASD诊断的60例患者随机将30名设为联合干预组,30名设为对照组。联合干预组采用药物治疗加心理联合干预,心理联合干预方法有:情绪管理训练、自助小册子、认知疗法,针对家属的团体辅导,心理联合干预时间共4周,对照组仅采用药物治疗和一般支持治疗,在治疗前后采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、事件影响量表(IES-R)进行检测。结果:经治疗后联合干预组的HAMD量表分低于对照组,差异均有统计学意义(t=-2.780,P=0.007);HAMD减分率高于对照组,差异均有统计学意义(t=-2.833,P=0.006);联合干预组的HAMD量表分低于对照组,差异均有统计学意义(t=-3.670,P=0.001);HAMD减分率高于对照组,差异均有统计学意义(t=3.776,P=0.000);联合干预组的IES-R量表总分低于对照组,差异均有统计学意义(t=-2.120,P=0.038)。结论 :药物治疗加心理治疗联合干预更能改善多发性创伤ASD患者的情绪状态及应激症状。