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Ham, Ok Kyung, Bo Gyeong Lee, Eunju Choi, and Su Jung Choi. "Efficacy of Cognitive Behavioral Treatment for Insomnia: A Randomized Controlled Trial." Western Journal of Nursing Research 42, no. 12 (April 22, 2020): 1104–12. http://dx.doi.org/10.1177/0193945920914081.
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This study examined the effects of cognitive behavioral treatment for insomnia. A randomized controlled trial was performed on 44 women. The intervention included one group session of sleep hygiene education and four individual sessions of counseling. The instruments included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, the Center for Epidemiological Studies Depression Scale, and Menopausal quality of life. The data were analyzed using repeated measure MANOVA, followed by repeated measure ANOVA. Repeated measure MANOVA showed that time had a significant main effect on the anthropometric variables (body mass index, waist circumference, and blood pressures) and revealed significant main effects of the group and time on the psychosocial variables (sleep quality, insomnia, depressive symptoms, and quality of life) ( p < .05). Repeated measure ANOVA results indicated a significant effect of the group on insomnia and sleep quality ( p < .05). Overall, the intervention was effective in improving insomnia and poor sleep quality.
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Ionescu, Claudiu Gabriel, Ovidiu Popa-Velea, Alexandra Ioana Mihăilescu, Ana Anca Talaşman, and Ioana Anca Bădărău. "Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment." Healthcare 9, no. 9 (August 30, 2021): 1128. http://dx.doi.org/10.3390/healthcare9091128.
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This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957–2020. Search terms included “somatic symptoms disorder”, “sleep disorders”, “insomnia”, “somatoform”, “somatization”, “therapeutic”, “psychotherapy”, and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4–48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.
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Jansson-Fröjmark, Markus, and Kalle Jacobson. "Cognitive behavioural therapy for insomnia for patients with co-morbid generalized anxiety disorder: an open trial on clinical outcomes and putative mechanisms." Behavioural and Cognitive Psychotherapy 49, no. 5 (January 28, 2021): 540–55. http://dx.doi.org/10.1017/s1352465821000023.
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AbstractBackground:Very little is known concerning the efficacy of psychosocial treatments for patients with insomnia disorder co-morbid with generalized anxiety disorder (GAD).Aim:The aim was to examine the efficacy of cognitive behavioral therapy for insomnia (CBT-I) for patients with insomnia disorder co-morbid with GAD.Method:Given the limited, previous research on therapies for patients with insomnia disorder co-morbid with GAD, an open trial design was used. Twenty-four patients with insomnia disorder and GAD were administered CBT-I across 10 weeks. Across the study period to 6 months follow-up, the participants completed measures indexing insomnia, anxiety, worry, depression, functional impairment, quality of life, treatment perception (credibility, expectancy and satisfaction), adverse events and putative mechanisms.Results:Moderate to large effect sizes for CBT-I were observed for insomnia symptoms. In terms of insomnia severity, approximately 61% of the patients responded to CBT-I and 26–48% remitted. Moderate to large effect sizes were also demonstrated for GAD symptoms, depression, functional impairment and quality of life. Roughly one-third of the participants reported an adverse event during CBT-I. Five of the seven putative mechanisms were significantly reversed in the expected direction, i.e. all four cognitive process measures and time in bed.Conclusions:This open trial indicates that CBT-I is an efficacious intervention for patients with insomnia disorder co-morbid with GAD. The results highlight the need for further research using a randomized controlled trial design with analyses of mechanisms of change.
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Barnes, E. A., and E. Bruera. "Fatigue in patients with advanced cancer: A review." International Journal of Gynecologic Cancer 12, no. 5 (2002): 424–28. http://dx.doi.org/10.1136/ijgc-00009577-200209000-00002.
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Fatigue is the most common symptom in patients with advanced cancer. It is a subjective sensation with physical, cognitive, and affective modes of expression. The etiology is often unclear, and multiple potential etiologic factors for fatigue may coexist. Assessing fatigue involves characterizing its severity, temporal features, exacerbating and relieving factors, associated distress, and impact on daily life. Potential factors contributing to fatigue are the cancer itself, cancer treatment, cancer or treatment complications, medications, and other physical and psychosocial conditions. Many fatigue assessment tools exist. Fatigue management involves specific (targeting potentially reversible causes of fatigue) and symptomatic (targeting symptoms because no obvious etiology or reversible cause for fatigue can be identified) intervention and treatment measures. Specific interventions include treating anemia or metabolic and endocrine abnormalities, as well as managing pain, insomnia, depression, and anxiety. Symptomatic treatment involves education, counseling, and pharmacologic, and nonpharmacologic measures. Pharmacologic agents that have been investigated for use in treating fatigue include corticosteroids, progestational agents, and psychostimulants. Agents that modulate cytokine activity are future treatment possibilities.
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Lowery-Allison, Amy E., Steven D. Passik, Matthew R. Cribbet, Ruth A. Reinsel, Barbara O'Sullivan, Larry Norton, Kenneth L. Kirsh, and Neil B. Kavey. "Sleep problems in breast cancer survivors 1–10 years posttreatment." Palliative and Supportive Care 16, no. 3 (May 16, 2017): 325–34. http://dx.doi.org/10.1017/s1478951517000311.
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ABSTRACTObjective:Sleep can affect quality of life (QoL) during cancer survivorship, and symptoms related to poor sleep can be exacerbated. We examined the prevalence, severity, and nature of subjective sleep complaints in women surviving stage I–III breast cancer who were 1–10 years posttreatment. We also examined the demographic, medical, physical, and psychosocial correlates of poor sleep in these women in order to identify the subgroups that may be most in need of intervention.Method:A total of 200 patients at a comprehensive cancer center who were 1–10 years posttreatment for primary stage I–III breast cancer with no evidence of disease at the time of enrollment completed a battery of questionnaires on demographics, sleep, physical symptoms, mood, cancer-specific fears, and QoL.Results:The women had a mean age of 57 years (SD = 10.0), with a mean of 63.3 months (SD = 28.8) of post-cancer treatment. Some 38% of these patients were identified as having poor-quality sleep. Women with poor sleep took longer to fall asleep, had more awakenings, and acquired 2 hours less sleep per night than those with good sleep. They also had a lower QoL, greater severity of pain, more concerns about health and recurrence, and increased vasomotor symptoms (p < 0.05). Daytime sleepiness and depression were found to be not significantly correlated with sleep quality.Significance of results:Many breast cancer survivors had severe subjective insomnia, and several breast cancer survivor subgroups were identified as having members who might be most in need of sleep-improvement interventions. Addressing physical symptoms (e.g., vasomotor symptoms and pain) and providing education about the behavioral, social, environmental, and medical factors that affect sleep could result in substantial improvement in the life course of breast cancer survivors.
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Pinto Jr, Luciano Ribeiro, Rosana Cardoso Alves, Eliazor Caixeta, John Araujo Fontenelle, Andrea Bacellar, Dalva Poyares, Flavio Aloe, et al. "New guidelines for diagnosis and treatment of insomnia." Arquivos de Neuro-Psiquiatria 68, no. 4 (August 2010): 666–75. http://dx.doi.org/10.1590/s0004-282x2010000400038.
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The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
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Kozasa, Elisa Harumi, Helena Hachul, Carlos Monson, Luciano Pinto Jr., Marcelo Csermak Garcia, Luiz Eugênio de Araújo Moraes Mello, and Sérgio Tufik. "Mind-body interventions for the treatment of insomnia: a review." Revista Brasileira de Psiquiatria 32, no. 4 (December 2010): 437–43. http://dx.doi.org/10.1590/s1516-44462010000400018.
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OBJECTIVE: As insomnia is highly prevalent, and side effects of medication are well-known, mind-body interventions are increasingly being sought. The objective of this study is to present a narrative review regarding the effects of mind-body interventions for the treatment of insomnia. METHOD: A PubMed search was conducted including only randomized, controlled trials in which the main objective was to treat insomnia. DISCUSSION: Twelve studies were selected. In three of the studies, objective parameters (polysomnography) were analyzed. Mind-body interventions were able to improve sleep efficiency and total sleep time. Most can ameliorate sleep quality; some can reduce the use of hypnotic drugs in those who are dependent on these drugs. CONCLUSION: According to the studies we selected, self-reported sleep was improved by all mind-body treatments, among them yoga, relaxation, Tai Chi Chih and music. Cognitive behavioral therapy seems to be the most effective mind-body intervention. Cognitive behavioral therapy was the only intervention that showed better results than medication. However, considering that only five of the twelve studies chosen reached a score of 3 in the Jadad scale, new studies with a higher methodological quality have to be conducted especially in mind-body interventions that belong to the complementary or alternative medicine field.
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Toner, Brenda B. "Cognitive-Behavioral Treatment of Irritable Bowel Syndrome." CNS Spectrums 10, no. 11 (November 2005): 883–90. http://dx.doi.org/10.1017/s1092852900019854.
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ABSTRACTThere is increasing evidence that supports the view that irritable bowel disorder (IBS) is a disorder of brain-gut function. Cognitive-behavioral therapy (CBT) has received increased attention in light of this recent shift in the conceptualization of IBS. This review has two main aims. The first is to provide a critical review of controlled trials on CBT for IBS. The second is to discuss ways of further developing CBT interventions that are more clinically relevant and meaningful to health care providers and individuals with a diagnosis of IBS. A theme from a CBT intervention will be presented to illustrate how CBT interventions can be incorporated within a larger social context. A review of CBT for IBS lends some limited support for improvement in some IBS symptoms and associated psychosocial distress. This conclusion needs to be expressed with some caution, however, in light of many methodological shortcomings including small sample sizes, inadequate control conditions and failure to identify primary versus secondary outcome measures. In addition, future studies will need to further develop more relevant CBT protocols that more fully integrate the patient's perspective and challenge social cognitions about this stigmatized disorder.
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Bradshaw, William. "Cognitive-Behavioral Treatment of Schizophrenia: A Case Study." Journal of Cognitive Psychotherapy 12, no. 1 (January 1998): 13–25. http://dx.doi.org/10.1891/0889-8391.12.1.13.
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Cognitive-behavioral treatment (CBT) has rarely been applied as the primary treatment for the multiple, severe and persistent problems that characterize schizophrenia. This case study describes the process of CBT in the long-term outpatient care of a young woman with schizophrenia. The study highlights the adaptation of cognitive-behavioral strategies to the unique needs of schizophrenia and presents data regarding clinical outcomes in this case. Measures of psychosocial functioning, severity of symptoms, attainment of treatment goals and hospitalization data were used to assess change over the 3- year treatment period and at 1-year follow-up. Results indicate considerable improvement in all outcome variables and maintenance of treatment gains. These findings suggest the potential usefulness of cognitive-behavioral interventions in the treatment of schizophrenia.
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Klomek, Anat Brunstein, and Barbara Stanley. "Psychosocial Treatment of Depression and Suicidality in Adolescents." CNS Spectrums 12, no. 2 (February 2007): 135–44. http://dx.doi.org/10.1017/s1092852900020654.
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ABSTRACTDepression is a common disorder among adolescents and is associated with a high risk of suicide. Suicide is the third leading cause of death among adolescents in the United States. Currently, there are only two evidence-based psychotherapies for adolescence depression: cognitive-behavioral therapy and interpersonal psychotherapy. Furthermore, psychosocial interventions that specifically target suicidal behavior in adolescents are even fewer in number than treatments for depression. This article will review the psychosocial interventions for depression and suicidality in adolescents and will describe a recently developed treatment that is under study for depressed suicidal adolescents.
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Miranda, Joyal, Souraya Sidani, Jose Côté, and Suzanne Fredericks. "A scoping review of insomnia treatments for people living with HIV." International Health Trends and Perspectives 1, no. 1 (April 4, 2021): 61–73. http://dx.doi.org/10.32920/ihtp.v1i1.1422.
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To date, little is known in terms of viable treatments for insomnia in people living with HIV. The primary aim of this scoping review is to identify non-pharmacological treatments for insomnia in people living with HIV (PLWH). A framework by Arksey and O’Malley was used to guide the conduct of this scoping review. Seven studies were identified. Three of the studies used cognitive-behavioral type of treatments versus physical or alternative types of treatment. The most effective treatments with the largest effect sizes were found to be cognitive-behavioral treatments for the sleep outcomes of sleep quantity (1.11-1.91) and sleep quality (1.11-1.91). This review found that cognitive behavioral interventions were found to be the most effective treatments for insomnia for PLWH. Further research would benefit from larger sample size studies in addition to focusing on the determinants of insomnia in PLWH in order to further provide a treatment that is focused on the needs of PLWH.
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Loveless, James P., Jaclyn M. Russo, and Virginia C. Andersen. "The Successful Treatment of Insomnia in a Patient With a Complex Neurological History." Clinical Case Studies 19, no. 2 (December 4, 2019): 101–14. http://dx.doi.org/10.1177/1534650119890123.
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Insomnia is one of the more common sleep–wake disorders from which people suffer. This is particularly true among individuals who have experienced neurological insult via conditions such as multiple sclerosis, stroke, and other neurodegenerative disorders. While cognitive-behavioral therapy for insomnia (CBT-I) is one of the most effective behavioral interventions for insomnia, there is a dearth of empirical literature on its application to patients who have a history of neurological disorders. The present case study illustrates a largely successful course of CBT-I to treat a persistent and severe case of insomnia for Eric, a 55-year-old Caucasian man with multiple sclerosis and a self-reported history of restless leg syndrome and stroke. His treatment course is described in detail, and the implications of this approach to care are discussed.
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Bianchi, Matt. "Chronic Insomnia." Seminars in Neurology 37, no. 04 (August 2017): 433–38. http://dx.doi.org/10.1055/s-0037-1605344.
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AbstractInsomnia is characterized by difficulty falling asleep or staying asleep, with consequent daytime impairment of mental and/or physical function. A detailed clinical history reveals the relative impact of a variety of different contributing and perpetuating factors, which then informs prioritization among different treatment options. Nonpharmacological approaches, especially the validated approach of cognitive–behavioral therapy for insomnia, are preferred over hypnotic medications. If hypnotics are chosen, the goal is short-term interventions after a careful risk-benefit assessment and shared decision-making with the patient. Although objective testing via polysomnography is not routinely indicated, such investigations can be informative in those at risk for concurrent primary sleep disorders, and in those who are treatment refractory. Circadian rhythm disorders can present with insomnia complaints, but are managed with chronotherapy. Whatever management pathway is pursued, the response to therapy should be anchored in improvements in daytime function.
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Garland, Sheila N., Sharon X. Xie, Kate DuHamel, Ting Bao, Qing Li, Frances K. Barg, Sarah Song, Philip Kantoff, Philip Gehrman, and Jun J. Mao. "Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial." JNCI: Journal of the National Cancer Institute 111, no. 12 (April 9, 2019): 1323–31. http://dx.doi.org/10.1093/jnci/djz050.
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AbstractBackgroundInsomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown.MethodsThis randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided.ResultsThe mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P < .001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: −8.31 points, 95% confidence interval = −9.36 to −7.26; CBT-I: −10.91 points, 95% confidence interval = −11.97 to −9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P < .001), white (P = .003), highly educated (P < .001), and had no pain at baseline (P < .001).ConclusionsAlthough both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.
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Nimrouzi, Majid, Babak Daneshfard, Vahid Tafazoli, and Rahimeh Akrami. "Insomnia in traditional Persian medicine." Acta medico-historica Adriatica 17, no. 1 (July 1, 2019): 45–54. http://dx.doi.org/10.31952/amha.17.1.2.
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Insomnia is a common complaint in outpatient clinics. It usually affects quality of life negatively, especially in severe cases. Nowadays, routine medical interventions comprise pharmacological approaches and cognitive behavioral therapy. Common medications used by afflicted patients are not competent enough in addition to their annoying side effects. It would naturally denote the need for considering novel strategies for treating insomniac patients. Approach to insomnia in traditional Persian medicine (TPM) has been cited in a scrutinized manner focusing on its main causes. Accordingly, its treatment is tailored based on the constitution of the patient, intensity of the disease, and type of the cause. In this paper we have discussed the causes of insomnia, diagnostic approach, and various medical interventions proposed in valid sources of TPM.
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Reilly-Harrington, Noreen. "Psychosocial Treatment for Bipolar Disorder." CNS Spectrums 15, S3 (February 2010): 14–16. http://dx.doi.org/10.1017/s1092852900027784.
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Medication is the mainstay of treatment for bipolar disorder. However, no medication will be effective if patients do not take it, and the rates of medication compliance in bipolar disorder are very low. Johnson and McFarland found that the modal length of compliance with a mood stabilizer was only 2 months. Keck and colleagues found that 50% to 66% of patients with bipolar disorder exhibit poor compliance within the first 12 months of treatment. In addition, even with adequate medication compliance, high rates of relapse persist.Adjunctive psychosocial treatments can help reduce relapse and provide patients as well as their families with tools to manage bipolar disorder more effectively. Several forms of intensive psychotherapy have shown promise for the treatment of bipolar disorder. In the Systematic Treatment Enhancement Program for Bipolar Disorder, Miklowitz and colleagues compared three forms of intensive interventions: cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy, and family-focused treatment. These were compared to a brief, 3-session psychoeducational intervention known as collaborative care. A total of 293 depressed patients with bipolar type I or type II disorder were treated with protocol pharmacotherapy and were randomly assigned to either one of the three intensive interventions or the brief psychoeducational intervention.The three intensive interventions provided up to 30 sessions of treatment over a 9-month period. The collaborative care intervention consisted of three sessions administered over a 6-week period. The authors found that patients who received one of the intensive interventions had a median time to recovery 110 days earlier than patients who had received the collaborative care conditions. Patients who received one of the three intensive psychotherapies also had significantly higher year-end recovery rates, and are more than 1 to 1.5 times more likely to be clinically well during any study month. No statistically significant differences were found between the 3 intensive treatments.
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Kalmbach, D. A., A. Cuamatzi-Castelan, C. V. Tonnu, T. Roth, R. Sangha, L. M. Swanson, L. M. O’Brien, and C. L. Drake. "0470 A Randomized Controlled Trial of Digital Cognitive Behavioral Therapy for Insomnia in Pregnant Women." Sleep 43, Supplement_1 (April 2020): A180. http://dx.doi.org/10.1093/sleep/zsaa056.467.
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Abstract Introduction Over half of pregnant women experience clinical insomnia, which is linked to perinatal depression and cognitive-emotional dysregulation. Despite high rates of prenatal insomnia and known maternal consequences, efficacious insomnia treatment options for this population are woefully scant. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy digital CBTI via mobile health app in pregnant women with insomnia. Methods Single-site RCT. Ninety-one pregnant women (29.03±4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. Blinded assessments were performed before treatment, after treatment (during pregnancy), and 6 weeks after childbirth. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale’s Cognitive factor (PSAS-C) served as study outcomes. Results From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p<.001) and PSQI (-2.98 points, p<.001) and increases in nightly sleep duration by 32 minutes. Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 minutes per night (p=.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed. Conclusion Digital CBTI improves sleep quality and increases sleep duration during pregnancy and after childbirth. Digitally delivered interventions have potential to improve the health of new and expectant mothers, but CBTI likely needs to be tailored for perinatal patients to optimize outcomes. Support This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach).
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Abreu, T. "Cognitive-behavioral therapy for bipolar disorder." European Psychiatry 33, S1 (March 2016): S556. http://dx.doi.org/10.1016/j.eurpsy.2016.01.2055.
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IntroductionBipolar disorder is a chronic disease with a major impact on patient's functioning and quality of life, not only during episodes of mania/hypomania or depression, but also during euthymic periods. In recent years, it has been noticed that pharmacotherapy, albeit its great value, is not enough to prevent recurrences of the disease. Therefore, it has been a greater investment in psychosocial interventions as adjuvant treatment. The utmost studied of these interventions is Cognitive-Behavioral Therapy (CBT).Objectives and aimsGather information about the efficacy of CBT in bipolar disorder.MethodsLiterature review.ResultsSeveral studies have compared groups of bipolar patients submitted to CBT to controls submitted to treatment as usual. The methods and size of samples differ, but the results are in general concordant. Individual or group CBT has had positive results in reducing symptoms, increasing the euthymic periods, decreasing duration of episodes and improving global functioning and quality of life.ConclusionsThere are limitations on the application of CBT in bipolar patients, mainly the decrease of its effects over time; less efficiency in patients with more severe disease; major impact on depressive symptoms than manic; and lack of human resources trained to apply these techniques. Notwithstanding these limitations, the demonstrated gain in the use of CBT on bipolar disorder is evident; hence, investment in this area is undoubtedly important.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Pallesen, S., I. H. Nordhus, G. Kvale, G. H. Nielsen, O. E. Havik, B. H. Johnsen, and S. Skjøtskift. "Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions." Behaviour Research and Therapy 41, no. 1 (January 2003): 31–48. http://dx.doi.org/10.1016/s0005-7967(01)00122-x.
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Pigeon, Wilfred R., Todd M. Bishop, and Jonathan A. Marcus. "Current Pharmacological and Nonpharmacological Options for the Management of Insomnia." Clinical Medicine Insights: Therapeutics 5 (January 2013): CMT.S10239. http://dx.doi.org/10.4137/cmt.s10239.
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Insomnia continues to be a major public health concern and to have a pronounced and detrimental effect on health care costs, productivity, and quality of life. Efficacious pharmacological and nonpharmacological interventions have emerged over the past few decades, giving providers several options for addressing this disruptive condition; these are herein reviewed. Benzodiazepines have long been the pharmacological treatment of choice for insomnia; however, novel hypnotics being developed by the pharmaceutical industry show promise in addressing insomnia with fewer side effects. From the nonpharmacological perspective, several different single-component interventions such as stimulus control have been shown to be effective, although a combination of these approaches (eg, cognitive-behavioral therapy for insomnia) also enjoy strong empirical support. Future research should continue to examine how sequencing of treatment components, treating different patient cohorts, and combinations of pharmacological and non-pharmacological treatments influence patient outcome.
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Maroto Martin, L., and P. Hervías Higueras. "Psychosocial therapy in schizophrenia." European Psychiatry 33, S1 (March 2016): S566. http://dx.doi.org/10.1016/j.eurpsy.2016.01.2099.
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IntroductionPsychosocial interventions are an essential part of the treatment of schizophrenia and are aimed at promoting the social, family and occupational functioning of the patient and relapse prevention. They are considered proven clinical measures whenever necessary, however they tend to be underused.ObjectiveAnswer the question on psychosocial therapies available today for schizophrenia.MethodsReview through PubMed by entering the following keywords: psychosocial therapy; schizophrenia; cognitive behavioral therapy, and clinical practice guidelines.DiscussionThere are several psychosocial therapies used in clinical practice. The main points of approach focus on self-management of the disease, everyday problems, education, crisis intervention, and acquiring insight. The cognitive impairment is an important aspect of schizophrenia to consider. It seems that cognitive remediation therapy has been associated with both neurobiological and cognitive improvement.ConclusionsThe combination of different therapies along with psychopharmacological treatment appears to provide better results in the reduction of negative symptoms, positive symptoms and reduced hospital stay.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Dom, G. "Pharmacological Management of Impulsivity and Compulsivity." European Psychiatry 41, S1 (April 2017): S22. http://dx.doi.org/10.1016/j.eurpsy.2017.01.121.
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Increasingly patients present themselves to psychiatrists and other care providers with a specific request for treatment of one or more behavioral addictions. From a pathogenic point of view impulsivity and compulsivity are important drivers of these behavioral disorders, and as such may represent a target of pharmacological and broader neurobiological, e.g. Neuro-stimulation, treatment. Although currently treatment as usual has a focus on psychosocial and cognitive behavioral interventions, interest is growing toward the pharmacological interventions. In the presentation a state of the art will be presented regarding the pharmacological treatment of behavioral addictions, with a focus on Gambling Disorder and Gaming Disorder.Disclosure of interestMember Advisory Board Lundbeck - Belgium.Received funding from Belgian LOTTO for research into Cognitive Behavioral Therapy for Gambling Disorder.
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Ferris, Steven H., and Mary S. Mittelman. "Behavioral Treatment of Alzheimer's Disease." International Psychogeriatrics 8, S1 (October 1996): 87–90. http://dx.doi.org/10.1017/s1041610296003146.
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In examining the current status and future potential of behavioral treatments for Alzheimer's disease (AD), it is important to begin by defining the scope and goals of such treatments. The category of behavioral treatments includes not only nonpharmacologic techniques to modify or enhance patient behavior, but also psychosocial interventions applied to family members and paid care providers. Caregiver interventions are important because they can reduce the negative impact of AD on those directly and indirectly affected by the disease. Based on current knowledge about the pathophysiology of AD, it is not considered likely that behavioral treatments can have a direct impact on the disease itself by affecting its clinical onset, rate of progression, or prognosis. Although it is conceivable that certain long-term behavioral interventions might delay onset of symptoms (e.g., mental “exercise” to enhance dendritic growth and increase “cognitive reserve,” or long-term stress reduction methods to minimize possible degenerative central nervous system effects of chronic stress), such approaches remain speculative, and their effectiveness would be difficult and expensive to demonstrate. Thus, the current goal of behavioral treatments is to reduce the negative effects of AD on the patient, on the patient's primary caregiver and immediate family, on the healthcare system, and on society as a whole. Such a goal is far from trivial because (a) successful treatment of primary pathophysiology is not on the immediate horizon, and (b) the impact of AD on the family and society represents a major cost of this tragic disease.
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Verma, Sumedha, Nina Quin, Laura Astbury, Cornelia Wellecke, Joshua Wiley, Margot Davey, Shantha Rajaratnam, and Bei Bei. "365 Cognitive Behavioral Therapy and Light Dark Therapy for Postpartum Insomnia Symptoms: Findings from a Randomized Controlled Trial." Sleep 44, Supplement_2 (May 1, 2021): A145. http://dx.doi.org/10.1093/sleep/zsab072.364.
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Abstract Introduction Symptoms of insomnia are common in the postpartum period and are associated with a range of negative outcomes. Despite this, interventions to improve maternal postpartum sleep remain scarce. Cognitive Behavioral Therapy (CBT) and Light Dark Therapy (LDT) target two different mechanisms to reduce sleep disturbance. This randomized controlled trial examined the efficacy of CBT and LDT against a treatment-as-usual (TAU) condition in reducing maternal postpartum insomnia symptoms. Methods Nulliparous women 4–12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores [ISI] >7) were included; excluded were those with: current severe health/psychiatric conditions, unsettled infant behaviors, sleep-affecting medication use and photosensitivity. Eligible women were randomized 1:1:1 to 6 weeks of CBT (CBT for insomnia and fatigue), LDT (morning bright light therapy, evening light hygiene), or TAU. Interventions were therapist-assisted and personalized through two telephone calls and included automated self-help intervention materials (i.e., emails) delivered over six weeks. Symptoms of insomnia (ISI; primary outcome), fatigue, sleepiness, depression, and anxiety were assessed at baseline, mid-intervention, post-intervention, and 1-month post-intervention. Analyses were intention-to-treat latent growth models. Results 114 women were randomized (mean age = 32.20 ± 4.62 years) and 108 women completed the intervention. Compared to TAU, symptoms of insomnia significantly reduced from baseline to post-intervention in both CBT and LDT groups (p-values <.001), with very large effect sizes (d > 1.5) at post-intervention; gains were maintained at follow-up. Fatigue symptoms significantly reduced in the CBT group (p<.0001; d = 0.85) but not LDT (p = 0.11) compared to TAU at post-intervention; gains were maintained for CBT at follow-up. Group differences in sleepiness, depression, and anxiety were nonsignificant (all p > 0.08). Conclusion Therapist-assisted self-help CBT and LDT with different therapeutic mechanisms are both efficacious for reducing maternal insomnia symptoms during the postpartum period. Findings were mixed for fatigue, sleepiness and mood. Future research on predictors of treatment responses is needed. Support (if any) Australian National Health and Medical Research Council, Department of Education RTP Scholarship. Lucimed SA supplied light therapy glasses. Funders had no role in design/implementation of the trial. ANZCTR: ACTRN12618000842268.
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Costa, Marcelle Barrueco, and Tamara Melnik. "Effectiveness of psychosocial interventions in eating disorders: an overview of Cochrane systematic reviews." Einstein (São Paulo) 14, no. 2 (June 2016): 235–77. http://dx.doi.org/10.1590/s1679-45082016rw3120.
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ABSTRACT Eating disorders are psychiatric conditions originated from and perpetuated by individual, family and sociocultural factors. The psychosocial approach to treatment and prevention of relapse is crucial. To present an overview of the scientific evidence on effectiveness of psychosocial interventions in treatment of eating disorders. All systematic reviews published by the Cochrane Database of Systematic Reviews - Cochrane Library on the topic were included. Afterwards, as from the least recent date of these reviews (2001), an additional search was conducted at PubMed with sensitive search strategy and with the same keywords used. A total of 101 primary studies and 30 systematic reviews (5 Cochrane systematic reviews), meta-analysis, guidelines or narrative reviews of literature were included. The main outcomes were: symptomatic remission, body image, cognitive distortion, psychiatric comorbidity, psychosocial functioning and patient satisfaction. The cognitive behavioral approach was the most effective treatment, especially for bulimia nervosa, binge eating disorder and the night eating syndrome. For anorexia nervosa, the family approach showed greater effectiveness. Other effective approaches were interpersonal psychotherapy, dialectic behavioral therapy, support therapy and self-help manuals. Moreover, there was an increasing number of preventive and promotional approaches that addressed individual, family and social risk factors, being promising for the development of positive self-image and self-efficacy. Further studies are required to evaluate the impact of multidisciplinary approaches on all eating disorders, as well as the cost-effectiveness of some effective modalities, such as the cognitive behavioral therapy.
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Kurz, Alexander, Linda Clare, and Nicola T. Lautenschlager. "Add life to years: psychosocial interventions for people with cognitive disorders." International Psychogeriatrics 25, no. 9 (June 28, 2013): 1389–91. http://dx.doi.org/10.1017/s1041610213000938.
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As population longevity increases, living with cognitive disorders during a significant part of the remaining lifespan becomes a strong possibility for the majority of older adults. Therefore, the development of treatment strategies to address the principal causes of cognitive and functional decline is a healthcare priority. The aims of medical and psychological therapies vary according to clinical severity. In the stages of mild cognitive impairment and early dementia, maintaining personal independence and enjoyment of life is a major objective from individual, societal, and economical perspectives (Neugroschl and Wang, 2011; Mokhtariet al., 2012). Current anti-dementia drugs contribute to this goal to a very limited extent. In individuals with mild cognitive impairment these compounds do not prevent the onset of dementia (Raschettiet al., 2007), and in those diagnosed with early dementia, these compounds delay the worsening of symptoms only for several months (Kurz and Lautenschlager, 2010). Drugs with novel mechanisms of action are being developed for Alzheimer's disease and other neurodegenerative conditions. These have the potential to slow down the progression of pathology and expand the number of years for which patients remain at mild levels of cognitive and functional impairment. It is less likely that these treatments will stop cognitive and functional decline completely (Kurz and Perneczky, 2011). Therefore, psychosocial interventions are urgently needed in addition to current and future pharmacotherapy. At any level of cognitive and functional impairment the role of psychosocial interventions is to strengthen and make the best use of preserved skills in order to attain or maintain optimal levels of activity, participation, and interpersonal relationships. In contrast to drugs, psychosocial treatments primarily operate at the behavioral level. Some attempt to restore functions through cognitive, social, or physical activity, while others attempt to minimize disability through compensatory cognitive, behavioral, or environmental strategies. Recent research has shown that psychosocial interventions may increase regional cortical thickness or modify the pattern of neuronal network activation (Draganski and May, 2008; van Paasschenet al., 2009; Vosset al., 2010; Ericksonet al., 2011). These neurobiological effects clearly demonstrate that brain plasticity persists into old age, but the relationship to behavioral gains and the importance for the prevention of cognitive decline (Lautenschlageret al., 2012; Steffener and Stern, 2012; Valenzuelaet al., 2012) are currently unclear.
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Simon, S. L., L. J. Meltzer, A. A. Williamson, D. M. Graef, K. C. Byars, and S. M. Honaker. "0924 Adolescent Perceptions of Insomnia Treatment." Sleep 43, Supplement_1 (April 2020): A351. http://dx.doi.org/10.1093/sleep/zsaa056.920.
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Abstract Introduction Approximately 10% of adolescents meet diagnostic criteria for insomnia, which is associated with increased health problems, academic difficulties, and psychological morbidity. Empirical evidence supports cognitive-behavioral treatments for insomnia, yet research suggests adolescent insomnia is undertreated. Thus, the goal of this study was to evaluate adolescent perceptions about insomnia treatment seeking and strategies. Methods Adolescents ages 13-18 years with self-reported insomnia symptoms completed an online survey assessing treatment-seeking behaviors and management strategies. English-speaking participants were recruited using targeted Facebook advertising. Descriptive statistics were used to summarize results. Results Of the 3,014 survey respondents, participants were predominantly female (77%) and white non-Hispanic (71%), with a mean age of 16±1.3 years. Most (87%) met DSM-V diagnostic criteria for insomnia, but only 29% reported seeking professional help for insomnia. Of these, participants reported waiting an average of 1-2 years after symptom onset to seek treatment. Participants most often sought help from a mental health professional (18%) or primary care provider (13%), while <2% saw a sleep specialist. Across adolescents, the most commonly endorsed strategies to manage insomnia symptoms were daytime caffeine consumption (48%), staying out of bed except when trying to sleep (38%), and daily exercise (28%). Nearly half of participants endorsed currently using medications to help with sleep, most commonly melatonin (18%) and antihistamine-based sleep aids (10%). Participants reported greatest preference to take medication (64%), meet individually with a sleep specialist (48%), or use a phone or tablet application (40%) to help with sleep. While 30% of participants felt that sleep researchers should prioritize increasing access to insomnia treatment, 20% encouraged developing new modes for treatment delivery (e.g., online). Conclusion Adolescents with insomnia reported using behavioral and pharmacological strategies to help with sleep, with very few receiving treatment from a sleep specialist. Further research is needed to increase accessibility and acceptability of interventions for adolescent insomnia. Support N/A
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Miklowitz, David J., and Michael W. Otto. "New Psychosocial Interventions for Bipolar Disorder: A Review of Literature and Introduction of the Systematic Treatment Enhancement Program." Journal of Cognitive Psychotherapy 20, no. 2 (June 2006): 215–30. http://dx.doi.org/10.1891/jcop.20.2.215.
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What is the evidence that psychosocial treatment adds to the efficacy of pharmacotherapy in forestalling episodes of bipolar disorder (BPD)? This article gives the rationale for including psychosocial intervention in the outpatient maintenance of BPD. Attention is placed on 4 psychosocial modalities that have achieved empirical support in randomized trials: family-focused psychoeducational treatment (FFT), cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and group psychoeducation. FFT, CBT, and IPSRT are being contrasted with a psychosocial control condition in the context of the ongoing, multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). The objectives, design, and potential contributions of the STEP-BD study are explained. Future directions for the evaluation and dissemination of manual-based psychosocial interventions are discussed.
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Simning, Adam, and Kelsey V. Simons. "Treatment of depression in nursing home residents without significant cognitive impairment: a systematic review." International Psychogeriatrics 29, no. 2 (October 19, 2016): 209–26. http://dx.doi.org/10.1017/s1041610216001733.
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ABSTRACTBackground:Depression in nursing facilities is widespread and has been historically under-recognized and inadequately treated. Many interventions have targeted depression among residents with dementia in these settings. Less is known about depression treatment in residents without dementia who may be more likely to return to community living. Our study aimed to systematically evaluate randomized control trials (RCTs) in nursing facilities that targeted depression within samples largely comprised of residents without dementia.Methods:The following databases were evaluated with searches covering January 1991 to December 2015 (PubMed, PsycINFO) and March 2016 (CINAHL). We also examined national and international clinical trial registries including ClinicalTrials.gov. RCTs were included if they were published in English, evaluated depression or depressive symptoms as primary or secondary outcomes, and included a sample with a mean age of 65 years and over for which most had no or only mild cognitive impairment.Results:A total of 32 RCTs met our criteria including those testing psychotherapeutic interventions (n=13), psychosocial and recreation interventions (n=9), and pharmacologic or other biologic interventions (n=10). Seven psychotherapeutic, six psychosocial and recreation, and four pharmacologic or other biologic interventions demonstrated a treatment benefit.Conclusions:Many studies had small samples, were of poor methodological quality, and did not select for depressed residents. There is limited evidence suggesting that cognitive behavioral therapies, reminiscence, interventions to reduce social isolation, and exercise-based interventions have some promise for decreasing depression in cognitively intact nursing home residents; little can be concluded from the pharmacologic or other biologic RCTs.
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Kissoon, Trisha, Jennifer Fisher, and Sridharan Gururangan. "QOLP-11. PSYCHOSOCIAL IMPAIRMENT IN PEDIATRIC NEURO-ONCOLOGY PATIENTS AND THEIR CAREGIVERS." Neuro-Oncology 21, Supplement_6 (November 2019): vi199—vi200. http://dx.doi.org/10.1093/neuonc/noz175.831.
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Abstract BACKGROUND Complex multi-modality treatment for children with brain tumors can cause major distress for patients and caregivers. Active coordination of medical and psychosocial services can improve QoL for affected patients and their caregivers. Few studies have evaluated manifestations of psychosocial distress in pediatric neuro-oncology patients and their caregivers. OBJECTIVE We aim to describe symptoms of psychosocial impairment in children with brain tumors and their caregivers in order to identify possible actionable determinants of psychological wellness. METHODS Children older than 3 years of age diagnosed with a malignant brain tumor receiving care at a large tertiary center and their caregivers underwent psychosocial assessment using the Kessler-10 and the Pediatric Symptoms Checklist. Questionnaires were voluntarily completed at routine visits. Rates of primary outcomes, patient and caregiver distress as defined by the respective scoring scales, were calculated for both groups. Correlation between patient and caregiver distress was evaluated with a Spearman’s Rho calculation. RESULTS A total of 30 patient-caregiver dyads consented to participation and 60 total questionnaires were analyzed. Median patient age was 10 years. 80% of caregivers (N= 24/30) scored high for symptoms of psychological illness on Kessler-10 assessments. Patients exhibited substantial psychosocial impairment in physical (N= 22/30), emotional (N= 18/30), cognitive (N= 12/30), and social (N= 26/30) subdomains of the PSC. There was a significant correlation between clinical manifestations of patient and caregiver psychosocial distress, specifically with regards to symptoms of anxiety (p < 0.05) and depression (p < 0.05). CONCLUSIONS Pediatric neuro-oncology patients and caregivers report considerable levels of psychosocial impairment, particularly in physical, cognitive, emotional, and social function, as well as fatigue and insomnia. The majority of patients and caregivers exhibited coinciding symptoms, suggesting that family-based intervention may improve psychosocial stressors. This hypothesis requires future study to determine optimal timing and methods for intervention.
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Mao, Jun J., Kevin Liou, James Root, Qing Susan Li, Ting Bao, Sheila N. Garland, and Tim Ahles. "Acupuncture versus cognitive behavioral therapy for cognitive impairment in cancer survivors with insomnia: Implications for personalized medicine." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 11522. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.11522.
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11522 Background: Cognitive impairment is a prevalent condition among cancer survivors that lacks effective treatment and can be maintained and exacerbated by poor sleep. This study explored whether treating insomnia with acupuncture or Cognitive Behavioral Therapy for Insomnia (CBT-I) improves subjective and objective cognitive functions in cancer survivors. Methods: We analyzed cognitive outcomes from a pragmatic randomized trial comparing acupuncture versus CBT-I for cancer survivors with insomnia. Analysis was limited to those reporting cognitive impairment at baseline. Acupuncture and CBT-I were delivered over 8 weeks. Perceived cognitive ability was assessed using the Brown Attention-Deficit Disorder Scale (BADDS). Objective cognitive function was evaluated with the Buschke Selective Reminding Test (BSRT). All outcomes were evaluated at baseline, Week 8 (end of intervention), and Week 20 (12 weeks post-intervention). Results: Among 99 cancer survivors, mean age was 60.4 years, 56.6% were women, and 26.3% were non-white. The most common cancer types were breast (31.3%) and prostate (19.2%). Perceived cognitive ability improved in both acupuncture and CBT-I groups at weeks 8 and 20 relative to baseline (all P < 0.001). No significant between-group differences were noted in BADDS total score (p = 0.28), but the CBT-I group demonstrated a better BADDS attention subscale score than the acupuncture group at weeks 8 and 20 (p = 0.031). With regards to objective cognitive functions assessed by BSRT, acupuncture improved attention (p = 0.017), learning (p = 0.040), and memory (p = 0.0020) at Week 8, whereas CBT-I only improved attention at Week 20 (p = 0.0002); between-group differences were not statistically significant. Conclusions: Among cancer survivors with insomnia, both acupuncture and CBT-I improved cognitive impairment relative to baseline, but their relative effects differed: the CBT-I group showed slightly better subjective attention, whereas the acupuncture group may have improved objective memory. Further investigation of these two therapies may lead to effective and personalized interventions for cancer survivors. Clinical trial information: NCT02356575.
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Sullivan, John E., Namkee G. Choi, Christian E. Vazquez, and Margaret A. Neaves. "Psychosocial Depression Interventions for Dialysis Patients, With Attention to Latinos: A Scoping Review." Research on Social Work Practice 29, no. 8 (January 25, 2019): 910–23. http://dx.doi.org/10.1177/1049731518820134.
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Purpose: Depression is a common and debilitating condition that often goes undetected and untreated among people with end-stage renal disease (ESRD). We conducted a scoping review to identify psychosocial depression interventions for adult dialysis patients and gaps in depression care, with particular attention to Latinos, a group disproportionately affected by ESRD in the United States. Methods: We searched electronic databases and grey literature sources for studies in English and Spanish. Results: We found 36 studies including cognitive behavioral, problem-solving, hope, psychoeducation, expressive writing, and physical activity interventions. Twelve studies (33%) were U.S.-based, while the rest were conducted elsewhere. U.S.-based studies involved mostly individual-format cognitive behavioral therapy (CBT) interventions carried out during dialysis. CBTs showed the most promising effect on depression in both randomized clinical and quasi-experimental studies. Among 22 randomized trials reviewed, 1 reported participants with Latino/Hispanic ethnicity. Conclusions: More intervention research is needed for depression treatment with ESRD patients, especially Latinos.
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Savard, Josée, and Charles M. Morin. "Insomnia in the Context of Cancer: A Review of a Neglected Problem." Journal of Clinical Oncology 19, no. 3 (February 1, 2001): 895–908. http://dx.doi.org/10.1200/jco.2001.19.3.895.
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ABSTRACT: This article reviews the evidence on the diagnosis, epidemiology, etiology, and treatment of insomnia in the context of cancer and proposes several areas for future research. Clinical and diagnostic features of insomnia are described and prevalence estimates of insomnia complaints in cancer patients are summarized. Then, potential etiologic factors (ie, predisposing, precipitating, and perpetuating factors) and consequences of insomnia (ie, psychologic, behavioral, and health impact) in the context of cancer are discussed. Finally, pharmacologic and psychologic treatments previously shown effective to treat insomnia in healthy individuals are discussed as valuable treatment options for cancer patients as well. Because long-term use of hypnotic medications is associated with some risks (eg, dependence), it is argued that psychologic interventions (eg, stimulus control, sleep restriction, cognitive therapy) are the treatment of choice for sleep disturbances in the context of cancer, especially when it has reached a chronic course. However, the efficacy of these treatments has yet to be verified specifically in cancer patients.
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Sabioni, Pamela, and Bernard Le Foll. "Psychosocial and pharmacological interventions for the treatment of cannabis use disorder." F1000Research 7 (February 12, 2018): 173. http://dx.doi.org/10.12688/f1000research.11191.1.
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Cannabis use has been continuously increasing, and cannabis use disorder (CUD) has become a public health issue. Some psychosocial interventions have demonstrated the ability to reduce cannabis use; however, there are no pharmacotherapies approved for the treatment of CUD. Some drugs have shown limited positive effects on use and withdrawal symptoms, but no controlled studies have been able to show strong and persistent effects on clinically meaningful outcomes. The aim of this review is to synthesize the evidence from the available literature regarding the effectiveness of psychosocial and pharmacological treatments for CUD among adults (that is, 18 years old or older). An analysis of the evidence shows that the current best psychosocial intervention to reduce cannabis use is the combination of motivational enhancement therapy and cognitive-behavioral therapy, preferably accompanied by a contingency management approach. In regard to pharmacological interventions, there are mostly unclear findings. Some drugs, such as CB1 agonists, gabapentin, and N-acetylcysteine, have been shown to produce improvements in some symptoms of CUD in single studies, but these have not been replicated. Other classes of medications, including antidepressants and antipsychotics, have been unsuccessful in producing such effects. There is an imminent need for more clinical trials to develop more effective treatments for CUD.
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Annesi, James. "Effects of Treatment Differences on Psychosocial Predictors of Exercise and Improved Eating in Obese, Middle-Age Adults." Journal of Physical Activity and Health 10, no. 7 (September 2013): 1024–31. http://dx.doi.org/10.1123/jpah.10.7.1024.
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Background:Behavioral interventions for weight-loss have been largely unsuccessful. Exercise is the strongest predictor of maintained weight loss and much of its effects may be from associated changes in psychosocial factors.Methods:Middle-aged, formerly sedentary adults with severe obesity were randomly selected to 6-month treatments of cognitive-behavioral exercise support paired with either standard nutrition education (n = 99) or nutrition change supported by cognitive-behavioral means with an emphasis on self-regulation (n = 101).Results:Overall improvements in self-efficacy and self-regulation for both exercise and managed eating, and mood, were found, with significantly greater improvements associated with the cognitive-behavioral nutrition condition in self-regulation for eating and mood. Change scores trended toward being stronger predictors of increased exercise and fruit and vegetable intake than scores at treatment end. Multiple regression analyses indicated that significant portions of the variance in both increased volume of exercise (R2 = 0.45) and fruit and vegetable intake (R2 = 0.21) were explained by changes in self-regulatory skill usage, self-efficacy, and mood.Conclusions:Cognitive-behavioral methods for improved eating paired with behavioral support of exercise may improve weight loss through effects on the psychosocial factors of self-regulation, self-efficacy, and overall mood more than when standard nutrition education is incorporated.
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Hruschak, MSW, Valerie, Gerald Cochran, PhD, and Ajay D. Wasan, MD, MSc. "Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature." Journal of Opioid Management 14, no. 5 (September 1, 2018): 345–58. http://dx.doi.org/10.5055/jom.2018.0467.
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Objective: Opioid misuse in the context of chronic noncancer pain (CNCP) is a multifaceted and complex issue. As opioid misuse and corresponding rates of addiction and overdose deaths exceed epidemic proportions, there is an urgent need for research in this area. The objective of this review is to evaluate the literature addressing psychosocial interventions targeting CNCP and prescription opioid misuse.Design: A systematic search of PubMed, MEDLINE, PsychINFO, ClinicalTrials. gov was conducted to identify studies evaluating psychosocial interventions targeting CNCP and prescription opioid misuse. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results: 56 peer-reviewed research articles from 1993 to July, 2016, which included studies of psychosocial interventions for CNCP and opioid use disorders. Studies that examined psychosocial interventions for CNCP, treatment modalities included: cognitive behavioral therapy (CBT), acceptance and commitment therapy, mindfulness-based cognitive therapy and mindfulness-based stress reduction, and chronic pain self-management programs. The psychosocial interventions for opioid misuse included: CBT and relapse prevention, motivational enhancement therapy and stages of change, contingency management, and self-help and peer support-based groups.Conclusions: The findings of this review offer clinical insight and reinforce the importance of psychosocial interventions in CNCP and opioid use disorders. However, little empirical data are available to guide practitioners in treating patients with CNCP who misuse opioid medications, and thus future research on integrated approaches, is needed.
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Umbreit, Audrey, Shirshendu Sinha, Bhanu Prakash Kolla, and Meghna P. Mansukhani. "Challenges in the Treatment of Restless Legs Syndrome: A Case Report." Journal of Primary Care & Community Health 12 (January 2021): 215013272110195. http://dx.doi.org/10.1177/21501327211019590.
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Treatment resistant restless legs syndrome (RLS) in the setting of psychiatric comorbidities can be difficult to manage. Our patient is a 69-year-old Caucasian gentleman with bipolar disorder type I, unspecified anxiety disorder, obstructive sleep apnea (OSA), and treatment-refractory RLS. At initial presentation, the patient’s prescribed medication regimen included fluoxetine 40 mg daily, gabapentin 800 mg in the morning and 3200 mg at bedtime, pramipexole 0.375 mg daily, lamotrigine 200 mg daily, trazodone 200 mg at bedtime, and temazepam 15 to 30 mg as needed for insomnia and RLS. Over the course of nearly 4 years, treatment interventions for this patient’s RLS included: cognitive behavioral therapy for insomnia, discontinuation of exacerbating medications, switching dopamine agonists, use of pregabalin and iron supplement. This report demonstrates a challenging case of RLS in the setting of psychiatric comorbidities, development of augmentation, and polypharmacy.
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Applebaum, Allison J., Kara Buda, Michael A. Hoyt, Kelly Shaffer, Sheila Garland, and Jun J. Mao. "Feasibility and acceptability of cognitive behavioral therapy for insomnia (CBT-I) or acupuncture for insomnia and related distress among cancer caregivers." Palliative and Supportive Care 18, no. 6 (December 2020): 644–47. http://dx.doi.org/10.1017/s1478951520001017.
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AbstractObjectiveInsomnia is a common, distressing, and impairing psychological outcome experienced by informal caregivers (ICs) of patients with cancer. Cognitive behavioral therapy for insomnia (CBT-I) and acupuncture both have known benefits for patients with cancer, but such benefits have yet to be evaluated among ICs. The purpose of the present study was to evaluate the feasibility, acceptability and preliminary effects of CBT-I and acupuncture among ICs with moderate or greater levels of insomnia.MethodParticipants were randomized to eight sessions of CBT-I or ten sessions of acupuncture.ResultsResults highlighted challenges of identifying interested and eligible ICs and the impact of perception of intervention on retention and likely ultimately outcome.Significance of the resultsFindings suggest preliminary support for non-pharmacological interventions to treat insomnia in ICs and emphasize the importance of matching treatment modality to the preferences and needs of ICs.
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Shean, Glenn D. "Empirically Based Psychosocial Therapies for Schizophrenia: The Disconnection between Science and Practice." Schizophrenia Research and Treatment 2013 (2013): 1–8. http://dx.doi.org/10.1155/2013/792769.
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Empirically validated psychosocial therapies for individuals diagnosed with schizophrenia were described in the report of the Schizophrenia Patient Outcomes Research Team (PORT, 2009). The PORT team identified eight psychosocial treatments: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. PORT listings of empirically validated psychosocial therapies provide a useful template for the design of effective recovery-oriented mental health care systems. Unfortunately, surveys indicate that PORT listings have not been implemented in clinical settings. Obstacles to the implementation of PORT psychosocial therapy listings and suggestions for changes needed to foster implementation are discussed. Limitations of PORT therapy listings that are based on therapy outcome efficacy studies are discussed, and cross-cultural and course and outcome studies of correlates of recovery are summarized.
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Horowitz, Deborah, Margaret Guyer, and Kathy Sanders. "Psychosocial approaches to violence and aggression: contextually anchored and trauma-informed interventions." CNS Spectrums 20, no. 3 (May 11, 2015): 190–99. http://dx.doi.org/10.1017/s1092852915000280.
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Psychosocial interventions are part of the complex understanding and treatment of violent behavior in our state mental health hospitals. A comprehensive assessment of violence and aggression includes attention to all 3 domains of prevention and assessment (primary-institutional, secondary-structural, and tertiary-direct). Trauma experiences and their consequences may include behavioral violence and aggression. The authors’ premise is that trauma is a universal component in the individual assessment of violent behavior. Therapeutic interventions must include a trauma-informed formulation to be effective. Organizational commitment to trauma-informed, person-centered, recovery-oriented (TPR) care is crucial to the efficacy of any of the interventions discussed. Thus, the dynamic nature of the individual, interpersonal, environmental, and cultural factors associated with the daily operations of the inpatient unit need to be assessed through the lens of primary and secondary violence prevention, building on the recognition that the majority of persons served and staff have significant trauma histories. Once a compassionate, respectful, empathic, and empowering approach is embraced by leadership and staff, the work with individuals can proceed more effectively. Interventions used include a variety of cognitive-behavioral, interpersonal, and somatosensory therapies. These interventions, when effectively applied, result in more self-esteem, self-mastery, self-control for the person served, and diminished behavioral violence.
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Wetherell, Julie Loebach, and Jürgen Unützer. "Adherence to Treatment for Geriatric Depression and Anxiety." CNS Spectrums 8, S3 (December 2003): 48–59. http://dx.doi.org/10.1017/s1092852900008270.
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AbstractPatient nonadherence to pharmacologic and psychosocial treatments for geriatric depression and anxiety poses a serious barrier to effective clinical care. Rates of nonadherence may be as high as 60% in older adults. Factors associated with nonadherence include lack of information and misperceptions about mental illness and its treatment, stigma, lack of family support, cognitive impairment, adverse events, side effects, cost of treatments, poor physician-patient communication or relationship, and other barriers, such as lack of transportation. Effective interventions to improve adherence are personalized and include both behavioral and educational components. Several current projects that combine pharmacotherapy and psychotherapy for geriatric depression in an integrated care model show promise as interventions to improve rates of treatment and adherence.
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Qiu, S., and D. Linghui. "Psychosocial Interventions to Improve the Quality of Life for Men with Prostate Cancer: A Network Meta-analysis of 31 Randomized Controlled Trials." European Psychiatry 41, S1 (April 2017): S252—S253. http://dx.doi.org/10.1016/j.eurpsy.2017.02.043.
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BackgroundThe treatment of prostate cancer (PCa) can trigger a sequence of life-altering decisions that can induce depression and effects on health-related quality of life. We aimed to simultaneously compare all available psychosocial interventions using both direct and indirect data.MethodsIn this systematic review and network meta-analysis, we searched the Embase, Medline, PsycINFO, and the Cochrane central register of controlled trials for randomized controlled trials (RCT) published before Oct, 2016, that compared active treatments dealing with psychosocial problems in PCa patients after treatment. The primary outcome was health-related quality of life improvement as measured by the 36-Item Short-Form Health Survey (SF-36). Psychological morbidity was assessed with the Hospital Anxiety and Depression Scale (HADS). This study is registered with PROSPERO, number CRD42016049621.ResultsWe screened 113 potentially eligible studies and identified 31 RCTs, that examined 7 psychosocial interventions in 3643 PCa participants. In terms of SF-36, cognitive behavioral therapy [standard mean difference (SMD) 2·48, credible interval [CrI] 0.23 to 4.46], group based counseling (SMD 1·36, CrI 0·40 to 3·17) had significantly greater effects than usual care. Participants assigned to all assessed interventions had a significantly improvement in depression compared with usual care, except for those assigned to psychoeducational therapy (SMD 0.02, 95% CrI -0.11 to 0.15).ConclusionThis review shows that cognitive behavioral therapy, group based counseling and exercise may have significant beneficial effects considering SF-36 and HADS when compared with usual care. However, additional well-done research studies are necessary to establish the role of psychosocial interventions in men with PCa.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hwang, Na-Kyoung, Young-Jin Jung, and Ji-Su Park. "Information and Communications Technology-Based Telehealth Approach for Occupational Therapy Interventions for Cancer Survivors: A Systematic Review." Healthcare 8, no. 4 (September 23, 2020): 355. http://dx.doi.org/10.3390/healthcare8040355.
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(1) Background: Occupational therapy (OT) practice has a unique perspective that addresses the complex needs of cancer survivors. Despite the expanded research and application of OT services using telehealth (TH) to promote clients’ health and well-being, studies on OT services using TH for cancer survivors are rare. This study aimed to review the TH approaches in the scope of OT and the outcome of factors affecting occupational engagement in adult cancer survivors. (2) Materials and Methods: This systematic review performed a literature search of five databases (Medline Complete, PubMed, CINAHL, PsycINFO, Web of Science) using a combination of keywords and cross-referencing. Studies were included if they described a TH intervention within the scope of OT practice to improve occupational engagement. (3) Results: Fifteen studies (12 randomized controlled trials, three quasiexperimental studies) were reviewed. Physical activity had a positive effect on physical and cognitive function. Symptom self-management showed positive effects on the relief of symptom burden. Psychosocial interventions, which included cognitive behavioral therapy, problem-solving, cognitive behavioral therapy for insomnia, mind–body training, reduced sleep disturbance, and improved physical activity. Lifestyle behavior change interventions improved participation in moderate-intensity physical activity and diet quality. In addition, these interventions reduced cancer-related symptoms such as pain, depression, fatigue, distress, and improved quality of life. There were no direct outcomes of occupational engagement, excluding sleep, that could be confirmed through this review. (4) Conclusion: This review explored and confirmed the usefulness of TH approaches in the scope of OT practice in adult cancer survivors. It also supports the notion that OT-specific research using TH interventions for cancer survivors will be needed in the future.
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Nenova, Maria, Loretta Morris, Laurie Paul, Yuelin Li, Allison Applebaum, and Katherine DuHamel. "Psychosocial Interventions With Cognitive-Behavioral Components for the Treatment of Cancer-Related Traumatic Stress Symptoms: A Review of Randomized Controlled Trials." Journal of Cognitive Psychotherapy 27, no. 3 (2013): 258–84. http://dx.doi.org/10.1891/0889-8391.27.3.258.
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Background: Cancer-related traumatic stress symptoms, including posttraumatic stress disorder (PTSD), can significantly impact the quality of life and psychological adjustment of patients and survivors with cancer. Cognitive behavioral therapy (CBT) is an effective intervention previously shown to ameliorate non-cancer-related PTSD. Because of some of the unique aspects of cancer-related traumatic stress, such as the internal and ongoing nature of the traumatic stressor, it is important to review the overall efficacy of CBT interventions in populations with cancer. Objective: To review the findings of randomized clinical trials (RCTs) testing the efficacy of interventions with CBT components for cancer-related traumatic stress symptoms, including intrusion and avoidance, in adults with cancer. Methods: Eligible RCTs were identified via search of OVID, PubMed, EMBASE, and Scopus. Bayesian random effects analysis of treatment effect sizes (ES) was conducted in a portion of the studies for which data were available. Results: Nineteen RCTs met search criteria. Six trials reported reductions in traumatic stress symptoms as a result of the intervention and 13 studies reported null findings. Bayesian modeling based on 13 studies showed no overall discernible effect of interventions with CBT components on intrusion and avoidance symptoms. Conclusions: Most of the studies were not designed to target traumatic stress symptoms in highly distressed patients with cancer and did not include previously validated CBT components, such as cognitive restructuring and exposure. Thus, there was insufficient evidence from which to draw definitive conclusions about the efficacy of CBT interventions for the treatment of cancer-related traumatic stress symptoms, including PTSD. However, interventions with CBT components may have potential for the reduction of PTSD symptoms in highly distressed patients. Future research should focus on testing trauma-focused interventions in demographically and clinically diverse samples.
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Brooks, Alyssa T., and Gwenyth R. Wallen. "Sleep Disturbances in Individuals with Alcohol-Related Disorders: A Review of Cognitive-Behavioral Therapy for Insomnia (CBT-I) and Associated Non-Pharmacological Therapies." Substance Abuse: Research and Treatment 8 (January 2014): SART.S18446. http://dx.doi.org/10.4137/sart.s18446.
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Sleep disturbances are common among alcohol-dependent individuals and are often associated with relapse. The utility of behavioral therapies for sleep disturbances, including cognitive-behavioral therapy for insomnia (CBT-I), among those with alcohol-related disorders is not well understood. This review systematically evaluates the evidence of CBT-I and related behavioral therapies applied to those with alcohol-related disorders and accompanying sleep disturbances. A search of four research databases (PubMed, PsycINFO, Embase, and CINAHL Plus) yielded six studies that met selection criteria. Articles were reviewed using Cochrane's Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. A majority of the studies demonstrated significant improvements in sleep efficiency among behavioral therapy treatment group(s), including but not limited to CBT-I. While behavioral sleep interventions have been successful in varied populations, they may not be utilized to their full potential among those with alcohol-related disorders as evidenced by the low number of studies found. These findings suggest a need for mixed-methods research on individuals’ sleep experience to inform interventions that are acceptable to the target population.
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Rahman, Md Shahidur. "Non-Pharmacological Treatment Options for Patients with Fibromyalgia." Journal of Enam Medical College 8, no. 3 (October 28, 2018): 165–69. http://dx.doi.org/10.3329/jemc.v8i3.38368.
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Fibromyalgia is a generalized chronic pain syndrome characterized by widespread pain and tenderness to palpation at multiple anatomically defined soft tissues and associated with depression, anxiety, insomnia, cognitive dysfunction, chronic fatigue, and autonomic dysfunction. In 2010, American College of Rheumatology modified classification criteria defined in 1990. This is one of the most common musculoskeletal complaints in physician’s chambers. For lack of specific pharmacological treatment options, non-pharmacological treatment modalities are found to have some immediate efficacy and a variable efficacy in the long term. We searched literatures and reviewed randomized controlled trials for possible predictors of outcome in fibromyalgia. The effects of non-pharmacological interventions are limited and positive outcomes largely disappear in the long term. However, within the various populations with fibromyalgia, treatment outcomes showed considerable individual variations. Subgroups of patients with high levels of psychological distress may benefit from non-pharmacological interventions. Some of the relevant published articles demonstrated the beneficial effects of non-pharmacological treatment options, specially exercise, cognitive behavioral therapy and alternative and complementary medicine, in the context of non-availability of specific pharmacotherapy.J Enam Med Col 2018; 8(3): 165-169
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Gosling, John A., Phil Batterham, Lee Ritterband, Nick Glozier, Frances Thorndike, Kathleen M. Griffiths, Andrew Mackinnon, and Helen M. Christensen. "Online insomnia treatment and the reduction of anxiety symptoms as a secondary outcome in a randomised controlled trial: The role of cognitive-behavioural factors." Australian & New Zealand Journal of Psychiatry 52, no. 12 (May 2, 2018): 1183–93. http://dx.doi.org/10.1177/0004867418772338.
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Objective: Insomnia and anxiety commonly co-occur, yet the mechanisms underlying this remain unclear. The current paper describes the impact of an Internet-based intervention for insomnia on anxiety, and explores the influence of two cognitive-behavioural constructs – dysfunctional beliefs about sleep and sleep-threat monitoring. Methods: A large-scale, 9-week, two-arm randomised controlled trial ( N = 1149) of community-dwelling Australian adults with insomnia and elevated yet subclinical depression symptoms was conducted, comparing a cognitive behavioural therapy–based online intervention for insomnia (Sleep Healthy Using The Internet) with an attention-matched online control intervention (HealthWatch). Symptoms of anxiety were assessed at pretest, posttest, and 6-month follow-up. Dysfunctional beliefs about sleep and sleep threat monitoring were assessed only at pretest. Results: Sleep Healthy Using The Internet led to a greater reduction in anxiety symptoms at both posttest ( t724.27 = –6.77, p < 0.001) and at 6-month follow-up ( t700.67 = –4.27, p < 0.001) than HealthWatch. At posttest and follow-up, this effect was found to moderated by sleep-threat monitoring ( t713.69 = –2.39, p < 0.05 and t694.77 = –2.98, p < 0.01 respectively) but not by dysfunctional beliefs about sleep at either posttest or follow-up ( t717.53 = –0.61, p = 0.55 and t683.79 = 0.22, p = 0.83 respectively). Participants in the Sleep Healthy Using The Internet condition with higher levels of sleep-threat monitoring showed a greater reduction in anxiety than those with lower levels from pretest to posttest, ( t724.27 = –6.77, p < 0.001) and through to 6-month follow-up ( t700.67 = –4.27, p < 0.001). This result remained after controlling for baseline anxiety levels. Conclusion: The findings suggest that online cognitive behavioral therapy interventions for insomnia are beneficial for reducing anxiety regardless of people’s beliefs about their sleep and insomnia, and this is particularly the case for those with high sleep-threat monitoring. This study also provides further evidence for cognitive models of insomnia.
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Dozier, Mary E. "SLEEP IN LATE LIFE: RECENT RESEARCH ON PSYCHIATRIC CORRELATES AND TREATMENT." Innovation in Aging 3, Supplement_1 (November 2019): S44. http://dx.doi.org/10.1093/geroni/igz038.171.
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Abstract Sleep is an often overlooked health factor, particularly in older adults. Sleep disturbance is associated with increased functional impairment as well as poorer cognitive, mental, and physical health trajectories. Understanding the clinical impact of disturbed sleep, and the optimal targets for intervention, is critical for the promotion of health and well-being in older adults. This symposium will highlight recent findings that advance the extant knowledge on the interplay of sleep disturbance and physical and psychiatric co-morbidities in older adults across a variety of settings. Darina V. Petrovsky will discuss the impact of medical, demographic, and contextual factors on excessive daytime sleepiness in older adults receiving long-term services and supports. Kathi L. Heffner will present data on a recent study examining change in slow wave sleep, and subsequent change in osteoarthritis pain, following insomnia treatment. Courtney Bolstad will discuss the differential impact of onset, maintenance, and terminal insomnia on anxiety and depression symptoms in community-dwelling older adults. Eliza Davidson will present research on the association between sleep disturbance and hoarding symptoms in older adults engaged in behavioral interventions for hoarding disorder. Finally, Christina McCrae will discuss the relationship between sleep and cognition in older adults with insomnia.
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Annesi, James J. "Relationship of Emotional Eating and Mood Changes Through Self-Regulation Within Three Behavioral Treatments for Obesity." Psychological Reports 122, no. 5 (September 4, 2018): 1689–706. http://dx.doi.org/10.1177/0033294118795883.
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An enhanced understanding of the dynamics of psychosocial change processes within behavioral weight loss treatments is required to improve their generally poor results. Based on social cognitive theory, self-regulation of eating has the possibility of affecting interrelations between psychosocial correlates of inappropriate eating behaviors such as emotional eating and negative mood. Within behavioral interventions, physical activity, treatment foci, and the length of treatment might moderate those relationships. The aim of this research was to contrast intervention effects based on treatment type, and evaluate interrelations of changes in theory-based psychosocial variables. Adult females with obesity (overall Mage = 48.6 years; overall MBMI = 35.3 kg/m2) were block randomized into groups of 28 weeks of phone-supported manual-based education (Group 1, n = 52), 58 weeks of cognitive-behavioral group treatment (Group 2, n = 52), and 99 weeks of cognitive-behavioral group treatment followed by phone-based reviews of intervention materials (Group 3, n = 48). Significant improvements in measures of emotional eating, negative mood, self-regulation for controlling eating, physical activity, and body composition were found in each group over 3, 6, 12, and 24 months, with generally larger effect sizes detected in Groups 2 and 3. Reciprocal, mutually reinforcing, relationships were found between changes in emotional eating and mood, which were significantly mediated by self-regulation changes. Physical activity level significantly moderated mood changes, treatment foci on emotional eating significantly moderated changes in emotional eating, and treatment length significantly moderated long-term changes in emotional eating, but not mood. Findings support a treatment duration of at least one year that emphasizes physical activity and self-regulatory skills usage, and interrelations between changes in emotional eating, self-regulation, mood, and physical activity.
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Granholm, Eric, Jason Holden, Kristen Dwyer, Tanya Mikhael, Peter Link, and Colin Depp. "Mobile-Assisted Cognitive Behavioral Therapy for Negative Symptoms: Open Single-Arm Trial With Schizophrenia Patients." JMIR Mental Health 7, no. 12 (December 1, 2020): e24406. http://dx.doi.org/10.2196/24406.
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Background Negative symptoms are an important unmet treatment need for schizophrenia. This study is a preliminary, open, single-arm trial of a novel hybrid intervention called mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn). Objective The primary aim was to test whether mCBTn was feasible and could reduce severity of the target mechanism, defeatist performance attitudes, which are associated with experiential negative symptoms and poor functioning in schizophrenia. Methods Participants with schizophrenia or schizoaffective disorder (N=31) who met prospective criteria for persistent negative symptoms were enrolled. The blended intervention combines weekly in-person group therapy with a smartphone app called CBT2go. The app extended therapy group skills, including recovery goal setting, thought challenging, scheduling of pleasurable activities and social interactions, and pleasure-savoring interventions to modify defeatist attitudes and improve experiential negative symptoms. Results Retention was excellent (87% at 18 weeks), and severity of defeatist attitudes and experiential negative symptoms declined significantly in the mCBTn intervention with large effect sizes. Conclusions The findings suggest that mCBTn is a feasible and potentially effective treatment for experiential negative symptoms, if confirmed in a larger randomized controlled trial. The findings also provide support for the defeatist attitude model of experiential negative symptoms and suggest that blended technology-supported interventions such as mCBTn can strengthen and shorten intensive psychosocial interventions for schizophrenia. Trial Registration ClinicalTrials.gov NCT03179696; https://clinicaltrials.gov/ct2/show/NCT03179696