Multiple-family group treatment as an effective intervention for children with psychological disorders

An estimated 20% of children suffer from psychological disorders and only 10-20% receive adequate treatment. A lack of empirically supported treatments is one reason why relatively few children receive treatment for their psychological difficulties. Multiple-family group treatment (MFGT) is an empirically supported intervention for adults with chronic mental illnesses that may be an effective treatment for children with psychological disorders. This article reviewed the adult MFGT model and its empirical support. The quantity and quality of child MFGT research was then reviewed. Child MFGT models are compared with one another and to the adult MFGT model. All studies provided initial support of MFGT as an appropriate treatment for childhood disorders. However, the child literature as whole was relatively limited, unfocused, and lacked replication. Suggestions for future research are made, focusing on a structured and scientific approach to establishing MFGT as an empirically supported intervention for children.     

Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004)

BACKGROUND: Recognition that psychological and behavioral factors play an important role in insomnia has led to increased interest in therapies targeting these factors. A review paper published in 1999 summarized the evidence regarding the efficacy of psychological and behavioral treatments for persistent insomnia. The present review provides an update of the evidence published since the original paper. As with the original paper, this review was conducted by a task force commissioned by the American Academy of Sleep Medicine in order to update its practice parameters on psychological and behavioral therapies for insomnia. METHODS: A systematic review was conducted on 37 treatment studies (N = 2246 subjects/patients) published between 1998 and 2004 inclusively and identified through Psyclnfo and Medline searches. Each study was systematically reviewed with a standard coding sheet and the following information was extracted: Study design, sample (number of participants, age, gender), diagnosis, type of treatments and controls, primary and secondary outcome measures, and main findings. Criteria for inclusion of a study were as follows: (a) the main sleep diagnosis was insomnia (primary or comorbid), (b) at least 1 treatment condition was psychological or behavioral in content, (c) the study design was a randomized controlled trial, a nonrandomized group design, a clinical case series or a single subject experimental design with a minimum of 10 subjects, and (d) the study included at least 1 of the following as dependent variables: sleep onset latency, number and/or duration of awakenings, total sleep time, sleep efficiency, or sleep quality. RESULTS: Psychological and behavioral therapies produced reliable changes in several sleep parameters of individuals with either primary insomnia or insomnia associated with medical and psychiatric disorders. Nine studies documented the benefits of insomnia treatment in older adults or for facilitating discontinuation of medication among chronic hypnotic users. Sleep improvements achieved with treatment were well sustained over time; however, with the exception of reduced psychological symptoms/ distress, there was limited evidence that improved sleep led to clinically meaningful changes in other indices of morbidity (e.g., daytime fatigue). Five treatments met criteria for empirically-supported psychological treatments for insomnia: Stimulus control therapy, relaxation, paradoxical intention, sleep restriction, and cognitive-behavior therapy. DISCUSSION: These updated findings provide additional evidence in support of the original review's conclusions as to the efficacy and generalizability of psychological and behavioral therapies for persistent insomnia. Nonetheless, further research is needed to develop therapies that would optimize outcomes and reduce morbidity, as would studies of treatment mechanisms, mediators, and moderators of outcomes. Effectiveness studies are also needed to validate those therapies when implemented in clinical settings (primary care), by non-sleep specialists. There is also a need to disseminate more effectively the available evidence in support of psychological and behavioral interventions to health-care practitioners working on the front line.     

Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review

This paper reviews the evidence regarding the efficacy of nonpharmacological treatments for primary chronic insomnia. It is based on a review of 48 clinical trials and two meta-analyses conducted by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on non-drug therapies for the clinical management of insomnia. The findings indicate that nonpharmacological therapies produce reliable and durable changes in several sleep parameters of chronic insomnia sufferers. The data indicate that between 70% and 80% of patients treated with nonpharmacological interventions benefit from treatment. For the typical patient with persistent primary insomnia, treatment is likely to reduce the main target symptoms of sleep onset latency and/or wake time after sleep onset below or near the 30-min criterion initially used to define insomnia severity. Sleep duration is also increased by a modest 30 minutes and sleep quality and patient's satisfaction with sleep patterns are significantly enhanced. Sleep improvements achieved with these behavioral interventions are sustained for at least 6 months after treatment completion. However, there is no clear evidence that improved sleep leads to meaningful changes in daytime well-being or performance. Three treatments meet the American Psychological Association (APA) criteria for empirically-supported psychological treatments for insomnia: Stimulus control, progressive muscle relaxation, and paradoxical intention; and three additional treatments meet APA criteria for probably efficacious treatments: Sleep restriction, biofeedback, and multifaceted cognitive-behavior therapy. Additional outcome research is needed to examine the effectiveness of treatment when it is implemented in clinical settings (primary care, family practice), by non-sleep specialists, and with insomnia patients presenting medical or psychiatric comorbidity.     

A meta‐analytic review of the efficacy of psychological treatments for violent offenders in correctional and forensic mental health settings

This meta‐analysis examined whether psychological treatments with adult violent offenders in correctional and forensic mental health settings are effective in preventing community recidivism and institutional (hospital/prison) misconduct. A total of 27 controlled studies containing 7,062 violent offenders were obtained via a comprehensive search strategy that yielded more than 13,000 records. Overall, treatments with violent offenders significantly reduced violent and general/nonviolent recidivism. The average effect for violent and general/nonviolent institutional misconduct did not attain statistical significance. Moderator analyses indicated numerous trends; however, most effects were nonsignificant following alpha‐level corrections. Findings regarding the impact of psychological treatments are promising and suggest that multimodal treatments are associated with the strongest treatment effects. However, the extant evidence base is limited by a small number of well‐controlled outcome studies and inconsistent/incomplete reporting of the evaluations. More high‐quality research is needed to investigate the effectiveness of violent offender treatment on outcomes and mechanisms of action, and to determine which treatment components are effective, in what combination, and for which offenders.     

社会支持、心理控制感和心理健康的关系研究

目的 :为探讨社会支持、心理控制感对心理健康的影响 ,及社会支持与心理控制感之间的关系。方法 :采用社会支持、心理控制感及 3个心理健康评定量表对 2 72 3名成年被试者进行测量。结果 :社会支持和心理控制感对心理健康有重要影响 ,社会支持水平低下、外控心理倾向的人主观幸福度低 ,心理症状多 ,心理健康水平低 ;同时还发现 ,内外控制感对社会支持水平也产生影响 ,内在控制感强的人所获得的社会支持更多。结论 :提示社会支持和心理控制感都是影响心理健康水平的中介因素 ,研究这二个中介因素之间的关系对维护个体的心理健康 ,探讨心理障碍产生的心理机制都很有意义     

Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia

BACKGROUND: Previous studies of insomnia focused mainly on the improvement of sleep condition and ignored the effects of sleep-related psychological activity and daytime function after pharmacological and behavioral treatments. We compared the clinical effects of both therapies on sleep condition, sleep-related psychological activity and daytime function in chronic insomnia. METHODS: Seventy-one patients with chronic insomnia were randomly divided into 4 groups and either received cognitive-behavior therapy (CBT, n = 19), pharmacological therapy (PCT, n = 17), CBT plus medication (Combined, n = 18) or placebo (n = 17). The treatments lasted for 8 weeks with follow-ups conducted at 3 and 8 months. On the day after treatment ended, all patients were assessed using a polysomnogram (PSG), a sleep diary and a psychological assessment. RESULTS: The three active treatments were more effective than placebo at the time the treatments were completed. Subjective sleep-onset latency, sleep efficacy and total sleep time were better in the PCT group than in the CBT group. At the 3-month follow-up, subjective and objective sleep-onset latency, sleep efficacy and total sleep time were better in the CBT group than in both the PCT and the Combined group. At the 8-month follow-up, the CBT group showed a steady comfortable sleep state, while the PCT and Combined groups were gradually returning to the pre-treatment condition. The Combined group showed a variable long-term effect. On the other hand, pre-sleep arousal at nighttime, dysfunctional beliefs about sleep as well as daytime functioning in the CBT group not only improved, but was better than in the other active treatment groups. CONCLUSION: Medication and Combined therapy produced a short-term effect on chronic insomnia while CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning.     

Developmental factors in the treatment of adolescents

Most empirically supported interventions for adolescent mental health problems are either downward adaptations of adult treatments or upward adaptations of child treatments. Although these treatments show respectable effects with teens, a review of the outcome research reveals significant gaps. both in coverage of adolescent conditions and problems (e.g., eating disorders, suicidality) and in attention to the biological, psychological, and social dimensions of adolescent development. The authors critique the field, propose a biopsychosocial framework for the development of dysfunction and intervention, and discuss ways the developmental literature can and cannot inform intervention and research. A long-term goal is an array of developmentally tailored treatments that are effective with clinically referred teens and an enriched understanding of when, how, and why the treatments work.     

Child abuse as a life-course social determinant of adult health

Despite prevention efforts worldwide, many children today continue to experience abuse within close relationships, and many adults carry with them histories of abuse. This narrative review focuses on the growing body of research regarding the long-term health consequences of child abuse. First, the review presents a brief introduction to the phenomenon of child abuse, as well as a discussion of theoretical approaches to describing processes through which child abuse can jeopardize later adult health. The review then provides an integrative summary of studies based on community samples that examine associations between physical, psychological, and sexual abuse in childhood and adult mental and physical health. The article concludes with a discussion of conceptualizing child abuse as a life-course social determinant of adult health for both clinical and public health purposes and calls for translational research that can inform efforts to promote the health of diverse individuals and populations with histories of child abuse.     

Child-Rearing Difficulties Reported by Parents of Infants and Toddlers

Surveyed a nonclinical sample of 413 parents of infants andtoddlers about child-rearing difficulties, child behavior problems,and their own needs for support. Despite their high educationaland income level, the parents surveyed reported raising youngchildren to be a difficult task. Most concerns centered on children'sirritating but developmentally typical behavior such as whining,noncompliance with adult requests, and interruption of adultactivities. Parental reports of difficulties were highest forparents with more than one child and when children were pasttheir second birthday.     

Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report

Insomnia is highly prevalent, has associated daytime consequences which impair job performance and quality of life, and is associated with increased risk of comorbidities including depression. These practice parameters provide recommendations regarding behavioral and psychological treatment approaches, which are often effective in primary and secondary insomnia. These recommendations replace or modify those published in the 1999 practice parameter paper produced by the American Sleep Disorders Association. A Task Force of content experts was appointed by the American Academy of Sleep Medicine to perform a comprehensive review of the scientific literature since 1999 and to grade the evidence regarding non-pharmacological treatments of insomnia. Recommendations were developed based on this review using evidence-based methods. These recommendations were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Psychological and behavioral interventions are effective in the treatment of both chronic primary insomnia (Standard) and secondary insomnia (Guideline). Stimulus control therapy, relaxation training, and cognitive behavior therapy are individually effective therapies in the treatment of chronic insomnia (Standard) and sleep restriction therapy, multicomponent therapy (without cognitive therapy), biofeedback and paradoxical intention are individually effective therapies in the treatment of chronic insomnia (Guideline). There was insufficient evidence to recommend sleep hygiene education, imagery training and cognitive therapy as single therapies or when added to other specific approaches. Psychological and behavioral interventions are effective in the treatment of insomnia in older adults and in the treatment of insomnia among chronic hypnotic users (Standard).     

Managing insomnia in the primary care setting: raising the issues

The optimal management of insomnia in the primary care setting should be viewed as a public health problem that will require specific attention. Important recent strides in the understanding of insomnia, its consequences, and its treatment do not always provide a basis for management strategies in a setting with distinct practical limitations. A somewhat different research focus will be needed if the scientific advances are to be translated into practical improvements in therapy. In primary care today, multiple agendas compete for the physician's time. Therefore, it is necessary to view diagnosis and management in terms of both what is efficient and what is optimally effective. Much can be learned from experience with medical risk factors of broad prevalence, such as hypercholesterolemia and hypertension. Large outcome trials demonstrating the benefits of drug therapy were required before pharmacologic management became standard care in the primary care setting. For insomnia, specific issues that must be addressed include the components of diagnosis that will guide therapy and affect prognosis. How can the 10% of adults with insomnia in the primary care practice be subdivided to identify those most in need of therapy? Stated another way, what are the features of insomnia that predict risk? Is duration important? Severity? Frequency? Which treatments are most effective? Which are most efficient in terms of the time required of patient and practitioner? Do treatments for insomnia produce patient satisfaction? Do they prevent adverse outcomes, such as depression and automobile accidents? Studies are now addressing many of these questions. In selecting research priorities, however, the practical application of this information in the clinical setting is important if the ultimate goal is to reduce the number of patients suffering from insomnia and its consequences.     

The Myth of the Superiority of Concurrent Combined Treatments for Anxiety Disorders

[Clin Psychol Sci Prac 17: 107–111, 2010] The treatment of anxiety disorders with combined cognitive‐behavioral therapy (CBT) and pharmacological treatments has been an ongoing topic of discussion. Combined treatments have failed to demonstrate additive benefits despite their continued use in practice. Otto, McHugh, and Kantak (2010) suggest that concurrent use of medication and CBT affects the acute release of cortisol during the extinction phase of exposure therapy and, in turn, interferes with memory consolidation. This commentary expands on some of the psychological aspects of combined treatments for anxiety disorders to consider along with this new biochemical perspective.     

Outpatient treatment of primary anorexia nervosa in adult males

The majority of studies of primary anorexia nervosa have focused on adolescent females. Relatively little has been written on anorectic males, and there has been scarcely any documentation of the occurrence of this disorder in adult males. The present paper describes three cases of adult-onset primary anorexia nervosa in males. For each case, the history and diagnostic patterns are considered, followed by a discussion of the course of outpatient treatment. The therapy was multimodal and included elements of behavioral contingency management, cognitive therapy, and dynamic psychotherapy. Suggestions are made for future research.     

A critical review of psychological treatments of posttraumatic stress disorder in refugees

Despite much research evidence that refugees suffer from elevated rates of posttraumatic stress disorder (PTSD), relatively few studies have examined the effectiveness of psychological treatments for PTSD in refugees. The field of refugee mental health intervention is dominated by two contrasting approaches, namely trauma-focused therapy and multimodal interventions. This article firstly defines these two approaches, then provides a critical review of 19 research studies that have been undertaken to investigate the efficacy of these treatments. Preliminary research evidence suggests that trauma-focused approaches may have some efficacy in treating PTSD in refugees, but limitations in the methodologies of studies caution against drawing definitive inferences. It is clear that research assessing the treatment of PTSD in refugees is lagging behind that available for other traumatized populations. The review examines important considerations in the treatment of refugees. A theoretical framework is offered that outlines contextual issues, maintaining factors, change mechanisms and the distinctive challenges to traditional trauma-focused treatments posed by the needs of refugees with PTSD.     

以头晕为主诉的无症状性脑梗死患者焦虑状态的临床分析

目的:探讨以头晕为主诉的无症状性脑梗死(ACI)患者的情绪状态及临床体验并观察抗焦虑/抑郁治疗的疗效.方法:对98例ACI患者采用汉密尔顿焦虑抑郁量表进行筛查,并根据ICD-10的诊断标准做出诊断后,给予抗焦虑/抑郁药物治疗和支持性心理治疗,以治疗前后的汉密尔顿焦虑量表(HAMA)的减分率和临床症状缓解程度来评定疗效.结果:处于焦虑状态的ACI患者,医检证实均有脑血管系统的轻微病损,头晕史0.5～7年,有心悸、气短、眩晕发作、失眠等自诉躯体症状,67.55%伴有高血压;经帕罗西汀和支持性心理治疗,100%显效,临床症状缓解.结论:以头晕为主诉的ACI患者,若经改善脑血流循环治疗无效者,则应实施抗焦虑/抑郁药物治疗和支持性心理治疗,可望获得良好疗效.     

Recent advances in the assessment and treatment of insomnia.

Persistent insomnia has multiple potential causes such as medical, pharmacological, life-style, personality, and behavioral factors. Although many poor sleepers use hypnotic medications, a wide array of cognitive-behavioral interventions are available that target somatic and cognitive arousal, dysfunctional thoughts, and learned maladaptive sleep habits. Outcome research conducted over the past decade reveals that the single treatments of stimulus control and sleep restriction produced the best results, reducing self-reported target complaints by 50-60%. Approximately half of insomniacs show reliable change although only about one third become good sleepers. Multicomponent methods offer considerable promise but on the whole have not surpassed results achieved with the simpler stimulus control. Recommended new directions of pursuit include (a) examination of a broader range of insomnia sufferers, (b) use of multimodal assessment and more objective verification of self-reported benefits (c) research on treatments tailored to individual causal and maintaining factors, and (d) further scrutiny of newer interventions like sleep restriction and more comprehensive multifaceted strategies.     

Development of Child Psychotherapy Process Measures

Developed self-report measures describing the process of individual child psychotherapy. Measures were adapted from those used in adult therapy research and were completed by child clients and their therapists at six points during a 3-month period. Twenty 6- to 12-year-old children receiving treatment at a community mental health center and their therapists participated. Both the therapist and child instruments yielded internally consistent scales, which paralleled those obtained in adult therapy research. There were no significant relationships between the childand therapist-completed measures, suggesting the value of exploring the therapy process from multiple perspectives.     

Treatment of insomnia in older adults

Insomnia outcome studies from the last 15 years show consistent success for behavioral treatment with older adults. The present review of evaluation and treatment covers the effects of aging on ability to sleep, the insomnia classification system, the treatment efficacy database, and critical outcome research methodology. Clinical trial methodology with older adults includes familiar challenges; for example, the need for placebo controls, and frequent failures to document the adequacy of treatment implementation. Recommendations for improving methodology are offered. A new review of treatment for primary insomnia in older adults shows strong improvement and consistent results for popular behavioral treatments. Older adult clinical trials show proven efficacy of behavioral treatment for primary insomnia, efficacy for secondary insomnia, and efficacy for insomnia associated with hypnotic dependency.