ACT HEALTHY: A Combined Cognitive-Behavioral Depression and Medication Adherence Treatment for HIV-Infected Substance Users

The two most common comorbid conditions with HIV are substance use disorders and depression, and individuals with comorbid HIV, depression, and substance dependence face a more chronic and treatment-resistant course. As an example of how to adapt evidence-based approaches to a complex comorbid population, the current case study examined the integration of a combined depression and HIV medication adherence treatment. The resulting intervention, ACT HEALTHY, combines a brief behavioral activation approach specifically developed to treat depression in individuals receiving residential substance abuse treatment (LETS ACT; Daughters et al., 2008) with a brief cognitive-behavioral approach to improving HIV medication adherence (Life-Steps; Safren et al., 1999; Safren et al., 2009). The current case series demonstrates the use of ACT HEALTHY among 3 depressed HIV-positive, low-income African Americans entering residential substance abuse treatment.     

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed.     

From Cognitive Behaviour Therapy (CBT) to Cognitive Behaviour Coaching (CBC)

This article focuses on how the principles and practice of cognitive behaviour therapy (CBT) can be adapted to the field of coaching to become cognitive behaviour coaching (CBC) and the current empirical status of CBC is discussed. The centrepiece of CBC practice is the ABCDE model of identifying psychological blocks and their removal. Typical tools and techniques used in CBC are outlined and ten key questions to ask in coaching are advanced. What CBC can offer coaches is discussed and, finally, suggestions are made to point out when coaching should really be counselling.     

Depression,Quantified Medication Adherence,and Quality of Life in Renal Transplant Candidates and Recipients

Journal of Clinical Psychology in Medical Settings - Like patients with many chronic illnesses, ESRD patients experience psychological challenges with greater incidence of depression and reduced...     

社区高血压患者心理一致感与服药依从性的关系研究

为了解社区高血压患者心理一致感及服药依从性现状,并探讨二者关系,本研究采用心理一致感量表、Morisky服药依从性量表对济南市214例社区高血压患者进行调查.结果显示,社区高血压患者服药依从性良好率仅为18.7％;心理一致感总分为58.78±10.44,处于中等水平,各维度条目均分由低至高依次为可理解感(4.36±0.94)、可控制感(4.47±1.00)及意义感(4.77±0.94);不同心理一致感水平的患者其服药依从性差异具有统计学意义(P＜0.01),高心理一致感的患者服药依从性最好,且心理一致感是患者服药依从性的保护性因素.因此,社区高血压患者的心理一致感能够影响其服药依从性,故应重视患者心理一致感的培养,以改善服药依从性.     

Latent Structure of the Davis Interpersonal Reactivity Index in Methadone Maintenance Patients

The latent structure of Davis's 28-item Interpersonal Reactivity Index (IRI) measure of empathy was examined in 241 methadone maintenance (MM) patients using factor analytic procedures and the divergent and convergent reliability of the derived structure was determined. Contrary to the four-factor structure determined for the IRI previously, three factors, comprised of 18 items, were found to best represent the construct of empathy in MM patients—an Empathy factor (nine items) combining the Empathic Concern and Perspective Taking factors originally described by Davis, and Fantasy (four items) and Personal Distress (five) factors. Canonical correlation analysis undertaken to determine concurrent validity of the IRI's revealed latent structure supported the validity of the derived Empathy factor as a measure of empathy, but indicated that Personal Distress appeared to be associated with neuroticism. These findings are consistent with more recent factor analytic and validity findings for the IRI.     

Cognitive-Behavioral Therapy: Innovations for Cardiopulmonary Patients With Depression and Anxiety

Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article describes the development of an innovative, modular-based cognitive-behavioral intervention (Adjusting to Chronic Conditions Using Education Support and Skills [ACCESS]) that integrates treatment for symptoms of anxiety and depression with medical disease self-management in patients with heart failure and chronic obstructive pulmonary disease. Data from 3 patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention.     

Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Patients

The purpose of this paper is to outline considerations for adapting cognitive-behavioral therapy (CBT) to Hispanic patients who have recently immigrated, particularly those presenting with depressive symptoms. Culturally competent CBT is framed within a model originally proposed by Rogler and his colleagues (1987). The considerations outlined by the model include ensuring that treatments provide access, are selected based on compatibility with Hispanic culture, and are adapted to fit the culture. Recommendations for culturally adapting CBT include consideration of each patient's unique ethnocultural background and their treatment expectations, as well as culturally relevant interpersonal styles, values, and metaphors/language. In addition, specific strategies for conceptualizing and conducting CBT techniques are discussed.     

维持性血液透析患者抑郁状态与MIA综合征各组分的关系

探讨血液透析患者抑郁的发生率及与营养不良、炎症、动脉粥样硬化的关系.采用Zung抑郁自评量表、改良主观全面营养评价法、颈动脉内中膜厚度(IMT)、hsCRP、血白蛋白、血红蛋白等对57例血液透析患者进行评估.根据SDS分值将患者分为抑郁组和对照组,分别进行炎症、营养不良和动脉粥样硬化比较.抑郁组患者19例(33.3%),hs-CRP,营养不良评分、IMT值明显高于对照组,血清白蛋白、血红蛋白明显低于对照组.Pearson相关分析显示SDS分值与hsCRP、营养不良评分、IMT值显著正相关.因此,血液透析患者抑郁发生率高,与营养不良、炎症、动脉粥样硬化关系密切,应注意抑郁状态的评估.     

Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to Predict Adherence to Highly Active Antiretroviral Therapy (HAART) Medication Regimens Among HIV-Positive Men and Women

Trait loyalty has received virtually no attention from researchers; consequently, the basic goal of this research was to create a measure of interpersonal loyalty. Principal factor analyses of an initial pool of items revealed 2 factors: Individual Loyalty (e.g., “I stand by my friends, even when they make mistakes”) and Group Loyalty (e.g., “I am loyal to my country”). Analyses of a revised item pool identified the same 2 factors in a second sample. Scales based on these factors were internally consistent and only moderately related to one another. Additional analyses indicated that both scales (a) were stable over time; (b) showed moderate to strong self-peer agreement; (c) positively correlated with conscientiousness, agreeableness, altruism, and positive emotionality; and (d) negatively related to an avoidant attachment style. However, these associations all were moderate in magnitude (in fact, none was as high as |.40|), indicating that the Individual and Group Loyalty Scales tap unique variance that is not captured by existing instruments.     

维持性血液透析患者抑郁状态与MIA综合征各组分的关系

探讨血液透析患者抑郁的发生率及与营养不良、炎症、动脉粥样硬化的关系。采用Zung抑郁自评量表、改良主观全面营养评价法、颈动脉内中膜厚度（IMT）、hsCRP、血白蛋白、血红蛋白等对57例血液透析患者进行评估。根据SDS分值将患者分为抑郁纽和对照组,分别进行炎症、营养不良和动脉粥样硬化比较。抑郁组患者19例（33．3％）...     

养老机构冠心病患者服药依从性现状及影响因素

采用Morisky推荐的MAQ对锦州市养老机构中153名冠心痛患者的服药依从性进行测评,探讨冠心病患者的服药依从性现状及影响因素.结果显示,养老机构冠心病患者服药依从性差的比率为81.7％,影响服药依从性的因素为文化程度、服药种类、医疗背景、入住年限.养老机构的护理人员应对上述因素给予更多的关注,从而提高其服药依从性,进而提升其临床治疗效果.     

Implementing Group CBT for Depression Among Latinos in a Primary Care Clinic

Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.     

Adaptation of CBT for Traumatized Egyptians: Examples from Culturally Adapted CBT (CA-CBT)

In this article we illustrate how CBT can be adapted to a traumatized Egyptian population with Islamic beliefs, giving examples from our adaptation of Culturally Adapted–CBT (CA-CBT) for this cultural group. We discuss a culturally sensitive assessment measure of local somatic complaints and cultural syndromes that was devised based on clinical experience with traumatized Egyptians. We also demonstrate how to normalize symptoms, create positive expectancy about the treatment, and educate about trauma. We give examples of how mindfulness can be adapted for an Egyptian Islamic population, and we describe local religious strategies, such as dhikr (religious chanting), salah (ritualistic prayer), and dua (supplication), that may be used to promote attentional shift from rumination topics and to teach attentional control. We describe how “loving kindness” can be adapted for this group. We outline how to modify culturally generated catastrophic cognitions and how to conduct interoceptive exposure and to create positive re-associations in a culturally sensitive manner. We describe how worry themes are explored and addressed based on a heuristic panic attack–PTSD model; how to teach anger management in a culturally sensitive way; and how to address sleep-related problems in this population. We suggest using cultural transitional “rituals” at the end of the treatment to give patients a sense of closure and a positive feeling of transformation. A case example is presented to illustrate cultural challenges associated with delivering CA-CBT to an Egyptian population. We introduce certain concepts such as cultural grounding and explanatory model bridging, both therapeutic techniques that increase adherence, positive expectancy, and cultural consonance.     

Development and Implementation of Health and Wellness CBT for Individuals With Depression and HIV

Rates of depression are reported to be between 22% to 33% in adults with HIV, which is double that of the general population. Depression negatively affects treatment adherence and health outcomes of those with medical illnesses. Further, it has been shown in adults that reducing depression may improve both adherence and health outcomes. To address the issues of depression and nonadherence, Health and Wellness (H&W) cognitive behavioral therapy (CBT) and medication management (MM) treatment strategies have been developed specifically for youth living with both HIV and depression. H&W CBT is based on other studies with uninfected youth and upon research on adults with HIV. H&W CBT uses problem solving, motivational interviewing, and cognitive-behavioral strategies to decrease adherence obstacles and increase wellness. The intervention is delivered in 14 planned sessions over a 6-month period, with three different stages of CBT. This paper summarizes the feasibility and acceptability data from an open depression trial with 8 participants, 16 to 24 years of age, diagnosed with HIV and with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of depression, conducted at two treatment sites in the Adolescent Trials Network (ATN). Both therapists and subjects completed a Session Evaluation Form (SEF) after each session, and results were strongly favorable. Results from The Quick Inventory of Depressive Symptomatology–Clinician (QIDS-C) also showed noteworthy improvement in depression severity. A clinical case vignette illustrates treatment response. Further research will examine the use of H&W CBT in a larger trial of youth diagnosed with both HIV and depression.     

不同程度尿蛋白患者血清甲状腺激素水平变化及其临床意义

探讨不同程度蛋白尿患者血清甲状腺激素水平的变化及其临床意义。66例不同程度蛋白尿患者,肾病综合征组28例,非肾病综合征组38例,健康对照组60例。发现蛋白尿水平与甲状腺激素水平尤其是FT3水平关系密切。在肾病综合征患者,主要表现为FT3显著降低,提示肾病综合征是正常甲状腺病态综合征的一种。     

Adaptation of an HIV Medication Adherence Intervention for Adolescents and Young Adults

Rising rates of human immunodeficiency virus (HIV) infection among adolescents and young adults underscore the importance of interventions for this population. While the morbidity and mortality of HIV has greatly decreased over the years, maintaining high rates of adherence is necessary to receive optimal medication effects. Few studies have developed interventions for adolescents and young adults and none have specifically been developed for sexual minority (lesbian, gay, and bisexual; LGB) youth. Guided by an evidence-based adult intervention and adolescent qualitative interviews, we developed a multicomponent, technology-enhanced, customizable adherence intervention for adolescents and young adults for use in a clinical setting. The two cases presented in this paper illustrate the use of the five-session positive strategies to enhance problem solving (Positive STEPS) intervention, based on cognitive-behavioral techniques and motivational interviewing. We present a perinatally infected heterosexual woman and a behaviorally infected gay man to demonstrate the unique challenges faced by these youth and showcase how the intervention can be customized. Future directions include varying the number of intervention sessions based on mode of HIV infection and incorporating booster sessions.