A randomized controlled trial of an internet-based treatment for chronic headache

Chronic headache is a significant public health problem in Western nations. Although controlled trials demonstrate the efficacy and cost-effectiveness of face-to-face behavioral therapy, most headache sufferers have limited access to these treatments. Delivery of behavioral interventions using Internet technology has the potential to reach a larger number of headache sufferers and reduce the burden of disease. This randomized controlled study evaluated an Internet-delivered behavioral regimen composed of progressive relaxation, limited biofeedback with autogenic training, and stress management versus a symptom monitoring waitlist control. Treatment led to a significantly greater decrease in headache activity than symptom monitoring alone. Thirty-nine percent of treated individuals showed clinically significant improvement on self-report measures of headache symptoms at post-treatment. At two-month follow-up, 47% of participants maintained improvement. Treatment had a significant impact on general headache symptoms and headache-related disability. There was a 35% within-group reduction of medication usage among the treated subjects. The Internet program was more time-efficient than traditional clinical treatment. Treatment and follow-up dropout rates, 38.1% and 64.8%, respectively, were typical of behavioral self-help studies. This approach to self-management of headache is promising; however, several methodological and ethical challenges need to be addressed.     

Exploring the experience of adhering to a prescribed pre-surgical exercise program for patients with advanced rectal cancer: A phenomenological study

ObjectivesThe aim of this study was to explore the lived experience of patients with advanced rectal cancer as they attempted to adhere to a prescribed, hospital-based pre-surgical exercise program.Design/MethodsTen patients took part in three semi-structured in-depth interviews prior to (week 0), midway (week 3), and at completion (week 6) of the exercise program. Data were analysed using a phenomenological approach.ResultsMain themes that were deemed important for remaining enrolled in the program included: (1) building camaraderie and peer support, (2) experiencing a sense of structure and control, and (3) feeling safe and encouraged. Patients also reported engaging in further exercise outside the program and feeling motivated to continue exercising in the future.ConclusionsThis study shows the potential to integrate exercise prior to surgery as it was viewed as acceptable and feasible by patients with advanced rectal cancer. Moreover, it provides much needed information into the possible mechanisms that underpin patient's continued participation in exercise programs during treatment for advanced rectal cancer. Prescribed, hospital-based program should be implemented to promote opportunities for exercise and provide on-going supportive care options for patients awaiting surgery.     

Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment*

This report presents the results of a 7-year prospective outcome study designed to examine the psychosocial changes during and after therapy among 25 outpatients suffering from personality disorders and psychoses. The therapeutic approach was based mainly on object relations theory and psychodynamic self-psychology, and focused in particular on affect consciousness, parental images, self-image and interpersonal relations. Twenty patients completed the form which measured psychosocial changes during therapy, and 21 persons participated at follow-up. The data show statistically significant changes in the capacity to tolerate intimate relationships and actually establish such relationships, improved quality of contact in relationships with friends, a general raising of socioeconomic status and reduced use of ordinary health and social services. Both the global psychosocial outcome at follow-up as measured by HSRS and the general level of symptoms measured by SCL-90 suggest that 76% of the sample had reached a level of psychosocial functioning and adaptation that can be defined as “no-caseness”.     

3-D bone models to improve treatment initiation among patients with osteoporosis: A randomised controlled pilot trial

Objective: To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis.

Design: Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models.

Main outcome measures: Participants’ beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data.

Results: Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%, p = .19).

Conclusion: The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment.     

Randomized controlled trial of an intervention to change cardiac misconceptions in myocardial infarction patients

There is converging evidence that changing beliefs about an illness leads to positive recovery outcomes. However, cardiac misconceptions interventions have been investigated mainly in Angina or Coronary Heart Disease patients, and less in patients following Myocardial Infarction (MI). In these patients, cardiac misconceptions may play a role in the adjustment or lifestyle changes. This article reports a randomized controlled trial of an intervention designed to reduce the strength of misconceptions in patients after a first MI. The primary outcome was the degree of change in misconceptions and the secondary outcomes were: exercise, smoking status, return to work and mood (anxiety and depression). Patients in the intervention condition (n = 60) were compared with a control group (n = 67) receiving usual care. Both groups were evaluated at baseline and 4, 8 and 12 months after hospital discharge. There was a significant time-by-group interaction for the total score of cardiac misconceptions. Patients in the intervention group significantly decreased their total score of cardiac misconceptions at 4 months compared with the control group and this difference was sustained over time. Patients in the intervention group were also more likely to exercise at the follow-up period after MI than the control group. This intervention was effective in reducing the strength of cardiac misconceptions in MI patients and had a positive impact on health behaviour outcomes. These results support the importance of misconceptions in health behaviours and the utility of belief change interventions in promoting health in patients with Myocardial Infarction.     

The Suitability of an Inhibitory Learning Approach in Exposure When Habituation Fails: A Clinical Application to Misophonia

Recent findings have led to a reconceptualization of the mechanisms that account for the efficacy of exposure-based treatments. Termed the “inhibitory learning model,” this approach emphasizes new learning when confronted with previously avoided stimuli rather than merely the cessation of fear or aversive emotional responding. In this paper, we propose the applicability of the inhibitory learning model for conditions and contexts in which simple exposure does not produce habituation. We illustrate this application from an in-progress randomized controlled treatment trial for adults with misophonia. Misophonia is a condition marked by strong aversive reactions to specific sounds. It is a difficult to treat and understudied syndrome. All participants in the trial received exposure, either before or after a stress management module of treatment. Exposure treatment emphasized altered expectancies for the target sounds as well as deliberate practice in hearing sounds on the individually developed hierarchy. Inhibitory learning strategies were employed to increase treatment adherence and commitment, shape patient behavior during exposures, manufacture negative prediction errors, increase perceived control over reactions, and promote learning that generalized to functional improvements. The findings are discussed in the context of future applications of the inhibitory learning model for psychopathology associated with avoidance.     

Working with parents to counteract bullying: A randomized controlled trial of an intervention to improve parent-school cooperation

This study examined the effectiveness of an intervention aimed at improving parent-school cooperation in counteracting bullying. Using a randomized controlled trial, data of teachers, parents of non-victimized children, and children themselves were collected at 13 intervention and 14 control schools (grades 3–6, N at post-assessment: teachers = 83, parents = 153, children = 2,510) at two time points (time lag about 6 months). Results showed positive effects of the intervention for some aspects of the primary outcomes: parents’ and teachers’ attitudes and efforts, whereas no effects were found of teachers’ or parents’ competences in counteracting bullying. No intervention effects were found for secondary outcomes: children's self-reported bullying, victimization, well-being, and self-esteem. The findings indicate that, due to the intervention, teachers and parents were more aligned and able to cooperate, even within the short time of the intervention: one school year. This is the first essential step to systematically addressing parents’ role in tackling bullying; future research is needed to examine the long-term effects of parent and school interventions in enhancing the effectiveness of anti-bullying programs.     

A randomised controlled trial to assess the effectiveness of providing self-help information to people with symptoms of acute stress disorder following a traumatic injury

BACKGROUND: Patients attending accident and emergency (A&E) may develop long-term psychological difficulties. Psycho-education has been suggested to reduce the risk of post-injury disorders. AIMS: We tested the efficacy of providing self-help information to a high-risk sample. METHODS: A&E attenders were screened for acute stress disorder and randomised to two groups: patients (n=116) receiving a self-help booklet and those who did not (n=111). A sample of 'low' scorers was also included (n=120); they did not receive a booklet. Psychological assessments were completed at baseline (within 1 month post-injury) and 3 and 6 months post-injury. RESULTS: Post-traumatic stress disorder (PTSD), anxiety and depression decreased (p<0.001) across time but there were no group differences in these measures or quality of life. However, subjective ratings of the usefulness of the self-help booklet were very high. CONCLUSIONS: This trial failed to support the efficacy of providing self-help information, as a preventative strategy to ameliorate PTSD.     

A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children

The current study is a pilot trial to examine the effects of a nonelective, classroom-based, teacher-implemented, mindfulness meditation intervention on standard clinical measures of mental health and affect in middle school children. A total of 101 healthy sixth-grade students (55 boys, 46 girls) were randomized to either an Asian history course with daily mindfulness meditation practice (intervention group) or an African history course with a matched experiential activity (active control group). Self-reported measures included the Youth Self Report (YSR), a modified Spielberger State-Trait Anxiety Inventory, and the Cognitive and Affective Mindfulness Measure –Revised. Both groups decreased significantly on clinical syndrome subscales and affect but did not differ in the extent of their improvements. Meditators were significantly less likely to develop suicidal ideation or thoughts of self-harm than controls. These results suggest that mindfulness training may yield both unique and non-specific benefits that are shared by other novel activities.     

Opportunity for thought as a mediator of attraction to a dissimilar stranger: A further test of an information seeking interpretation

It has previously been shown that confusion, produced by an ambiguous film, leads to increased attraction to attitudinally dissimilar others. It was posited that confusion leads to a search for information that will help to structure the confusing situation, and that dissimilar others have perspectives that are of value in this regard. In the present study, subjects were exposed to either a confusing film, a nonconfusing film preceded by an explanation designed to produce confusion, or the nonconfusing film with no preceding explanation. They then were either given an opportunity to think about the film's meaning or were deprived of this opportunity through a filler task. It was argued that the opportunity to think about the film would allow subjects to gain structure, and that this would reduce their confusion, decrease their need for more information, and thereby decrease their attraction to a dissimilar other. The results supported this contention. That is, subjects exposed to either the confusing film or the nonconfusing film with an explanation and then given an opportunity for thought showed significantly less attraction to a dissimilar stranger than their counterparts who were deprived of this opportunity.     

A prospective naturalistic study of the impact of an intensive medical treatment on the social behavior of child and adolescent cancer patients

The impact of intensive chemotherapy and prolonged hospitalization on the social behavior of child and adolescent cancer patients was assessed. Twenty-three patients, aged 18 months to 21 years, were observed while they received chemotherapy in a protected environment or in a regular hospital room. Single-subject analyses were used to examine changes on six behaviors in relation to changes in physiological status. Fourteen patients showed significant change in the frequency of at least one behavior. Play and sleep were the behaviors most likely to change. The changes began to occur as patients experienced the systemic toxic effects of the drugs, although a dissipation of drug toxicity generally was not accompanied by a corresponding behavior change. The findings are discussed in relation to age-developmental and interindividual heterogeneity in response to treatment.     

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.