Massage therapy improves the development of HIV-exposed infants living in a low socio-economic,peri-urban community of South Africa

The aim of this study was to assess the effect of massage therapy on the growth and development of infants of HIV-infected mothers in a low socio-economic community in Cape Town. It was a prospective, randomised, controlled intervention trial that included massage therapy and control groups of HIV-infected mothers and their normal birth weight infants who were enrolled in the prevention of mother-to-child transmission (PMTCT) programme. Participants were recruited at the 6-week clinic visit and followed up every 2 weeks until their infants were 9 months of age. Mother–infant pairs in the massage therapy and control groups included 73 and 88 at 6 weeks and 55 and 58 at 9 months, respectively. Mothers in the intervention group were trained to massage their infants for 15 min daily. The socioeconomic status, immunity, relationship with the partner and mental pain of mothers; the infants’ dietary intake, anthropometry and development (Griffiths Mental Development Scales); and haematological and iron status of mothers and infants were assessed at baseline and follow-up. Nine infants (5.3%) were HIV-infected on the HIV DNA PCR test at 6 weeks. Despite significantly higher levels of maternal mental pain, infants in the massage therapy compared to control group scored higher in all five of the Griffiths Scales of Mental Development and significantly higher in the mean quotient (p = 0.002) and mean percentile (p = 0.004) for the hearing and speech scale at 9 months. Based on the mean difference in scores, the massage therapy group showed greater improvement for all five scales compared to the control group. The mean difference in scores was significantly greater for the hearing and speech quotient (21.9 vs. 11.2) (p < 0.03) and the general quotient percentile (19.3 vs. 7.7) (p = 0.03) in the massage therapy compared to the control group. These scales remained significant when adjusting for the relationship with the partner and maternal mental pain. Both groups had lower scores in the performance scale at 9 months although this was significantly worse in the control compared to the massage therapy group when adjusting for maternal CD4 count, anaemia, relationship with the partner and mental pain. There were no significant differences in the anthropometric measurements between the two groups. In conclusion, based on the Griffiths Scales, massage therapy improved the overall development and had a significant effect on the hearing and speech and general quotient of HIV-exposed infants in this study.     

Self-Structure in Persecutory Delusions

There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes.In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control.In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.     

Comparison of “rap” groups with traditional group therapy in the treatment of Vietnam combat veterans

An estimated 500,000–700,000 veterans suffer from posttraumatic stress disorder characterized by mental flashbacks of the war, recurrent dreams of the trauma, repetitive, intrusive thoughts of the war, irritability, generalized anxiety and difficulty relating to others. For many years, these individuals went undiagnosed and, except for rap groups, untreated. The rap groups were formed to talk about the war in a general debriefing process during the early 1970s. Rap groups failed to focus on the individual pathology, but, instead, provided a forum to refashion value and meaning in the veterans' lives. Recently, more traditional forms of group therapy have been used to help treat individuals suffering from posttraumatic stress disorder secondary to the Vietnam war. This paper discusses the unique features of traditional group therapy with Vietnam veterans.     

Relationships between early and final reports of treatment outcome in long-term group psychotherapy

A study of the report of treatment outcome in three long-term therapy groups focused on two questions: 1) Are early reports of treatment outcome significantly related to final reports, i.e., is there substantial consistency in outcome reports over the course of therapy? 2) Are final reports of treatment outcome significantly more favorable than early reports, i.e., do patients experience significant improvement after the early part of therapy? Affirmative answers to these two questions for a number of outcome variables led to a consideration of a number of clinical and research implications.     

Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders,Co-Occurring ADHD,and Psychosocial Impairment

Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10–17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.     

Winter Depression Recurrence One Year After Cognitive-Behavioral Therapy, Light Therapy, or Combination Treatment

The central public health challenge in the management of seasonal affective disorder (SAD) is prevention of depression recurrence each fall/winter season. The need for time-limited treatments with enduring effects is underscored by questionable long-term compliance with clinical practice guidelines recommending daily light therapy during the symptomatic months each year. We previously developed a SAD-tailored group cognitive-behavioral therapy (CBT) and tested its acute efficacy in 2 pilot studies. Here, we report an intent-to-treat (ITT) analysis of outcomes during the subsequent winter season (i.e., approximately 1 year after acute treatment) using participants randomized to CBT, light therapy, and combination treatment across our pilot studies (N = 69). We used multiple imputation to estimate next winter outcomes for the 17 individuals who dropped out during treatment, were withdrawn from protocol, or were lost to follow-up. The CBT (7.0%) and combination treatment (5.5%) groups had significantly smaller proportions of winter depression recurrences than the light therapy group (36.7%). CBT alone, but not combination treatment, was also associated with significantly lower interviewer- and patient-rated depression severity at 1 year as compared to light therapy alone. Among completers who provided 1-year data, all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy, antidepressants, and psychotherapy. If these findings are replicated, CBT could represent a more effective, practical, and palatable approach to long-term SAD management than light therapy.     

Patient distortion in reporting outcome: A procedure for correcting patient outcome scores

Outcome scores that are provided by patient report are routinely used in therapy outcome studies. Despite their popularity they are usually viewed with suspicion since they are assumed to reflect a considerable amount of distortion. Two procedures for estimating patient distortion and for creating corresponding correction factors for outcome scores are presented. When either procedure was used to correct the outcome scores of 34 outpatients from six therapy groups in a process-outcome study, a number of significant correlations emerged where none had existed previously when uncorrected scores had been used. When a third correction procedure based on social desirability was used, significant correlations did not emerge. The findings have implications for correcting patient distortion in both individual and group therapy outcome studies.     

The lowering of bilirubin levels in patients with neonatal jaundice using massage therapy: A randomized,double-blind clinical trial

ObjectiveDue to the effects of massage on various laboratory parameters (including those related to jaundice) in infants and the expansion of existing studies to achieve effective and safe therapy in the treatment of neonatal jaundice, this study aimed to investigate the effect of massage on bilirubin levels in cases of neonatal jaundice.MethodsIn this study, 134 patients were randomly assigned to either an intervention group (massage combined with phototherapy, n = 67) or a control group (phototherapy only, n = 67). In both groups, serum total bilirubin level and frequency of daily bowel movements were measured and compared during each of the first four days of treatment.ResultsBaseline levels of bilirubin were similar between the two groups (P > 0.05). During the measurements obtained post-intervention, significant differences surfaces between the two groups in bilirubin levels and frequency of daily bowel movements (P < 0.05 for both). No significant relationship was observed during days 1 and 2 of massage therapy between daily frequency of bowel movements and serum bilirubin level (P > 0.05); this relationship became significant during the third and fourth days (P < 0.05).ConclusionMassage therapy combined with phototherapy is an effective method for reducing serum total bilirubin in infants with neonatal jaundice.     

Conducting Outcomes Research in a Clinical Practice Setting: The Effectiveness and Acceptability of Acceptance and Commitment Therapy (ACT) in a Partial Hospital Program

Multiple challenges exist integrating research into clinical practice, particularly in acute care settings where randomized controlled trials may be impractical or unethical. Partial or day hospitals are one such setting. As compared to outpatients and inpatients, relatively little research is conducted or reported in partial hospital program (PHP) patients, leaving providers in this setting without a solid empirical basis from which to draw. We report treatment outcomes and patient satisfaction from the first 750 patients enrolled in a clinical research PHP utilizing the acceptance and commitment therapy (ACT) treatment model. ACT is a well-established, transdiagnostic behavior therapy. However, to date no study has examined the use of ACT in acute day hospitals. We hypothesized that applying ACT with this patient group would result in significantly improved depression, anxiety, functioning, and quality of life from intake to discharge. We additionally expected that patients would report high satisfaction with ACT treatment groups. Patients (n = 750 full sample, n = 518 completed treatment) completed daily measures of symptoms, functioning, and ACT processes at intake and discharge, and postgroup satisfaction surveys. Results showed significant improvements in symptoms and impairment. ACT process variables also increased over the course of treatment. Importantly, patient satisfaction was high for all groups. Thus, ACT provides an appropriate, flexible, effective, and satisfactory model for this patient group. A comparison of our findings using ACT to the limited research using other models in PHP settings is discussed, as well as challenges in the overall process of integrating research into routine clinical care.     

The relationship between auditory recall and dysfluency in young stutterers

This study examined the relationship between auditory recall and dysfluent behavior in children. Subjects were 11 stutterers and 11 nonstutterers, ages 4.9–11.10. The Auditory Sequential Memory subtest of the ITPA and the Auditory Attention Span for Related Syllables subtest of the Detroit Test of Learning Aptitudes were administered to both groups. Results indicated that scores on the ITPA were not significantly different. Comparison of the group's scores on the DTLA were highly significant with the control group's scoring 35 months higher. After 6 months of therapy, six children in the experimental group were fluent. Posttests revealed no significant differences on the ITPA. On the DTLA, the experimental group's mean scores significantly increased by 13.9 months. The gain in auditory recall of meaningful material substantiated the hypothesized relationship between auditory recall and dysfluency. This relationship was not viewed as causative of stuttering; data were interpreted as evidence that increased fluency allows children to use previously suppressed linguistic data.     

Randomized Controlled Trial of a Smartphone Application as an Adjunct to Acceptance and Commitment Therapy for Smoking Cessation

There is a major public health need for innovative and efficacious behavioral and cognitive interventions for smoking cessation. This randomized controlled trial evaluated the efficacy of an acceptance and commitment therapy (ACT) smartphone application in augmenting ACT group treatment for smoking cessation. One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to 6 weekly group sessions of behavioral support, ACT, or ACT combined with the smartphone application. Access to the app was provided from the start of the in-person treatment until the 6-month follow-up assessment. Participants were encouraged to make their quit attempts after the third session, and the posttreatment assessment occurred 3 weeks later. Measures of smoking status and ACT processes were obtained at baseline, posttreatment, and 6-month follow-up. Biochemically verified quit rates in the combined, ACT, and behavioral support groups were 36% (p = .079 relative to ACT; p = .193 relative to behavioral support), 20% (p = .630 relative to behavioral support) and 24% at posttreatment, as compared with 24% (p = .630 relative to behavioral support), 24% (p = .630 relative to behavioral support) and 20% at follow-up. There was no significant difference (p = > .999) in the primary outcome of biochemically verified 7-day point-prevalence abstinence at 6-month follow-up between the combined and ACT groups. The combined group reported significantly greater smoking reduction, acceptance and present-moment awareness than the behavioral support group at posttreatment, but not at follow-up. There were no significant differences between the groups in positive mental health. Contrary to hypotheses, the ACT group did not display significant improvements in positive mental health or ACT processes relative to the behavioral support group at posttreatment or follow-up. Implications and directions for future research are discussed.     

Impact of Treatment Setting and Format on Symptom Severity Following Cognitive Processing Therapy for Posttraumatic Stress Disorder

Preliminary data suggest cognitive processing therapy (CPT) significantly reduces posttraumatic stress disorder (PTSD) symptom severity among military personnel and veterans when delivered over 12 days and combined with daily recreational activities (Bryan et al., 2018). The present study aimed to examine how therapy pace (i.e., daily vs. weekly sessions) and setting (i.e., clinic vs. recreational) impacts change in PTSD symptom severity. Forty-five military personnel and veterans diagnosed with PTSD chose to receive CPT (a) daily at a recreational facility with recreational programming, (b) daily on a university campus without recreational programming, and (c) weekly on a university campus without recreational programming. PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Reductions in CAPS-5 and PCL-5 scores were large and statistically significant across all three settings (Cohen’s ds > 2.1). As compared to reductions in CAPS-5 and PCL-5 scores in daily therapy at a recreational facility (CAPS-5: d = 1.63–2.40; PCL-5: d = 1.99–2.17), reductions in CAPS-5 and PCL-5 scores were significantly larger in daily therapy on campus, CAPS-5: t(80) = –2.9, p = .005, d = 2.23–2.69; PCL-5: t(78) = 2.6, p = .010, d = 2.54–4.43, but not weekly therapy on campus, CAPS-5: t(80) = 0.2, p = .883, d = 1.04–2.47; PCL-5: t(78) = 1.0, p = .310, d = 1.77–3.44. Participants receiving daily therapy on campus and weekly therapy on campus also had higher rates of clinically significant improvement and good end-state functioning. Results support the effectiveness of CPT across multiple treatment settings and formats and suggest that daily CPT may be less effective when delivered in combination with recreational activities.     

A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training

In this comparative intervention study, 107 working individuals with above average levels of distress were randomly assigned to one of three conditions: acceptance and commitment therapy (ACT; n = 37); stress inoculation training (SIT; n = 37); or a waitlist control group (n = 33). The interventions were delivered to small groups in the workplace via two half-day training sessions. ACT and SIT were found to be equally effective in reducing psychological distress across a three month assessment period. Mediation analysis indicated that the beneficial impact of ACT on mental health resulted from an increase in psychological flexibility rather than from a change in dysfunctional cognitive content. Contrary to hypothesis, a reduction in dysfunctional cognitions did not mediate change in the SIT condition. Results suggest that the worksite may offer a useful, yet underutilised, arena for testing cognitive-behavioural theories of change.     

The effect of a conditioned fear inhibitor (CS-) during response prevention upon extinction of an avoidance response

Pairing a Pavlovian safety signal (CS—) with a response prevention period was contrasted with other response prevention procedures to determine relative effectiveness for the elimination of learned avoidance behavior. After acquiring a one-way avoidance response, five groups of ten rats received various blocking or control treatments and were then compared on extinction performance. The four blocking treatments included blocking paired with a safety signal; blocking only; blocking paired with a novel stimulus; and blocking paired with a preexposed noncontingent tone. The fifth group served as a handling control. Compared to the handling control, all four blocking groups reached extinction criterion in fewer trials. Further, the safety signal group extinguished faster than the blocking only group or the blocking with noncontingent tone group. Results were viewed as an indication of the potential efficacy of pairing-conditioned fear-inhibiting cues with response prevention procedures for the elimination of fear-motivated behavior. Implications for behavioral therapy techniques were discussed.     

Bulimia nervosa: a descriptive and therapeutic study

This study examined a sample of 24 Ss who met strict criteria for a diagnosis of bulimia nervosa. Assessments were made on: (1) demographic characteristics, (2) eating attitudes and behaviour and (3) personality measures. The effectiveness of two types of therapeutic intervention (cognitive-behavioural group therapy vs cognitive-behavioural group therapy plus specific behavioural instruction) was examined in a baseline, therapy intervention, follow-up design.The group was characterized prior to therapy by high N, Depression and Anxiety and low Self-esteem scores compared with control group data. Following therapy, Depression and Anxiety scores were significantly lower and Self-esteem scores higher, whereas N scores remained high. Binge-purging frequencies were significantly reduced in some of the Ss but the reduction could not unequivocally be attributed to the therapeutic interventions. The pattern of results suggested that bulimia nervosa (defined by a binge-purging pattern in association with high neuroticism) should be distinguished from bulimia (defined by a binge pattern not related to purging or high neuroticism) and that DSM-III should be revised to reflect this distinction. A theory is advanced to account for the rapid association of binging and purging in Ss high in neuroticism but not in Ss low in neuroticism.     

Mapping people's positions regarding the acceptability of somatic gene therapy

IntroductionAs gene therapy entails potential drawbacks, studies are needed in order to know people's opinions regarding its use.ObjectivesThe present study examined French people's positions regarding somatic gene therapy.MethodA sample of 224 adults living in various areas in France was presented with 32 realistic scenarios that were created by orthogonally combining the levels of four factors: the type of illness (e.g., hemophilia), the probability of transmission of the pathogenic gene, the technique used (e.g., transfer of a functional gene just after birth), and le probability of success of the therapy.ResultsThrough cluster analysis, six qualitatively different positions were found: Never very acceptable (8% of the sample, mostly males and more educated people), Legalist (17%, mostly people who have been informed of the legal and technical aspects of the therapy), Depends on the chances of success (18%), Fully acceptable after birth (5%), Fully acceptable before birth (8%), and Quite always acceptable (33%, mostly older people with children).ConclusionAlthough it has some few detractors, the recourse to gene therapy seems to be well accepted by a majority of the participants, and this high level of acceptation hold whether the pathology considered is hemophilia, immunodeficiency, propensity to develop cancer, or cardiovascular pathology.     

Two Trajectories of Depressive Symptom Reduction Throughout Behavioral Activation Teletherapy Among Underserved,Ethnically Diverse,Primary Care Patients: A VitalSign6 Report

While prior research has investigated trajectories of depressive symptom change throughout psychotherapy, such work has not been conducted exclusively among underserved patients receiving brief Behavioral Activation (BA) teletherapy, intervention modifications that should reduce barriers to therapy initiation and engagement. The current project used cluster analysis to determine discrete groups of symptom change among patients receiving an 8-session BA teletherapy intervention, and analyzed whether demographic and clinical characteristics were associated with group membership. Data from 105 patients referred from charity primary care clinics and receiving at least two therapy sessions were analyzed. Patients were predominantly female and Latina. The 9-item Patient Health Questionnaire (PHQ-9) was the outcome. Two categories were determined: a larger group (N = 61) demonstrating initially less severe symptoms and experiencing a gradual recovery, and a smaller group beginning with more severe symptoms, and experiencing a steeper recovery. In both groups, a majority of participants experienced at least a 5-point drop in depressive symptoms, while in the latter group, a majority of patients achieved depressive symptom remission (PHQ-9 < 5). Monolingual Spanish speakers were more likely to be in the former group, but no other demographic or clinical characteristics were associated with group membership. In both groups, a majority of the symptom reduction occurred by sessions 4–6. Therefore, two categories of depressive symptom change, slow responders and rapid responders, occur among patients receiving a brief BA teletherapy intervention. No demographic differences aside from primary language, nor any clinical characteristics, distinguish group membership, suggesting similar patterns of symptom reduction among a primarily underserved sample.     

Couple Therapy for Depression Within a Naturalistic Setting in Finland: Factors Related to Change of the Patient and the Spouse

The study examined factors related to change in treatments for depression in couple therapy (CT; N = 29) and treatment-as-usual (TAU; N = 22). Treatments were adapted in accordance with the patient’s need. The patients’ depressive symptoms, general mental health and marital satisfaction were assessed at baseline and at 6 months post-baseline. The Hamilton Depression Rating Scale, the Beck Depression Inventory (BDI), the Symptom Check List-90, and the Dyadic Adjustment Scale (DAS) were used for the patients. The BDI and the DAS were used for the spouses. The couples in CT group assessed their subjective distress (SD) at every session by using the Outcome Rating Scale. The results showed that the spouses’ gender, the spouses’ depressive symptoms at baseline, and the number of therapy sessions were related to differing changes in the CT and TAU groups at the 6-month post-baseline assessment. The spouses in the CT group demonstrated a higher treatment response than those in the TAU group. In the CT group, the spouse’s benefit from the treatment was related to SD at the outset on the part of either the patient or the spouse or both. The change in the patient’s SD predicted the patient’s change in depressive symptoms, general mental health, and was associated with the patient’s change in marital satisfaction. The study emphasizes the importance of the spouse’s involvement in the treatment of depression, the provision of feedback on SD, and discussion of individual well-being and relational issues, in addition to the focus on depression.