Psychological intervention

心理干预
  • 文章类型: Journal Article
    背景:暴食症(BED)是普通人群中最常见的饮食行为(GuerdjikovainMedClin103:669-680,2019)。在美国和欧洲已经进行了许多关于干预和BED治疗的研究,在拉丁美洲人口中很少有报道。患有这种疾病的人不仅有身体上的后果,还有社会和心理上的后果,因此,多学科治疗方法是治疗这种疾病的好选择。
    目的:评估多学科在线干预的可行性(即,心理,营养,和身体活动)在BED患者中。
    方法:设计是两个临床治疗组的病例系列研究,进行测试前和测试后的心理测量以及两次随访(2个月和6个月)。15人被诊断为BED(2名男性和13名女性),平均年龄34.93岁(SD=11.91),平均初始BMI为42,参与本研究.治疗在28个疗程中进行,每周2小时,包括1小时的小组治疗和1小时的单独治疗.有四个评价:pre,后和两个后续行动。
    结果:5例患者未完成治疗(30%)。通过非参数弗里德曼检验进行比较,发现暴饮暴食症状的统计学显着减少(x2=15.57;p=.001),焦虑症状(x2=15.96;p=.001)和抑郁(x2=15.03;p=.002)。清晰度(x2=11.60;p=.010)和情绪调节(x2=7.75;p=.050)有所改善,只有在女人。病人减轻了体重,并通过在日常生活中引入水果和蔬菜以及包括20-30分钟的体育锻炼来改善他们的饮食和运动习惯。关于客观临床变化指数,就客观的临床变化而言,在所处理的所有变量中均观察到正变化.
    结论:所提供的数据使我们得出结论,在线多学科干预对BED的治疗是有效的。试用登记追溯登记。
    BACKGROUND: Binge eating disorder (BED) is the most frequent eating behavior among the general population (Guerdjikova in Med Clin 103:669-680, 2019). Many studies on interventions and BED treatments have been carried out in the United States and Europe, few have been reported in Latin American populations. People with this disorder not only have physical consequences of it but also social and psychological ones, therefore a multidisciplinary treatment approach is a good option to treat this condition.
    OBJECTIVE: To evaluate the feasibility of a multidisciplinary online intervention (i.e., psychological, nutritional, and physical activity) in patients with BED.
    METHODS: The design was a case series study of two clinical treatment groups, with pre-test and post-test psychometric measures along with two follow-ups (at 2 and 6 months). Fifteen people diagnosed with BED (2 men and 13 women), with a mean age of 34.93 years (SD=11.91) and a mean initial BMI of 42, participated in this study. The treatment was carried out over the span of 28 sessions, each one being two hours per week consisting of 1 hour of group therapy and 1 hour of individual therapy. There were four evaluations: pre, post and two follow-ups.
    RESULTS: Five patients did not complete the treatment (30%). The comparisons were made through the non-parametric Friedman test, finding a statistically significant decrease in binge eating symptoms (x2=15.57; p=.001), anxiety symptoms (x2=15.96; p=.001) and depression (x2=15.03; p=.002). There was an improvement in clarity (x2=11.60; p=.010) and emotional regulation (x2=7.75; p=.050), only in women. The patients reduced their body weight, and improved their eating and exercise habits by introducing fruits and vegetables and including 20-30 minutes of physical activity into their daily routine. Regarding the Objective Clinical Change Index, in terms of the objective clinical change, a positive change was observed in all the variables addressed.
    CONCLUSIONS: The data presented allowed us to conclude that the online multidisciplinary intervention was effective in the treatment of BED. Trial registration Retrospectively registered.
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  • 文章类型: Journal Article
    减少常见精神障碍的全球负担的努力集中在扩大非专业提供者的循证培训计划,以提供简短的心理干预。要评估这些提供者培训计划,需要与他们一起开发适当和可扩展的能力评估。我们遵循了一种系统的方法来进行文化适应,并将其翻译成有效的印地语,英语,多项选择应用知识测量来评估非专业人士对印度农村抑郁症进行简短心理干预的能力。然后,我们探索了30个非专业提供商在相同书面度量上的绩效与由两个角色扮演组成的基于绩效的结构化度量之间的关系。多项选择评估的结果的总体平均得分为37.40(SD=11.31),而角色扮演A(更容易的角色扮演)的平均得分为43.25(SD=14.50)和角色扮演B(更困难的角色扮演)的平均得分为43.25(SD=13.00)。角色扮演基于绩效的度量和书面应用知识度量代表了不同的方法,具有独特的优势和挑战来衡量能力。扩大培训计划需要开发可扩展的能力评估方法。探索这两种措施之间的关系,我们的团队发现两种评估模式之间没有明显差异.需要对这些方法进行持续比较,以确定两种格式的结果一致性,并将这些措施的得分与护理质量和患者结果所反映的临床表现联系起来。试用注册:ClinicalTrials.gov标识符:NCT04157816;2019年11月8日。
    Efforts to reduce the global burden of common mental disorders have focused on scaling up evidence-based training programs for non-specialist providers to deliver brief psychological interventions. To evaluate these provider training programs, appropriate and scalable assessments of competency need to be developed alongside them. We followed a systematic approach for the cultural adaptation and translation into Hindi of a valid, English, multiple-choice applied knowledge measure to assess non-specialists\' competence to deliver a brief psychological intervention for depression in rural India. We then explored the relationship between the performance of 30 non-specialist providers on the same written measure compared with a structured performance-based measure consisting of two role-plays. The results of the multiple-choice assessment had an overall mean score of 37.40 (SD = 11.31) compared to the mean scores of role-play A (the easier role-play) of 43.25 (SD = 14.50) and role-play B (the more difficult role-play) of 43.25 (SD = 13.00). Role-play performance-based measures and written applied knowledge measures represent different approaches with unique strengths and challenges to measuring competence. Scaling up training programs requires the development of scalable methods for competency assessment. Exploring the relationship between these two measures, our team found no apparent differences between the two modes of assessment. Continued comparison of these approaches is needed to determine the consistency of outcomes across the two formats and to link the scores on these measures with clinical performance as reflected by the quality of care and patient outcomes.Trial Registration: ClinicalTrials.gov Identifier: NCT04157816; 8th November 2019.
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  • 文章类型: Journal Article
    中度至重度获得性脑损伤(ABI)可能对ABI幸存者及其家人造成巨大的终身后果。尽管自20世纪80年代以来的康复实践渴望充满活力,连贯和整体的方法,心理层面似乎仍然是一个挑战,研究表明ABI后持续存在的心理社会损伤.因此,我们开发了BackUp©,针对成人ABI患者的手动短期心理干预。本研究通过一项小型可行性研究探讨了干预的效果,采用单一案例设计。一位客户接受了干预。收集了自我报告措施,进行了半结构化访谈。虽然来自pre的结果,事后和后续措施没有显示出明显的积极效果,访谈揭示了积极的经历,参与者报告说他实现了治疗目标。本案例研究为心理干预提供了支持,以支持ABI后的心理康复。
    A moderate-to-severe acquired brain injury (ABI) can have tremendous lifelong consequences for ABI-survivors and their families. Despite rehabilitation practice since the 1980s aspiring to a dynamic, coherent and holistic approach, the psychological dimension still seems to be a challenge and research has revealed persisting psychosocial impairments after ABI. Therefore, we developed BackUp©, a manual based short term psychological intervention for adults with ABI. This study explores the effect of the intervention though a small feasibility study, employing a single case design. One client received the intervention. Self-report measures were collected, and a semi structured interview was conducted. While results from pre, post and follow-up measures do not show clear positive results, the interview reveals positive experiences and the participant reported achieving his therapy goal. This case study provides support for a psychological intervention to support the psychological rehabilitation after an ABI.
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  • 文章类型: Case Reports
    BACKGROUND: Novel coronavirus disease 2019 (COVID-19) was first found in Wuhan, China, and it has rapidly spread worldwide since the end of 2019. There is an urgent need to treat the physical and psychological aspects of COVID-19. Interpersonal psychotherapy (IPT)-based psychological intervention is an evidence-based therapy for depression and post-traumatic stress disorder.
    METHODS: This report describes a case of COVID-19 in a patient who transmitted the disease to his entire family. The patient received four sessions of IPT-based psychological intervention. We used the Hamilton Rating Scale for Depression and Patient Health Questionnaire to measure depression level, and the Hamilton Anxiety Scale and Generalized Anxiety Disorder to measure anxiety among the patients.
    CONCLUSIONS: This case shows that IPT-based therapy can reduce COVID-19 patient depression and anxiety and the advantage of IPT-based therapy.
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  • 文章类型: Journal Article
    目的:在对精神病认知行为疗法(CBTp)进行了20年的研究之后,有必要考虑在什么时候证据基础被认为是足够的。我们完成了一项累积荟萃分析,以评估幻觉和妄想证据的充分性和稳定性。
    方法:我们更新了从2013年8月到2019年12月之前的荟萃分析综述的系统搜索。我们确定了20个新的随机对照试验(RCTs),结果纳入了35个RCTs,比较CBTp与照常治疗(TAU)或主动对照(AC)。我们分析了来自精神病患者(N=2407)的75个常规荟萃分析比较的数据。我们完成了关键比较的累积荟萃分析(包括故障-安全比率)。出版偏见,异质性,并对偏倚风险进行了检查。
    结果:累积荟萃分析显示幻觉和妄想证据的充分性和稳定性。故障安全比表明,证据基础在2016年足以用于幻觉,在2015年足以用于妄想。在传统的荟萃分析中,与任何对照组相比,CBTp在幻觉(g=0.34,P<0.01)和妄想(g=0.37,P<0.01)方面均优于对照组。与TAU相比,CBTp在幻觉(g=0.34,P<0.01)和妄想(g=0.37,P<0.01)方面具有优势。与AC相比,CBT优于幻觉(g=0.34,P<0.01),但不是妄想,尽管这种比较是不足的。案例制定的敏感性分析,主要结果焦点,和偏倚的风险表明幻觉的影响幅度增加。
    结论:CBTp对幻觉和妄想的影响的证据基础证明了比较的充分性和稳定性,提示新试验评估通用CBTp的价值有限。
    OBJECTIVE: Following 2 decades of research on cognitive behavioral therapy for psychosis (CBTp), it is relevant to consider at which point the evidence base is considered sufficient. We completed a cumulative meta-analysis to assess the sufficiency and stability of the evidence base for hallucinations and delusions.
    METHODS: We updated the systematic search from our previous meta-analytic review from August 2013 until December 2019. We identified 20 new randomized controlled trials (RCTs) resulting in inclusion of 35 RCTs comparing CBTp with treatment-as-usual (TAU) or active controls (AC). We analyzed data from participants with psychosis (N = 2407) over 75 conventional meta-analytic comparisons. We completed cumulative meta-analyses (including fail-safe ratios) for key comparisons. Publication bias, heterogeneity, and risk of bias were examined.
    RESULTS: Cumulative meta-analyses demonstrated sufficiency and stability of evidence for hallucinations and delusions. The fail-safe ratio demonstrated that the evidence base was sufficient in 2016 for hallucinations and 2015 for delusions. In conventional meta-analyses, CBTp was superior for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01) when compared with any control. Compared with TAU, CBTp demonstrated superiority for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01). Compared with AC, CBT was superior for hallucinations (g = 0.34, P < .01), but not for delusions although this comparison was underpowered. Sensitivity analyses for case formulation, primary outcome focus, and risk of bias demonstrated increases in effect magnitude for hallucinations.
    CONCLUSIONS: The evidence base for the effect of CBTp on hallucinations and delusions demonstrates sufficiency and stability across comparisons, suggesting limited value of new trials evaluating generic CBTp.
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  • 文章类型: Case Reports
    BACKGROUND: Primary malignant melanoma of the esophagus accounts for 0.1%-0.2% of all esophageal malignancies, including melanotic and amelanotic melanomas. Primary amelanotic malignant melanoma of the esophagus is extremely rare, and only about 20 cases have been published in the literature to date. Most primary malignant melanomas of the esophagus are diagnosed following development of metastatic lesions and thus have a very poor prognosis. The median survival duration of patients with metastatic melanoma has been reported to be 6.2 mo.
    METHODS: A 49-year-old woman was referred to our hospital with a diagnosis of esophageal cancer. Endoscopy, biopsy, imaging evaluation, and physical examination at our hospital indicated a diagnosis of advanced primary amelanotic malignant melanoma of the esophagus. Immunohistochemical staining confirmed melanoma. Nuclear medicine examination revealed a left iliac bone metastatic lesion. After discharge, the patient self-administered apatinib for 3 mo, followed by oral treatment with Chinese medicines (also self-administered) for 2 mo. No treatments had been taken since then. The patient has survived with no growth out to the most recent follow-up (24 mo post diagnosis), and she always presented with a positive attitude about her condition during this period.
    CONCLUSIONS: Survival following metastatic melanoma might be related to the pharmaceutical and Chinese medicine treatment and the patient\'s positive attitude.
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  • 文章类型: Journal Article
    尽管有精神病症状的人的创伤发生率很高,创伤后应激症状在临床实践中经常被忽视。在再处理创伤的治疗程序加剧精神病症状的情况下,也不愿治疗创伤后症状。最近的证据表明,在该人群中使用再处理策略是安全的。然而,大多数已发表的研究都是基于治疗创伤后症状,而不是精神病性症状。当前案例系列的目的是评估可接受性,可行性,以及将创伤后应激和精神病症状的认知行为方法整合到单一方案中的初步有效性。9名报告令人痛苦的精神病和创伤后症状的参与者从精神病的专业心理治疗服务中招募。在五个时间点对客户进行评估(基线,pre,mid,治疗结束,并在6个月以上的随访中)由独立评估者对当前精神病症状的测量,创伤后应激,情绪问题,和幸福。治疗是基于配方和个性化的,取决于症状和创伤类型。它由五个广泛的,灵活的阶段,并包括想象的再处理策略(重述和/或重新编写脚本)。干预得到了好评,具有积极的治疗后反馈和满意度评分。对于这个人群来说,不同寻常的是,没有人退出治疗.治疗后,与治疗前相比,除一名患者(88%的参与者)在至少一项结果指标上实现了可靠的改善:创伤后症状(63%),声音(25%),妄想(50%),抑郁症(50%),焦虑(36%),幸福(40%)。78%(n=7)完成了后续评估,其中86%(n=6)保持至少一个可靠的改善。治疗后的改善率(治疗后措施的平均值为44%;随访时为32%)是等待列表期间发现的两倍(19%)。没有参与者在治疗期间或治疗后出现任何症状的可靠恶化。研究表明,对于这个小样本,结合后处理策略的综合疗法是一种可接受且可行的干预措施,有希望的有效性。有必要进行随机对照试验以测试干预对该人群的疗效。
    Despite high rates of trauma in individuals with psychotic symptoms, post-traumatic stress symptoms are frequently overlooked in clinical practice. There is also reluctance to treat post-traumatic symptoms in case the therapeutic procedure of reprocessing the trauma exacerbates psychotic symptoms. Recent evidence demonstrates that it is safe to use reprocessing strategies in this population. However, most published studies have been based on treating post-traumatic symptoms in isolation from psychotic symptoms. The aims of the current case series were to assess the acceptability, feasibility, and preliminary effectiveness of integrating cognitive-behavioural approaches for post-traumatic stress and psychotic symptoms into a single protocol. Nine participants reporting distressing psychotic and post-traumatic symptoms were recruited from a specialist psychological therapies service for psychosis. Clients were assessed at five time points (baseline, pre, mid, end of therapy, and at 6+ months of follow-up) by an independent assessor on measures of current symptoms of psychosis, post-traumatic stress, emotional problems, and well-being. Therapy was formulation based and individualised, depending on presenting symptoms and trauma type. It consisted of five broad, flexible phases, and included imaginal reprocessing strategies (reliving and/or rescripting). The intervention was well received, with positive post-therapy feedback and satisfaction ratings. Unusually for this population, no-one dropped out of therapy. Post therapy, all but one (88% of participants) achieved a reliable improvement compared to pre-therapy on at least one outcome measure: post-traumatic symptoms (63%), voices (25%), delusions (50%), depression (50%), anxiety (36%), and well-being (40%). Follow-up assessments were completed by 78% (n = 7) of whom 86% (n = 6) maintained at least one reliable improvement. Rates of improvements following therapy (average of 44% across measures post therapy; 32% at follow-up) were over twice those found during the waiting list period (19%). No participant indicated a reliable worsening of any symptoms during or after therapy. The study shows that an integrative therapy incorporating reprocessing strategies was an acceptable and feasible intervention for this small sample, with promising effectiveness. A randomised controlled trial is warranted to test the efficacy of the intervention for this population.
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  • 文章类型: Journal Article
    有许多有希望的心理干预措施即将出现,但是没有明确的方法来准备扩大规模。借鉴设计思维,本研究正式化了重新设计和定制初始干预措施的方法。在向高中过渡期间,我们使用固定思维与增长思维的情况来测试该方法。定性调查和快速,迭代,对约3,000名参与者进行了随机“A/B”实验,以告知该人群的干预修订。接下来,两项实验性评估表明,修订后的成长心态干预措施在短期代理结果方面比以前的版本有所改善(研究1,N=7,501),它提高了9年级核心课程的GPA,并降低了D/FGPA,以在常规条件下通过互联网提供的成绩较低的学生,其中10所学校的学生约95%(研究2,N=3,676)。尽管干预措施仍可以进一步改善,当前的研究为如何改进和扩大干预措施提供了一个模型,开始解决紧迫的教育问题。它还提供了如何更有效地教授成长心态的见解。
    There are many promising psychological interventions on the horizon, but there is no clear methodology for preparing them to be scaled up. Drawing on design thinking, the present research formalizes a methodology for redesigning and tailoring initial interventions. We test the methodology using the case of fixed versus growth mindsets during the transition to high school. Qualitative inquiry and rapid, iterative, randomized \"A/B\" experiments were conducted with ~3,000 participants to inform intervention revisions for this population. Next, two experimental evaluations showed that the revised growth mindset intervention was an improvement over previous versions in terms of short-term proxy outcomes (Study 1, N=7,501), and it improved 9th grade core-course GPA and reduced D/F GPAs for lower achieving students when delivered via the Internet under routine conditions with ~95% of students at 10 schools (Study 2, N=3,676). Although the intervention could still be improved even further, the current research provides a model for how to improve and scale interventions that begin to address pressing educational problems. It also provides insight into how to teach a growth mindset more effectively.
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  • 文章类型: Journal Article
    The purpose of this study is developing and applying psychological skill training (PST) program as one of the methods of intervention for psychological rehabilitation in order for a successful recovery of the professional soccer player (K). He is currently on rehabilitation training after an injury, and we tried to see the results of this program. It was designed as a program of 17 sessions including 3 interviews and diagnostic checks (psychological skill questionnaire: PSQ, profiles of mood states: POMS) and 14 sessions of PST (goal setting, anxiety reduction, concentration, confidence). After the application of the program, the levels of anxiety reduction, goal setting, concentration, and confidence were visibly increased, and in POMS, which is an indicator of physical rehabilitation process of K, vigor was increased. Meanwhile negative emotions, such as tension, depression, and fatigue were decreased. This program was developed for K, and therefore it has some difficulties in applying it to other players. However, the significance of this study is that it could serve as a basis on developing programs for other players in the rehabilitation process. In addition, it has also proven that PST can be used as a successful method for psychological rehabilitation intervention.
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  • 文章类型: Journal Article
    This study explored the processes of significance about the risk communication in prenatal/preconception setting within 1 month to the end of genetic counselling intervention. Participants were all attending a programme of Cardiomyology and Medical Genetics in Naples, Italy, for the first time. Transcripts of 18 semi-structured interviews were analysed using interpretative phenomenological analysis. Themes arising included the following: the familiar outcomes of genetic counselling, the risk representation and the impacts on decision-making. The findings suggest the significance of the experience of genetic risk and the implications for the support of individuals and their family after the conclusion of the genetic counselling intervention.
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