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41.
M. Kathleen B. Lustyk Winslow G. Gerrish Shelley Shaver Shaunie L. Keys 《Archives of women's mental health》2009,12(2):85-96
We systematically reviewed empirical studies that investigated the use of cognitive-behavioral therapy (CBT) for premenstrual
syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Our multi-database search identified seven published empirical reports.
Three were identified as randomized controlled trials (RCTs). The methods utilized to investigate therapeutic efficacy of
CBT in these studies varied widely from case reports to RCTs with pharmacotherapy comparison groups. Initially we provide
a brief overview of CBT and justifications for its potential use to treat PMS/PMDD. Next, we provide critical evaluations
of the analyses used in each study focusing on the detection of intervention effects assessed by statistically significant
time by group interactions. When possible we calculate effect sizes to elucidate the clinical significance of results. Our
review revealed a dearth of evidence providing statistically significant CBT intervention effects. Issues such as overall
time investment, latency to treatment effects, and complementary and combined therapies are considered. We present a theoretical
argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this
area. In conclusion, to produce the necessary evidence-base support for PMS/PMDD given the limited empirical evidence reported
here, researchers are called on to produce methodologically rigorous investigations of psychosocial interventions for PMS/PMDD. 相似文献
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Objective
To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic control measured by HbA1c and psychological status in type 2 diabetes and to compare effects when interventions are delivered by generalist clinicians compared to psychological specialists.Methods
We used the original review protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants, interventions, delivery methods, comparison groups and outcome measures.Results
35 trials were reviewed and meta-analysis of 19 trials (n = 1431), reporting HbA1c found a reduction in HbA1c by 0.54% (−0.32; 95% CI: −0.47 to −0.16). In nine trials (n = 832) interventions were delivered by diabetes or general clinicians reducing HbA1c by 0.51% (−0.27; 95% CI: −0.50 to 0.04). In nine trials, interventions (n = 561) were delivered by psychological specialists reducing HbA1c by 0.57% (−0.36; 95% CI: −0.61 to 0.12). Meta-analysis of 13 trials reporting psychological status found psychological status to be lower in the intervention groups −0.56 (95% CI: 1.00 to −0.13). Trial quality for the majority of studies remained poor.Conclusion
Our findings suggest that psychological and general clinicians are similarly effective in delivering psychological interventions, however, effect sizes for all clinicians have reduced since the earlier review.Practice implications
Psychological training opportunities for generalist clinicians could lead to wider availability of effective psychological care. 相似文献44.
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Irwin Goldstein Noel N. Kim Anita H. Clayton Leonard R. DeRogatis Annamaria Giraldi Sharon J. Parish James Pfaus James A. Simon Sheryl A. Kingsberg Cindy Meston Stephen M. Stahl Kim Wallen Roisin Worsley 《Mayo Clinic proceedings. Mayo Clinic》2017,92(1):114-128
The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration–approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments. 相似文献
46.
Joseph A. Himle Michelle L. Van Etten Amy S. Janeck Daniel J. Fischer 《Cognitive therapy and research》2006,30(5):661-666
The presence of poor insight into the senselessness of symptoms of obsessive–compulsive disorder (OCD) has been theoretically linked to poor treatment response, yet few studies have examined this question. This study examined the role of poor insight in 69 OCD patients, who completed 7 weeks of cognitive behavioral group therapy. Participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and other measures of psychopathology. Insight was measured using interviewer ratings on an item of the Y-BOCS and participants were grouped as having “poor” or “adequate” insight. The analyses revealed that, after pre-treatment levels of OCD severity, depression, and medication status, were controlled, patients with adequate insight experienced better post-treatment outcomes than those with poor insight. These results suggest that patients with poorer insight can still benefit from treatment, but may experience a less favorable outcome than patients with better insight. Implications for the treatment of OCD are discussed. 相似文献
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The purpose of the present study was to determine if we could identify a specific subtype of temporomandibular disorder (TMD) pain patients that does not respond to treatment. Patients were 101 men and women with chronic TMD pain recruited from the community and randomly assigned to 1 of 2 treatment conditions: a standard conservative care (STD) condition or a standard care plus cognitive-behavioral therapy condition (STD + CBT) in which patients received all elements of STD but also received cognitive-behavioral coping skills training. Growth mixture modeling, incorporating a series of treatment-related predictors, was used to distinguish several distinct classes of responders or nonresponders to treatment based on reported pain over a 1-year follow-up period. Results indicated that treatment nonresponders accounted for 16% of the sample and did not differ from treatment responders on demographics or temporomandibular joint pathology, but that they reported more psychiatric symptoms, poorer coping, and higher levels of catastrophizing. Treatment-related predictors of membership in treatment responder groups versus the nonresponder group included the addition of CBT to STD, treatment attendance, and decreasing catastrophization. It was concluded that CBT may be made more efficacious for TMD patients by placing further emphasis on decreasing catastrophization and on individualizing care. 相似文献