Factors Associated with Treatment Outcomes in Mindfulness-Based Cognitive Therapy for Panic Disorder

Purpose

Although the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for panic disorder (PD) has been studied previously, data on the predictors of treatment outcomes in MBCT for PD are scarce.

Materials and Methods

Eighty patients with PD were screened to analyze treatment outcomes such as MBCT completion, treatment response, and remission after undergoing MBCT for PD. Sociodemographic characteristics, comorbid personality disorders, and baseline medication doses were examined. The study administered the Panic Disorder Severity Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale and Anxiety Sensitivity Inventory-Revised to patients at baseline and at eight weeks.

Results

Sixty-five participants were enrolled in the present study. Comorbid personality disorder was significantly associated with MBCT non-completion. We found that anxiety sensitivity (AS) improvement after an eight week MBCT program was a statistically significant factor associated with treatment response. Using logistic regression analysis, AS improvement after MBCT showed significant association with PD remission after MBCT.

Conclusion

Comorbid personality disorders of participants could be a potential predictor of MBCT non-completion. Furthermore, AS improvement after MBCT may predict treatment response and remission after MBCT for PD. However, better designed studies with a larger number of patients are needed to confirm our findings.     

Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness

Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure.     

Adherence to continuous positive airway pressure therapy in obstructive sleep apnoea sufferers: a theoretical approach to treatment adherence and intervention

Obstructive Sleep Apnoea (OSA) is a common sleep disorder associated with significant health, quality of life and psychosocial problems. The aims of this review are to investigate the contribution of psychological constructs and theory to the assessment and treatment of OSA. Adherence to CPAP treatment remains a primary concern for improving treatment outcomes for OSA. Modifiable, psychological constructs of self-efficacy, coping, social support, treatment satisfaction and self-reported daytime sleepiness improve the prediction of CPAP adherence. These predictors are particularly robust in the context of a theoretical model. Social Cognition Theory (SCT) and Health Belief Model (HBM) are emerging as promising psychological models for understanding patient acceptance and adherence to CPAP treatment. An overview of psychologically informed interventions for CPAP use is presented. Education-based interventions have promise, but the strongest and robust findings are emerging from theory-driven interventions. Specifically, Cognitive-Behaviourally informed interventions and Motivational Interventions demonstrate consistent and large effect sizes in improving CPAP adherence rates.     

Patients' expectancies, the alliance in pharmacotherapy, and treatment outcomes in bipolar disorder

Bipolar disorder is characterized by a chronic and fluctuating course of illness. Although nonadherence to pharmacotherapy is a frequent problem in the disorder, few studies have systematically explored psychosocial factors related to treatment discontinuation. Previous research with depressed patients receiving psychotherapy has suggested that expectancies for improvement are related to treatment outcomes and that the therapeutic alliance may partially mediate this relationship. The current study found evidence for a similar relationship between patients' initial expectancies for improvement, patient and doctor-rated alliance, and long-term outcomes in bipolar patients treated with pharmacotherapy for up to 28 months following an acute episode. The results highlight the need for the assessment of expectancies and alliance in bipolar treatment and suggest possible targets for psychosocial interventions.     

A systematic review of randomised controlled trials of interventions reporting outcomes for relatives of people with psychosis

Relatives play a key role in supporting people with psychosis at all stages of recovery, but this can be associated with high levels of distress. Family interventions, with an international evidence base, improve outcomes for service users but little is known about their impact on relatives' outcomes. This review of published evaluations aimed to assess whether family interventions are effective in improving outcomes for relatives of people with psychosis, to identify the key components of effective intervention packages, and to identify methodological limitations to be addressed in future research. Fifty studies were identified which evaluated an intervention to support relatives against a control group, and in which outcomes for the relatives were reported. Thirty (60%) studies showed a statistically significant positive impact of the intervention on at least one relatives' outcome category. Eleven key intervention components were identified across all 50 studies, but there was no evidence that the presence or absence of any of these key components reliably distinguished effective from ineffective interventions. Methodological quality of studies was generally poor with only 11 studies rated as adequate using the Clinical Trial Assessment Measure (CTAM). Recommendations to improve future research include larger samples; better defined interventions and controls; true randomisation and blind assessors; clearly specified primary outcomes; pre-published analysis plans that account appropriately for missing data and clustering of data; a consensus on the most relevant outcomes to assess and valid and reliable measures to do so. Alternative research designs need to be considered to evaluate more recent approaches which focus on family support, personalised to meet individual need, and offered as an integral part of complex clinical services.     

情绪反应、个性特征与月经失调的关系

目的：了解月经失调在女学生中的发生情况，探讨月经失调与情绪状态、个性特征等心理社会因素之间的关系。方法：本研究采用分层整群抽样的调查法和心理测验法，对521名调查对象实施了月经健康问卷、状态特质焦虑问卷、流调中心用抑郁量表、艾森克个性问卷调查。结果：月经失调占总调查人数的44．7％；应激时的焦虑、抑郁评分均值显著高于平时；女生月经失调发生率有随年龄、考试应激时焦虑、抑郁反应强度以及特质焦虑水平增加而增加的趋势。结论：情绪状态、个性特征等心理社会因素对女生月经失调的发病起重要作用,临床应重视相应心理干预对策的运用。     

Who benefits from psychosocial interventions in oncology? A systematic review of psychological moderators of treatment outcome

Medical and demographic characteristics and psychological morbidity of individuals with cancer prior to a psychosocial intervention can influence the efficacy of interventions. However, little is known about the moderating role of patients’ psychosocial characteristics on intervention effects. This review sought to identify and synthesize the impacts of psychosocial moderators of the effect of psychosocial interventions on the psychological well-being of cancer patients. A systematic review of the published literature was conducted. Databases searched included PsycINFO, PubMed, MEDLINE, Scopus, CINAHL, Web of Science, and Psychology and Behavioural Sciences Collection. Randomized controlled studies examining a moderator effect of patients’ psychosocial characteristics other than baseline depression and anxiety levels were included. Of 199 potential papers, a total of 20 studies, involving 3,340 heterogeneous cancer patients are included. Of the 17 potential psychosocial moderators examined in this review, 14 significantly moderated the effects of interventions. Moderators were categorized into personality traits, mental and physical quality of life, social environment, and self-efficacy. Patients with poorer quality of life, interpersonal relationships and sense of control benefitted more from interventions than those who already had adequate resources. Patients with low levels of optimism and neuroticism, high levels of emotional expressiveness, interpersonal sensitivity, and dispositional hypnotizability also showed greater benefits from various interventions. This review adds to the growing literature aimed at personalizing psychosocial cancer treatment by identifying who benefits from which psychosocial interventions.     

Clinical experience with patients suffering from hyperemesis gravidarum (severe nausea and vomiting during pregnancy): thoughts about subtyping of patients,treatment and counseling models

The medical and psychological treatment of hyperemesis gravidarum (HG) is generally acknowledged as being difficult. It is also recognized that the somatic changes during pregnancy play a role in the process of HG and that psychosocial factors are of particular importance. The following issues have been studied: psychosocial stressors; personality disorders; coping mechanisms and stress tolerance. The reviewed studies mention many different causes of HG. Some produce symptoms in certain women and some will not. As a result of clinical experience and observation during several years treating women with HG from a broad social, cultural and ethnic background in a large inner-city general hospital, we have been able to identify several subgroups of HG patients according to personality pathology, psychiatric symptoms and psychosocial stress factors. Accurate assessment is necessary in order to be able to tailor the interventions to the characteristics and needs of the individual patient. For the various subgroups different treatment strategies are recommended.     

Psychosocial Research on the Course of Bipolar Disorder: Appreciating Its Past and Encouraging Its Future

Miklowitz and Johnson (2009 ) review the accumulating accomplishments of studies of psychosocial contributors to and treatments of bipolar disorder. Much of the initial work was influenced by paradigms that addressed predictors and treatments of unipolar depression. That personality, stress, and family factors also play an important role in the course and outcomes of bipolar disorders has now been well established, but because depression appears to be especially debilitating and difficult to manage in bipolar disorder, further challenges remain to understand and treat it. At the same time the predictors of mania, and switching/cycling mechanisms, require further conceptualization and study, with a fruitful emphasis on the behavioral activation/reward dependence systems emerging in recent research. Cutting across all manifestations of the bipolar disorder is the need for additional study of mechanisms by which stressful experiences (acute, chronic, early adversity, and the family context) have adverse effects on mood regulation and the pathophysiology of bipolar disorder. Future growth in our understanding of bipolar disorder and its treatment will increasingly require integrative, multivariate, and longitudinal research. Clinical psychology has much to contribute to the conceptualization, methodology, and design of the new generation of research on the psychosocial aspects of bipolar disorder's course and treatment.     

Wellness and HIV: Developing a model for progression from theoretical knowledge about psychosocial factors to application

Psychosocial factors and immunological markers have been associated not only with progression from HIV to AIDS, and AIDS survival, but also with wellness. Not yet identified, and therefore not yet formalized into a system for clinical decision-making, are those individual differences that moderate both the impact of psychosocial factors and the potential benefit of interventions. Therefore the link between theoretical knowledge and application has not yet been established in a manner that would predict the outcome of recommended interventions. Presented here are background considerations to a combination of short-term and longitudinal studies which investigate these issues. The decision process devised here would be suitable for use with individuals with any physical disorder that has a psychosocial component.     

It's My Body: A Book to Teach Young Children How to Resist Uncomfortable Touch (Book)

Reviews psychosocial interventions for child and adolescent conduct problems, including oppositional defiant disorder and conduct disorder, to identify empirically supported treatments. Eighty-two controlled research studies were evaluated using the criteria developed by the Division 12 (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures. The 82 studies were also examined for specific participant, treatment, and methodological characteristics to describe the treatment literature for child and adolescent conduct problems. Two interventions were identified that met the stringent criteria for well-established treatments: videotape modeling parent training program (Spaccarelli, Cotler, &; Penman, 1992; Webster-Stratton, 1984, 1994) and parent-training programs based on Patterson and Gullion's (1968) manual Living With Children (Alexander &; Parsons, 1973; Bernal, Klinnert, &; Schultz, 1980; Wihz &; Patterson, 1974). Twenty of the 82 studies were identified as supporting the efficacy of probably efficacious treatments.     

Psychosocial factors and incident asthma hospital admissions in the EPIC-Norfolk cohort study

BACKGROUND: Case series and case-control studies have shown high rates of psychosocial and behavioural risk factors amongst patients admitted to hospital with severe asthma. General population studies have shown associations between psychosocial factors and prevalent asthma but few have investigated incident asthma outcomes. METHODS: Data on psychosocial factors and asthma hospital admissions were available for 20 854 participants, aged 41-80 years, in the Norfolk cohort of the European Prospective Investigation into Cancer study. Postal assessments included details of physical functioning, mood disorder history, social adversity and social support. RESULTS: A total of 686 asthma hospital admissions were recorded. Psychosocial factors present at baseline, including current mood disorders, adverse circumstances in childhood, the impact of life events experienced during adulthood and negative perceived support from a close confidant, were associated with increased rates of hospital admission independent of age, sex, indicators of socio-economic status, physical functional health, and obesity. Restricted to those participants who reported lifetime doctor-diagnosed asthma at baseline, the reported impact of adverse life events experienced in adulthood, and both confiding and negative aspects of support quality, were associated with asthma hospital admission. The magnitude of these associations was comparable to those involving indicators of socio-economic status and physical health. CONCLUSIONS: These results show that psychosocial factors are associated with incident asthma hospital admissions and highlight the potential importance of taking account of psychosocial factors, including availability and quality of support networks, in guiding long-term asthma management.     

Suicide in current psychiatric in-patients: a case-control study The National Confidential Inquiry into Suicide and Homicide

BACKGROUND: Few controlled studies have investigated factors associated with suicide in current in-patients. We aimed to identify psychosocial, behavioural and clinical risk factors, including variations in care, for in-patient suicide. METHOD: We conducted a national population-based case-control study of people who died by suicide between 1 April 1999 and 31 December 2000 while in psychiatric in-patient care in England. Cases were 222 adult mental health in-patients who died by suicide matched on date of death with 222 living controls. RESULTS: Nearly a quarter of suicides took place within the first week of admission; most of these died on the ward or after absconding. After the first week, however, most suicides occurred away from the ward, the majority of patients having left the ward with staff agreement. Previous deliberate self-harm, recent adverse life events, symptoms of mental illness at last contact with staff and a co-morbid psychiatric disorder were associated with increased risk for suicide. Being off the ward without staff agreement was a particularly strong predictor. Those patients who were detained for compulsory treatment were less likely to die by suicide. Independent predictors of in-patient suicide were male sex, a primary diagnosis of affective disorder and a history of self-harm. Being unemployed or on long-term sick leave appeared to be independently protective. CONCLUSION: Prevention of in-patient suicide should emphasize adequate treatment of affective disorder, vigilance in the first week of admission and regular risk assessments during recovery and prior to granting leave. Use of compulsory treatment may reduce risk.     

College students and problematic drinking: a review of the literature

Problem drinking during the college years is a significant public health concern. The goal of the current review was to examine the primary psychosocial factors that predict problem drinking in college students. Variables examined included demographic variables, personality, drinking history, alcohol expectancies, drinking motives, stress and coping, activity involvement, and peer and family influence. Evidence from studies of college drinking indicated that the variables associated with college drinking seem to vary at levels dealing with one's personality and coping mechanisms, one's thought processes about drinking, and the environment. It seems that expectancies and drinking motives may serve as explanations for the pathways from certain personality types (i.e., sensation seeking and neurotic) to problem drinking in the college setting. Factors that predicted future drinking problems after college were also examined. Overall, it seems that interventions and prevention programs would need to reach college students at all three levels--the environment, individual personality traits, and cognitive processes. Future research should address the limitations in the previous research as well as test comprehensive models of college drinking.     

Sociodemographic,sexual, and reproductive variables associated with pregnancy among adolescents from low socioeconomic background

Adolescent pregnancy remains a public health concern in both developed and developing countries. Portugal and Brazil represent some of the best examples of this phenomenon. The present study aimed to identify sociodemographic, sexual, and reproductive health-related variables associated with adolescent pregnancy among students from low socioeconomic backgrounds in both countries. The sample included 984 female adolescents, among whom 215 became pregnant. Living with a partner and lack of information about sex and contraception from the family were the best explicative factors for pregnancy occurrence in both countries. Country-specific variables were also identified. Our results may contribute to developing global preventive interventions, addressing the school as an ideal setting for primary intervention and considering culture-specific characteristics of high-risk populations.     

A systematic scoping review of psychosocial and psychological factors associated with patient activation

ObjectivePatient activation has been identified as an important predictor of how patients manage their own health, but little is known about its determinants. In this scoping review, we aim to address this research gap by (1) identifying literature on psychosocial/psychological factors associated with patient activation, and (2) extracting and synthesizing major results reported on that relationship.MethodsUsing a systematic search of four electronic databases (Web of Science, PubMed, PsychInfo, CINAHL), our search algorithm combined related terms for “psychosocial factors” or “psychological factors” and “patient activation”.ResultsOf the 1128 records identified, we included 13 studies in this scoping review. In these, we identified 21 psychosocial/psychological factors that were significantly associated with patient activation. The four most frequently investigated factors were depression, self-efficacy, hope, and health status. Overall, the methodological quality of studies was low. The majority were cross sectional in design, and only one assessed causality.ConclusionsOur results suggest that psychosocial/psychological factors explain variations in patient activation. However, further research is needed to identify causal relationships between psychosocial/psychological factors and patient activation.Practice ImplicationsThe insights from our review could be used for designing and evaluating interventions to improve patient activation.     

Future Directions in Father Inclusion,Engagement, Retention,and Positive Outcomes in Child and Adolescent Research

Fathers make important and unique contributions to positive child development. In spite of these findings, the research literature has lagged in the study of the role and impact of fathers on child development and in the development of effective approaches and interventions for fathers. Parameters for additional study include the inclusion of fathers in treatment outcome studies, the engagement of fathers within studies once included, the retention of fathers in interventions and studies once engaged, and the appropriate measurement of father-related outcomes. A systematic review of 64 studies indicated that there is evidence that fathers have been included within multiple studies aimed at improving parenting but that there are relatively fewer studies of other targeted outcomes such as coparenting. A set of recommendations for future directions in the next generation of father-focused studies in the child and adolescent psychology literature is presented, with an emphasis on improving study of the parameters of inclusion, engagement, retention, and measurement of outcomes.     

Abnormal eating attitudes in London schoolgirls--a prospective epidemiological study: factors associated with abnormal response on screening questionnaires

One thousand and ten unselected London state schoolgirls were screened by questionnaire to identify an 'at risk' cohort displaying abnormal eating attitudes and two control cohorts, one with probable general psychiatric morbidity, one without. Members of all cohorts were assessed at interview for the presence of eating disorder and for putative risk factors implicated in the development of anorexia nervosa. A prevalence rate of 0.99% was detected for clinical eating disorder and 1.78% for the partial syndrome of eating disorder. Factors specifically associated with abnormal eating attitudes were identified, in particular, current or past overweight, history of amenorrhoea and perceived stress in school and social life. Some commonly accepted risk factors for eating disorders were discovered to be associations with general psychiatric morbidity. These were perceived parental pressure to eat more, taking exercise to lose weight, perceived stress at home and reporting a family history of anxiety or depression. Other well reported putative risk factors for eating disorder, including social class, birth order, age at menarche, obsessional personality and weight related career choice were not associated specifically with abnormal eating attitudes in schoolgirls. These findings represent cross-sectional data at entry into a prospective epidemiological study.