Use of evidence-based therapies for youth psychiatric treatment is slow to catch on: Intensive training and practices with 'proficient culture' are critical to evidence-based therapy use -- ScienceDaily"Evidenced-based therapies are effective for treating a wide range of psychiatric conditions, but there is still a gap in widespread use," said the study's lead author Rinad S. Beidas, PhD, an associate professor of Psychiatry and Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania, and founding director of the Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI). "While findings showed a modest increase in use, the data point to a clear need for finding better ways to support clinicians and organizations in using EBP therapies. This research-to-practice gap is a historically intractable problem, which exists not only in behavioral health but all across health care specialties."
Your Brain on Imagination: It's a Lot Like Reality - Neuroscience NewsFor the study, 68 healthy participants were trained to associate a sound with an uncomfortable, but not painful, electric shock. Then, they were divided into three groups and either exposed to the same threatening sound, asked to “play the sound in their head,” or asked to imagine pleasant bird and rain sounds – all without experiencing further shocks. The researchers measured brain activity using functional magnetic resonance imaging (fMRI). Sensors on the skin measured how the body responded. In the groups that imagined and heard the threatening sounds, brain activity was remarkably similar, with the auditory cortex (which processes sound), the nucleus accumens (which processes fear) and the ventromedial prefrontal cortex (associated with risk and aversion) all lighting up. After repeated exposure without the accompanying shock, the subjects in both the real and imagined threat groups experienced what is known as “extinction,” where the formerly fear-inducing stimulus no longer ignited a fear response.
Pear Therapeutics, Novartis announce commercial launch of reSET | MobiHealthNewsreSET — a substance use disorder treatment that was the first software-only therapeutic cleared by the FDA — is now commercially available for clinicians to prescribe to their patients, according to a release from Pear Therapeutics and Sandoz, a division of Novartis with which Pear partnered back in April. But while physical prescription drugs are usually handled through a pharmacy, the process is a bit different for the digital therapeutic, Dr. Yuri Maricich, Pear’s chief medical officer and head of clinical development, told MobiHealthNews. Prescribing physicians will write a script that is sent to Pear’s reSET Connect Patient Service Center, which staffs specialists who guide the patient through downloading and using the app. Outside of that wrinkle, though, Maricich said that disseminating the treatment to care centers has been “very similar” to how a pharmaceutical company might put a novel treatment into the wild. “We have a team of salespeople who are going out and educating clinicians about the product, its data, how to use it; and we also have a set of services that support dispensing, but they aren’t selling to the clinicians,” he said. “Also, that dispensing and fulfillment process allows the physician to access the dashboard and the therapeutic for their patient as well. And in the background we [Pear and Sandoz] work with payers around coverage and contracts. So, really, what we’re focusing on now is getting the therapeutic in the hands of patients who need it and helping clinicians understand how to use it, who’s the right patient for it, how do I prescribe it and interact with it as part of standard care.” Still, Pear and Sandoz seem to be playing it safe with the new treatment modality — beyond general distribution and sales, the Patient Service Center is also equipped talk patients and providers through any questions or troubles they might be having. “How a patient gets access to [reSET] and how it’s prescribed is new, so we really wanted to try to provide bespoke services to the clinician and the patient,” Maricich explained. “The Patient Service Center is available to help with troubleshooting, they have clinical staff available if there’s clinical questions, and then they also are available if there are complaints or adverse events. So they are, basically, the central node for all of those activities to help clinicians and patients get access to therapeutic and to use it.” reSET is a 12-week digital cognitive behavioral therapy program accessed through an app and designed to accompany outpatient care delivered by a physician. According to Maricich, it is the only treatment authorized by the FDA for patients aged 18 years and older experiencing addiction to and dependency on stimulants, cannabis and cocaine (as well as alcohol).
Why It Matters How You Think About Pain | Outside OnlineBut the most interesting data deals with the difference between “adaptive” and “maladaptive” pain coping strategies. Adaptive strategies are things like ignoring pain, deciding that you won’t let it bother you, or overriding it with the urge to keep going. Maladaptive strategies are things like catastrophizing (“I’m going to have to drop out!”), fear (“It’s going to keep getting worse!”), and despondence (“This is awful!”). Each athlete was assigned daily composite scores of zero to six for adaptive and maladaptive coping, with zero corresponding to “never” and six corresponding to “always,” Alschuler says, reflecting “the extent to which the person is having thoughts that exemplify being willing to coexist with their pain versus the extent to which they are viewing their pain as a barrier that is difficult to overcome.” Overall, the ultrarunners were remarkably good at relying on adaptive coping (3.04 out of six, on average) rather than maladaptive coping (1.31 out of six). If that wasn’t the case, they probably would never have made it to one of these grueling races. Still, there were some interesting findings. For example, when runners used more than their usual level of maladaptive coping, they reported a greater perception that pain was interfering with their performance—even when the actual level of reported pain was held constant. They also spent more time thinking about their pain, which should be a reminder that sometimes it’s best not to dwell on it. The other interesting finding was a link between the use the maladaptive coping and the probability that a runner would finish the race. For every one-point increase in the maladaptive score, a runner’s likelihood of finishing the race dropped by a factor of three.
OCD treatment could someday start with a brain scan -- ScienceDailyUsing a functional MRI machine, or fMRI, the researchers scanned the brains of 42 people with OCD, ages 18 to 60, before and after four weeks of intensive, daily cognitive behavioral therapy. Researchers specifically analyzed how different areas of the brain activate in sync with each other -- a property called functional connectivity -- during a period of rest. Functional MRI does this by measuring blood flow in the brain, which correlates with neurons' activity levels. In addition, the scientists assessed the severity of participants' OCD symptoms before and after the treatment, using a scaled system in which a lower score indicates less severe or less frequent symptoms.
Lack of sleep could contribute to mental health problems, researchers reveal | Society | The GuardianAfter taking into account effects not linked to treatment – as deduced from the no-treatment group – insomnia in the CBT group was found to have fallen by almost half 10 weeks into the study, while both anxiety and depression dropped by a fifth, and paranoia and hallucinations fell by 25% and 30% respectively. “Having insomnia doubles your chances of developing depression and we now know that if you treat the insomnia it reduces depression,” said Freeman.
Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset SchizophreniaThe UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community “moments feed” to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform.
CBT plus video games plus heart rate monitorsIn a subsequent outpatient study the researchers randomized 20 youth to 10 cognitive behavior therapy sessions and videogame therapy that required them to control their heart rate, and 20 youth to CBT with the same videogame but not linked to heart rates. All the adolescents had anger or aggression problems, said Dr. Gonzalez-Heydrich, who was senior author of the study. Therapists interviewed the children’s primary caregiver before and two weeks after their last therapy session. They found the children’s ratings on aggression and opposition were reduced much more in the group that played the game with the built-in biofeedback. The ratings for anger went down about the same in both groups. The findings were presented at the American Academy of Child and Adolescent Psychiatry conference in 2015. The study is currently under review for publication.
Meta analysis: exercise promotion is ineffective for social anxiety disorder (see powerpoint slide)All psychological interventions apart from promotion of exercise and other psychological therapies (supportive therapy, mindfulness, and interpersonal psychotherapy) had greater effects on outcomes than did waitlist (table; figure 3). In decreasing order of effect size, these were individual cognitive–behavioural therapy (CBT; class effect SMD −1·19, 95% CrI −1·56 to −0·81), group CBT (−0·92, −1·33 to −0·51), exposure and social skills (−0·86, −1·42 to −0·29), self-help with support (−0·86, −1·36 to −0·36), self-help without support (−0·75, −1·25 to −0·26), and psychodynamic psychotherapy (−0·62, −0·93 to −0·31).
Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis - The Lancet PsychiatryIndividual CBT compared with psychological placebo (SMD −0·56, 95% CrI −1·00 to −0·11), and SSRIs and SNRIs compared with pill placebo (−0·44, −0·67 to −0·22) were the only classes of interventions that had greater effects on outcomes than appropriate placebo. Individual CBT also had a greater effect than psychodynamic psychotherapy (SMD −0·56, 95% CrI −1·03 to −0·11) and interpersonal psychotherapy, mindfulness, and supportive therapy (−0·82, −1·41 to −0·24). Interpretation Individual CBT (which other studies have shown to have a lower risk of side-effects than pharmacotherapy) is associated with large effect sizes. Thus, it should be regarded as the best intervention for the initial treatment of social anxiety disorder. For individuals who decline psychological intervention, SSRIs show the most consistent evidence of benefit.
Why Exercise May Be the Best Fix for Depression - Scientific Americanin 2015, Swedish scientists assigned 946 patients with mild to moderate depression to one of three 12-week treatments: thrice-weekly sessions of yoga, aerobics or strength training; Internet-based cognitive-behavioral therapy; or standard counseling plus medication. Patients in all groups improved, but those engaging in exercise experienced the greatest benefits. Internet-based therapy came in as a close runner-up, but the typical treatment plan lagged behind both alternatives.
Look at the ends -- what's being controlled -- not the meansHomeFeatured Study Reveals How Little We Know About Each Other’s Intentions Neuroscience NewsJanuary 19, 2017 FeaturedNeuroscience VideosOpen Neuroscience ArticlesPsychology5 min read Summary: Researchers report people need to understand what a person is trying to control by using a certain behavior, rather than trying to change the behavior itself. Source: University of Manchester. Psychologists from The University of Manchester have shown how difficult it is for us to guess the true intention of each other’s behaviour. The study, published today in Attention, Perception, and Psychophysics, has important implications on public policies designed to impact on areas such as smoking, obesity, eating disorders, self-harm, alcohol use and gambling. Clinical psychologist Dr Warren Mansell, who led the study, says policy makers need to accurately understand what a person is trying to control using their behaviour, rather than trying to change the behaviour itself. He said: “We think we know what someone is doing just by observing them. For example if we see someone move a steering wheel of their car, we assume they are aiming to keep their car in the centre of the lane. “But our study shows that it is incredibly easy to be mistaken – and that has important implications on anyone whose task is to change human behaviour. “In psychological research, for example, this study suggests that some behaviour studied may be no more than a side effect of participants’true intentions. “We should therefore avoid focusing on people’s behaviour itself . That would lead to multiple and inevitably futile interventions for each and every problem.” He added: “In terms of public policy, we frequently we see money spent on another new initiative for ‘behaviour change’. “Yet if these behaviours are just side effects of people trying to exert control, then this multi-pronged approach to health is highly inefficient and fails to address the common root cause of people’s difficulties. “You need to ask people what they want in their life and how they solve their problems. Smoking, for example, is just one of many different ways in which a person might try to control something important to them – such as their social confidence, or emotional state.”
CBT creates lasting changes in connectivity, drugs do notIn the original study, participants underwent fMRI imaging to assess the brain’s response to images of faces expressing different emotions, before and after six months of CBT. Participants were already taking medication when they took part in the study, and so were compared to a group receiving medication only. The group receiving medication only did not show any increases in connectivity, suggesting that the effects on brain connections could be attributed to the CBT. For the new study, the health of 15 of the 22 participants who received CBT was tracked for eight years through their medical records. They were also sent a questionnaire at the end of this period to assess their level of recovery and wellbeing. The results show that increases in connectivity between several brain regions – most importantly the amygdala (the brain’s threat centre) and the frontal lobes (which are involved in thinking and reasoning) – are associated with long-term recovery from psychosis. This is the first time that changes in the brain associated with CBT have been shown to be associated with long-term recovery in people with psychosis.
Talking therapy changes the brain's wiring, study reveals for first time -- ScienceDailyCBT -- a specific type of talking therapy -- involves people changing the way they think about and respond to their thoughts and experiences. For individuals experiencing psychotic symptoms, common in schizophrenia and a number of other psychiatric disorders, the therapy involves learning to think differently about unusual experiences, such as distressing beliefs that others are out to get them. CBT also involves developing strategies to reduce distress and improve wellbeing. The findings, published in the journal Translational Psychiatry, follow the same researchers' previous work which showed that people with psychosis who received CBT displayed strengthened connections between key regions of the brain involved in processing social threat accurately. The new results show for the first time that these changes continue to have an impact years later on people's long-term recovery.
Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depressionWithin-patient Socratic questioning significantly predicted session-to-session symptom change across the early sessions, with a one standard deviation increase in Socratic-Within predicting a 1.51-point decrease in BDI-II scores in the following session. Within-patient Socratic questioning continued to predict symptom change after controlling for within-patient ratings of the therapeutic alliance (i.e., Relationship and Agreement), suggesting that the relation of Socratic questioning and symptom change was not only independent of stable characteristics, but also within-patient variation in the alliance.
Socratic questioningIf you’re having trouble challenging your negative thoughts, try this approach. Imagine that your friend is the one who received the bad news. What advice would you give him or her? Now think of how that advice might apply to you. A study conducted at Ohio State University found that this method — known as Socratic questioning — was a simple way to reduce depressive symptoms in adults. In the study, 55 adults were enrolled in a 16-week course of cognitive therapy sessions. Researchers studied videotapes of the sessions and found that the more frequently therapists used Socratic questioning, the more the patients’ depressive symptoms lessened. The study’s authors theorized that Socratic questioning helped patients examine the validity of their negative thoughts and gain a broader, more realistic perspective on them.
The Lancet: Simpler, cheaper psychological treatment as effective as cognitive behavioural therapy for treating depression | EurekAlert! Science News"Behavioural activation is an 'outside in' treatment that focuses on helping people with depression to change the way they act. The treatment helps people make the link between their behaviour and their mood. Therapists help people to seek out and experience more positive situations in their lives. The treatment also helps people deal with difficult situations and helps them find alternatives to unhelpful habitual behaviours," explains Professor Richards. "In contrast, CBT is an 'inside out' treatment where therapists focus on the way a person thinks. Therapists help people to identify and challenge their thoughts and beliefs about themselves, the world, and their future. CBT helps people to identify and modify negative thoughts and the beliefs that give rise to them."
The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analysesCognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
For example, cognitive-behavioral therapy (CBT) has been shown to be the most effective treatment for PTSD and has the fewest side-effects, yet many psychologists do not use this method. Baker and colleagues cite one study in which only 30 percent of psychologists were trained to perform CBT for PTSD and only half of those psychologists elected to use it. That means that six of every seven sufferers were not getting the best care available from their clinicians. Furthermore, CBT shows both long-term and immediate benefits as a treatment for PTSD; whereas medications such as Paxil have shown 25 to 50 percent relapse rates.