Abstract Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have ...demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.
Potential insomnia in healthcare workers is a public health concern as it may degrade the quality of patient care. We examined the prevalence of insomnia symptoms in healthcare workers and their ...perceived need for a sleep intervention. Participants were 62 nurses working full-time at a U.S. hospital. These nurses were asked about background characteristics, perceived stress, sleep concerns, and need for a sleep intervention. They also participated in 14-d ecological momentary assessment (EMA) and actigraphy sleep study. A qualitative analysis showed that the majority (92%) of participants reported at least one sleep concern with insomnia-related concerns being most prevalent (68%). Quantitative analyses indicated that those with insomnia-related concerns had higher perceived stress overall and lower EMA sleep sufficiency and sleep quality. Moreover, participants with insomnia concerns had shorter actigraphy-measured nap duration prior to non-workdays than those without. Nearly all (95%) expressed interest in participating in a sleep intervention; an online format and mindfulness contents were most preferred. Our results suggest a high prevalence of insomnia symptoms and a high interest in a sleep intervention in nurses. Information obtained from this study could be used to deliver a tailored sleep intervention for nurses whose role in public health is essential.
Cognitive-behavioral therapy (CBT) has been developed and modified to treat anxiety symptoms in youth with high-functioning autism spectrum disorders (ASD) but has yielded varying findings. The ...present report is a systematic review and meta-analysis examining the efficacy of CBT for anxiety among youth with ASD. A systematic search identified 14 studies involving 511 youth with high-functioning ASD. A random effects meta-analysis yielded a statistically significant pooled treatment effect size (
g
) estimate for CBT (
g
= −0.71,
p
< .001) with significant heterogeneity
Q
(13) = 102.27,
p
< .001. Removal of a study outlier yielded a statistically significant pooled treatment effect size, (
g
= −0.47,
p
< .001). Anxiety informant and treatment modality were not statistically significant moderators of treatment response. Findings suggest that CBT demonstrates robust efficacy in reducing anxiety symptoms in youth with high-functioning ASD.
IMPORTANCE: Anxiety is common among youth with autism spectrum disorder (ASD), often interfering with adaptive functioning. Psychological therapies are commonly used to treat school-aged youth with ...ASD; their efficacy has not been established. OBJECTIVE: To compare the relative efficacy of 2 cognitive behavioral therapy (CBT) programs and treatment as usual (TAU) to assess treatment outcomes on maladaptive and interfering anxiety in children with ASD. The secondary objectives were to assess treatment outcomes on positive response, ASD symptom severity, and anxiety-associated adaptive functioning. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial began recruitment in April 2014 at 3 universities in US cities. A volunteer sample of children (7-13 years) with ASD and maladaptive and interfering anxiety was randomized to standard-of-practice CBT, CBT adapted for ASD, or TAU. Independent evaluators were blinded to groupings. Data were collected through January 2017 and analyzed from December 2018 to February 2019. INTERVENTIONS: The main features of standard-of-practice CBT were affect recognition, reappraisal, modeling/rehearsal, in vivo exposure tasks, and reinforcement. The CBT intervention adapted for ASD was similar but also addressed social communication and self-regulation challenges with perspective-taking training and behavior-analytic techniques. MAIN OUTCOMES AND MEASURES: The primary outcome measure per a priori hypotheses was the Pediatric Anxiety Rating Scale. Secondary outcomes included treatment response on the Clinical Global Impressions–Improvement scale and checklist measures. RESULTS: Of 214 children initially enrolled, 167 were randomized, 145 completed treatment, and 22 discontinued participation. Those who were not randomized failed to meet eligibility criteria (eg, confirmed ASD). There was no significant difference in discontinuation rates across conditions. Randomized children had a mean (SD) age of 9.9 (1.8) years; 34 were female (20.5%). The CBT program adapted for ASD outperformed standard-of-practice CBT (mean SD Pediatric Anxiety Rating Scale score, 2.13 0.91 95% CI, 1.91-2.36 vs 2.43 0.70 95% CI, 2.25-2.62; P = .04) and TAU (2.93 0.59 95% CI, 2.63-3.22; P < .001). The CBT adapted for ASD also outperformed standard-of-practice CBT and TAU on parent-reported scales of internalizing symptoms (estimated group mean differences: adapted vs standard-of-practice CBT, −0.097 95% CI, −0.172 to −0.023, P = .01; adapted CBT vs TAU, −0.126 95% CI, −0.243 to −0.010; P = .04), ASD-associated social-communication symptoms (estimated group mean difference: adapted vs standard-of-practice CBT, −0.115 95% CI, −0223 to −0.007; P = .04; adapted CBT vs TAU: −0.235 95% CI,−0.406 to −0.065; P = .01); and anxiety-associated social functioning (estimated group mean difference: adapted vs standard-of-practice CBT, −0.160 95% CI, −0.307 to −0.013; P = .04; adapted CBT vs TAU: −0.284 95% CI, −0.515 to −0.053; P = .02). Both CBT conditions achieved higher rates of positive treatment response than TAU (BIACA, 61 of 66 92.4%; Coping Cat, 47 of 58 81.0%; TAU, 2 of 18 11.1%; P < .001 for each comparison). CONCLUSIONS AND RELEVANCE: In this study, CBT was efficacious for children with ASD and interfering anxiety, and an adapted CBT approach showed additional advantages. It is recommended that clinicians providing psychological treatments to school-aged children with ASD consider developing CBT expertise. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02028247
Evidence is mixed regarding long-term cognitive deficits in patients treated with chemotherapy. Previous meta-analyses have not focused specifically on the postchemotherapy period and have not ...incorporated several recent studies. The goal of the current study was to conduct a meta-analysis of cognitive functioning in breast cancer survivors who were treated with chemotherapy ≥ 6 months previously.
A search of PubMed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library yielded 2,751 abstracts, which were independently evaluated by pairs of raters. Meta-analysis was conducted on 17 studies of 807 patients previously treated with standard-dose chemotherapy for breast cancer. Neuropsychological tests were categorized according to eight cognitive domains: attention, executive functioning, information processing, motor speed, verbal ability, verbal memory, visual memory, and visuospatial ability.
Deficits in cognitive functioning were observed in patients treated with chemotherapy relative to controls or prechemotherapy baseline in the domains of verbal ability (g = -0.19; P < .01) and visuospatial ability (g = -0.27; P < .01). Patients treated with chemotherapy performed worse than noncancer controls in verbal ability and worse than patients treated without chemotherapy in visuospatial ability (both P < .01). Age, education, time since treatment, and endocrine therapy did not moderate observed cognitive deficits in verbal ability or visuospatial ability (all P ≥ .51).
Results indicate that, on average, observed cognitive deficits in patients with breast cancer previously treated with chemotherapy are small in magnitude and limited to the domains of verbal ability and visuospatial ability. This information can be used to inform interventions to educate patients with breast cancer regarding the long-term impact of chemotherapy on cognitive functioning.
Objective: This prospective, longitudinal study examined fear of cancer recurrence (FCR) among breast cancer survivors having mammograms. FCR was hypothesized to increase prior to the mammogram, ...decrease from immediately pre- to immediately post-mammogram with negative results, and then increase following the mammogram. The possible presence of different trajectories of FCR was also examined. Based on the cognitive-behavioral model (CBM) of health anxiety, greater perceived risk of recurrence, worse perceived consequences of recurrence, lower treatment efficacy beliefs, lower coping self-efficacy, and more engagement in reassurance-seeking behaviors were hypothesized to be associated with greater FCR across all study time points. Methods: Following treatment completion for Stage 0-IIIA breast cancer, 161 women completed the following measures: perceived risk and perceived consequences of recurrence, treatment efficacy beliefs, coping self-efficacy, and reassurance-seeking behaviors. Participants reported FCR at 3 time points before and 3 after the mammogram. Growth curve analysis was used to test for changes in FCR over time and growth mixture modeling examined different trajectories in FCR and the ability of the CBM to predict these trajectories. Results: As hypothesized, FCR significantly changed over time; scores increased prior to the mammogram, decreased immediately following receipt of negative mammography results, and increased during the month following the mammogram. Growth mixture models revealed 2 classes, higher-FCR and lower-FCR, which were predicted by the CBM. Conclusions: These study findings support the use of the CBM in predicting which cancer survivors experience greater FCR and indicates that CBM-driven interventions may prove beneficial for reducing distressing FCR.
50•Dementia has no definite curative intervention available through the modern medical management.50•The current systematic review with meta-analysis aims to evaluate whether yoga, as a preventive ...mind-body therapy, is effective for the management of cognitive decline in older adults.50•These effect sizes obtained are similar to those observed in RCTs testing the efficacy of cholinesterase inhibitors such as donepezil, in participants with a similar level of cognitive impairment.50•Yoga interventions for older adults are safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline.
Considering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults.
Seven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d).
Twelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported.
Yoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.
Abstract Context Although cognitive impairments have been identified in patients with non–central nervous system cancer, especially breast cancer, the respective roles of cancer and therapies, and ...the mechanisms involved in cognitive dysfunction remain unclear. Objectives To report a state-of-the-art update from the International Cognitive and Cancer Task Force conference held in 2012. Methods A report of the meeting and recent new perspectives are presented. Results Recent clinical data support that non–central nervous system cancer per se may be involved in cognitive dysfunctions associated with inflammation parameters. The role of chemotherapy on cognitive decline was confirmed in colorectal and testicular cancers. Whereas the impact of hormone therapy remains debatable, some studies support a negative impact of targeted therapies on cognition. Regarding interventions, preliminary results of cognitive rehabilitation showed encouraging results. The methodology of future longitudinal studies has to be optimized by a priori end points, the use of validated test batteries, and the inclusion of control groups. Comorbidities and aging are important factors to be taken into account in future studies. Preclinical studies in animal models highlighted the role of cancer itself on cognition and support the possible benefits of prevention/care during chemotherapy. Progress in neuroimaging will help specify neural processes affected by treatments. Conclusion Clinical data and animal models confirmed that chemotherapy induces direct cognitive deficit. The benefits of cognitive rehabilitation are still to be confirmed. Studies evaluating the mechanisms underlying cognitive impairments using advanced neuroimaging techniques integrating the evaluation of genetic factors are ongoing.
Purpose:
Using data from a randomized clinical trial evaluating cognitive behavioral therapy (CBT) for children with autism and co-occurring anxiety, this study examined the relationship between ...autism features and anxiety symptoms throughout CBT.
Methods:
Two multilevel mediation analyses were run which examined the mediating role of changes in anxiety for changes in two core features of autism, (a) repetitive and restrictive behaviors (RRBs) and (b) social communication/interaction impairments, between pre- and post-treatment.
Results:
Indirect effects between time and autism characteristics were significant for both models, indicating that as anxiety changes, so do RRBs and social communication/interaction as the outcomes respectively.
Conclusion:
Findings suggest a bidirectional relationship between anxiety and autism features. Implications of these findings are discussed.
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