Negative effects of psychological treatments is a fairly unexplored area of clinical research. Previous investigations have indicated that a portion of all patients experience negative effects in ...terms of deterioration and various adverse events. Meanwhile, evidence suggests that many clinicians are untrained in identifying negative effects and unaware of the current research findings. The objective of the current study is thus to investigate clinicians' own perspectives and experiences of possible negative effects of psychological treatments. An invitation to participate in an anonymous online survey consisting of 14 open-ended questions was distributed via three mailing lists used by clinicians that primarily identify themselves as cognitive behavior therapists. The responses were analyzed using a qualitative method based on thematic analysis. In total, 74 participants completed the survey. A majority agreed that negative effects of psychological treatments exist and pose a problem, and many reported having experienced both deterioration and adverse events among patients in their own practice. The thematic analysis resulted in three core themes: characteristics of negative effects, causal factors, as well as methods and criteria for evaluating negative effects. The clinicians recognize that negative effects exist, but many are unaware of the current research findings and are unfamiliar with methods and criteria for identifying and preventing deterioration and adverse events. The results provide evidence for further dissemination of the present knowledge regarding negative effects, particularly during basic clinical training, as well as the need for raising awareness of the available methods for identifying and preventing negative effects.
Guided Internet-based cognitive-behavioural self-help (ICBT) has been proven to be effective for social anxiety disorder (SAD) by several independent research groups. However, as the proportion of ...clinical significant change has room for improvement, new treatments should be developed and investigated. A novel treatment is attention bias modification (ABM). This study aimed at evaluating the combination of ABM and ICBT. We compared two groups, one group receiving ICBT and ABM targeting attentional avoidance and the other group receiving ICBT and control training. ABM and control training tasks were both based on the dot-probe paradigm. A total of 133 participants, diagnosed with SAD, were randomised to these two groups. The attention training group (N = 66) received 2 weeks of daily attention training followed by 9 weeks of ICBT. The control group (N = 67) received 2 weeks of daily control training, also followed by 9 weeks of ICBT. Social anxiety measures as well as the attention bias were assessed at pre-assessment, at week 2, and at post-treatment. Results showed no significant differences between the attention training group and the control group. Both groups improved substantially on social anxiety symptoms from pre- to post-assessment (d
within
= 1.39-1.41), but showed no change in attention processes (d
within
= 0.10-0.17). In this trial, the attention modification training failed to induce differential change in attention bias. Results demonstrate that the applied ABM procedure with its focus on the reduction of attentional avoidance was ineffective in the Internet-based setting. The results do not suggest that adding ABM targeting attentional avoidance to ICBT results in better outcomes than ICBT alone.
Bacterial nanocellulose (BNC) shows high biocompatibility as wound dressing or
dura mater
, blood vessel, and cartilage implant. Three-dimensional perforation (3-D-∅) favors migration of chondrocytes ...into the BNC and cartilage matrix formation. Thus, the regenerative capacity of 3-D-∅ BNC implants was tested in a standardized bovine cartilage punch model. Cartilage rings containing a central defect with an outer diameter of 6 mm and an inner diameter of 2 mm were prepared from the trochlear groove (femur-patellar articulation site). Three-D-∅ BNC implants (cell-free or cell-loaded) were cultured inside the cartilage rings for up to 12 weeks. Cartilage-BNC-constructs were then investigated by histology (hematoxylin/eosin; safranin O) and immunohistology (aggrecan, collagens 1 and 2), as well as for protein content, RNA expression, and implant push-out force. Cartilage-BNC-constructs remained vital with preserved matrix integrity during culture and almost no loss of matrix-bound proteoglycan (aggrecan) or collagen 2 from ‘host’ cartilage (with very limited quantities of collagen 1). Interestingly, 3-D-∅ BNC implants displayed: (1) significantly increased superficial, but also 3-D cell seeding over time (cell-loaded significantly earlier than cell-free); (2) progressively increased aggrecan/collagen 1 and collagen 2/collagen 1 mRNA ratios, as well as aggrecan and collagen 2 protein levels; and (3) significantly increased push-out forces over time (cell-loaded). Progressively increasing cell seeding and chondrogenic differentiation suggest beginning cartilage regeneration of the 3-D-∅ BNC in this model system, and indicate an excellent potential of 3-D-∅ BNC as a cartilage replacement material. Cell-loading may favor implant performance by accelerating cell colonization.
Graphical abstract
Objectives
The aim of the study was to assess the convergent and divergent validity, reliability, utility, and treatment sensitivity of a newly translated German version of the Southampton ...Mindfulness Questionnaire (SMQ). The SMQ is a 16-item instrument measuring mindful awareness of distressing thoughts, images, and perceptions, developed originally within the mindfulness for psychosis field.
Methods
Overall, three studies were conducted, comprising (1) a non-clinical sample of
n
= 848 (638 community sample and 210 meditators); (2) a clinical sample of
n
= 213 (106 schizophrenia and 107 depression); and (3) a clinical sample with
n
= 122 participants with emotional disorders within a randomized controlled study, of which 30 participants were also included in study 2. To assess convergent validity, participants completed the SMQ, Freiburg Mindfulness Inventory (FMI), and Comprehensive Inventory of Mindfulness Experiences (CHIME). To measure divergent validity, participants completed the Brief Symptom Inventory 18 (BSI-18), Positive and Negative Affect Schedule (PANAS), Brief Experiential Avoidance Questionnaires (BEAQ), and Anxiety Sensitivity Index 3 (ASI-3).
Results
Mean internal consistency (α = 0.89) and convergent (
r
= 0.66 to 0.73) and divergent validity (
r
= − 0.09 to − 0.50) were established and sensitivity to change over time following treatment (
d
= 0.86) was shown. For the clinical sample, a single-factor structure is suggested by principal component analysis.
Conclusions
Results provide first evidence for the utility of the German version of the SMQ for clinical practice and research in healthy individuals, meditators, and clinical groups. Further research is needed to examine the underlying construct of mindfulness.
The Unified Protocol (UP) as a transdiagnostic intervention has primarily been applied in the treatment of anxiety disorders and in face-to-face-settings. The current study investigated the efficacy ...of a 10-week Internet-based adaptation of the UP for anxiety, depressive, and somatic symptom disorders. The trial was registered under DRKS00014820 at the German Clinical Trial Registry, DRKS. Participants (n = 129) were randomized to treatment or waitlist control. Significant treatment effects were found for symptom distress, satisfaction with life, positive/negative affect and markers of anxiety, depression, and somatic symptom burden (within-group Hedges' g = 0.32-1.38 and between-group g = 0.20-1.11). Treatment gains were maintained at 1- and 6-month-follow-up. Subgroup analyses showed comparable effects in participants with anxiety and depressive disorders. 26.6% dropped out of treatment and 35.38% did not provide post-treatment assessments. The results strengthen the application of the UP as an Internet-based treatment for alleviating symptom distress across emotional disorders. More research on the applicability for single disorders is needed and avenues to improve adherence and attrition rates should be explored.
Transdiagnostic cognitive behavioural psychotherapy (TD-CBT) may facilitate the treatment of emotional disorders. Here we investigate short- and long-term efficacy of TD-CBT for emotional disorders ...in individual, group and internet-based settings in randomized controlled trials (PROSPERO CRD42019141512). Two independent reviewers screened results from PubMed, MEDLINE, PsycINFO, Google Scholar, medRxiv and OSF Preprints published between January 2000 and June 2023, selected studies for inclusion, extracted data and evaluated risk of bias (Cochrane risk-of-bias tool 2.0). Absolute efficacy from pre- to posttreatment and relative efficacy between TD-CBT and control treatments were investigated with random-effects models. Of 56 identified studies, 53 (6,705 participants) were included in the meta-analysis. TD-CBT had larger effects on depression (g = 0.74, 95% CI = 0.57-0.92, P < 0.001) and anxiety (g = 0.77, 95% CI = 0.56-0.97, P < 0.001) than did controls. Across treatment formats, TD-CBT was superior to waitlist and treatment-as-usual. TD-CBT showed comparable effects to disorder-specific CBT and was superior to other active treatments for depression but not for anxiety. Different treatment formats showed comparable effects. TD-CBT was superior to controls at 3, 6 and 12 months but not at 24 months follow-up. Studies were heterogeneous in design and methodological quality. This review and meta-analysis strengthens the evidence for TD-CBT as an efficacious treatment for emotional disorders in different settings.
Guided Internet-based cognitive-behavioral therapy (ICBT) has been found to be effective for social anxiety disorder (SAD) by several independent research groups. However, since the extent of ...clinically significant change demonstrated leaves room for improvement, new treatments should be developed and investigated. A novel treatment, which has generally been found to be effective, is cognitive bias modification (CBM). This study aims to evaluate the combination of CBM and ICBT. It is intended that two groups will be compared; one group randomized to receiving ICBT and CBM towards threat cues and one group receiving ICBT and control training. We hypothesize that the group receiving ICBT plus CBM will show superior treatment outcomes.
Participants with SAD (N = 128), will be recruited from the general population. A composite score combining the scores obtained from three social anxiety questionnaires will serve as the primary outcome measure. Secondary measures include self-reported depression and quality of life. All treatments and assessments will be conducted via the Internet and measurement points will be baseline, Week 2, post-treatment, and 4 months post-treatment.
There is no direct evidence of the effects of combining CBM and ICBT in SAD. Adding attention-training sessions to ICBT protocols could increase the proportion of participants who improve and recover through Internet-based self-help.
ClinicalTrials.gov: NCT01570400.
Zusammenfassung
Hintergrund
Viele Geflüchtete, die insbesondere seit 2015 nach Deutschland kamen, sind von psychischen Störungen betroffen. Aufgrund von Sprachbarrieren und eingeschränktem Anspruch ...ist ihr Zugang zu psychotherapeutischer Versorgung jedoch erschwert.
Ziel der Arbeit
Es soll eine exemplarische Übersicht über digitale Interventionen für Geflüchtete mit psychischen Störungen erstellt und ihre Wirksamkeit diskutiert werden. Herausforderungen digitaler Interventionen sollen beleuchtet werden.
Material und Methoden
Metaanalysen und Übersichtsbeiträge zu digitalen Interventionen für Migrant*innen und Geflüchtete weltweit sowie deren Referenzlisten wurden nach relevanten Interventionen durchsucht. Zusätzlich wurden die App Stores durchsucht. Interventionen wurden aufgenommen, wenn (1) es sich um digitale Angebote handelt, die sich (2) primär an Geflüchtete in Deutschland richten, die (3) in arabischer oder persischer Sprache vorliegen und die (4) aktuell zur Verfügung stehen.
Ergebnisse und Diskussion
Zum aktuellen Zeitpunkt gibt es eine geleitete und 8 ungeleitete Interventionen für Geflüchtete zur Behandlung u. a. von posttraumatischer Belastungsstörung (PTBS), Depression und Angststörungen als App oder Web-Anwendung. Nur 2 dieser Anwendungen wurden bereits evaluiert, und nur eine Anwendung konnte eine Reduktion der Primärsymptomatik demonstrieren. Hohe Abbruchraten stellen eine Herausforderung in der digitalen Versorgung Geflüchteter dar.
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