BACKGROUND: Providing smoking cessation care has not successfully prevented women who quit smoking during pregnancy from relapsing due to multi-level barriers.
OBJECTIVE: This paper explores systemic barriers to providing smoking cessation care, focusing on relapse prevention among pregnant and postpartum Aboriginal and Torres Strait Islander women (hereafter Aboriginal).
METHODS: Twenty-six interviews were conducted between October 2020 and July 2021 with health professionals, health promotion workers and managers working in Aboriginal smoking cessation across six Australian states and territories. Data were thematically analysed.
RESULTS: Themes emerging from the data included: (a) limited time, competing priorities and shortage of health professionals; (b) a need for more knowledge and skills for health professionals; (c) influences of funding allocations and models of smoking cessation care; (d) lack of relevance of anti-tobacco messages to pregnancy and postpartum relapse; and (e) ways forward. Several barriers emerged from policies influencing access to resources and approaches to smoking cessation care for Aboriginal women. Individual-level maternal smoking cessation care provision was often under-resourced and time-constrained to adequately meet Aboriginal women\'s needs. Identified needs for health professionals included more time, knowledge and skills, better cultural awareness for non-Indigenous health professionals, and salient anti-tobacco messages for pregnant women related to long-term cessation.
CONCLUSIONS: To drive smoking cessation in pregnant and postpartum Aboriginal women, we recommend adequately reimbursing midwives and Aboriginal Health Workers/Professionals to allow them to provide intensive support, build confidence in Quitline, continue health professionals\' capacity-building and allocate consistent funding to initiatives that have been efficacious with Aboriginal women.

OBJECTIVE: To describe the experiences of women with a mental health diagnosis with making and using a pregnancy relapse prevention plan (PRPP) in an effort to prevent mental health symptom relapse during the period of pregnancy, birth, and postpartum.
METHODS: Qualitative design with a phenomenological approach.
METHODS: Participants were recruited from an outpatient clinic within a \"psychiatry and pregnancy\" mental health institute in the Netherlands.
METHODS: Twelve women with a mental health diagnosis who gave birth.
METHODS: Data were collected by individual semistructured interviews supported by a topic list.
RESULTS: Four categories/themes of findings emerged from the data: Making and Advantage of the PRPP, Using the PRPP, Cooperation, and Care After Childbirth.
CONCLUSIONS: Making and using a PRPP provided pregnant women with overview, predictability, and feelings of tranquility on all aspects related to pregnancy, childbirth, and the postpartum period. Participants appreciated the support and recognition the PRPP provided. The signal function of the PRPP for all who were involved (professional and nonprofessional caregivers) was described as an added value. Involvement of women\'s partners and caretakers was essential. An evaluation afterward is recommended.

BACKGROUND: Patients with alcohol use disorder (AUD) tend to selectively approach alcohol cues in the environment, demonstrating an alcohol-approach bias. Alcohol-approach-bias modification (Alcohol-ApBM) effectively increases abstinence rates in patients with AUD when added to abstinence-focused treatment, but the evidence for its proposed working mechanism (reduction of the alcohol-approach bias) is limited. Moreover, not all patients benefit from Alcohol-ApBM, and previous research did not identify reliable pretreatment predictors of Alcohol-ApBM effectiveness. Therefore, the current study focused on learning processes during the Alcohol-ApBM training itself. Specifically, we examined whether changes in approach-avoidance tendencies over the course of Alcohol-ApBM would predict abstinence after inpatient treatment.
METHODS: The training data of 543 AUD patients in Germany (70% male, M = 47.96, SD = 9.08), receiving Alcohol-ApBM training during inpatient treatment, were used to examine whether various aspects of learning during training predicted abstinence 1 year after treatment discharge, both separately and in interaction with potential sociodemographic and clinical moderators of Alcohol-ApBM effectiveness.
RESULTS: Overall, successful learning across six Alcohol-ApBM training sessions was observed; that is, the approach tendency toward alcoholic stimuli was reduced over time. However, none of the examined learning parameters were predictive of abstinence, neither separately nor in combination with clinical or sociodemographic variables.
CONCLUSIONS: Previous studies have shown that Alcohol-ApBM is an effective add-on to abstinence-focused treatment for AUD, and this study showed that learning took place during Alcohol-ApBM training. However, specific learning parameters during training did not predict abstinence 1 year after treatment discharge. Therefore, we cannot specify which patients are most likely to benefit from ApBM with regard to abstinence after 1 year.

The aim of this study was to differentiate between types of bipolar disorders and the associated features using explorative analysis. The focus was particularly on the role of bipolar 1 and bipolar 2 disorders as well as the influence of prophylactic interventions for relapse in a randomized, controlled treatment study. A total of 274 of the 305 originally included persons could be investigated in the study. Patients participated in either cognitive behavioral group therapy (SEKT) or supportive, patient-centered group therapy (FEST). Treatment took place over 4 days separated by a 1-month interval (equivalent to 16 double hours). Depressive and manic symptoms were assessed using the longitudinal interval follow-up evaluation (LIFE). The symptoms were retrospectively assessed for the previous 6 months, with respect to each week before and after the intervention phase and for 6‑month and 12-month follow-ups. The results show that the effects of both group therapies were comparable; however, there were statistically significant differences in a multivariate proportional hazards model for the factors bipolar 1 and 2 as well as the interaction of therapy with bipolar 1 and 2. In particular, bipolar 2 patients benefited significantly less from the SEKT intervention than from the FEST intervention. There were three clusters identified that separated bipolar 1 (SEKT, no comorbidity, predominantly no recurrences, younger patients), from bipolar 2 (FEST, no comorbidity, at least 1 often 2 recurrences, older patients) and from a heterogeneous group (SEKT and FEST, comorbidity). The distinction between bipolar 1 and bipolar 2 disorder is important and has so far not received sufficient attention. Bipolar 2 disorders generally have a worse course and respond particularly poorly to cognitive behavioral therapy (SEKT). An open, unstructured, supportive, patient-centered psychotherapy (FEST) is generally effective.
UNASSIGNED: Anliegen dieser Arbeit ist es, mittels explorativer Auswertungen verschiedene Verlaufstypen bipolarer Störungen und den damit verbundenen Merkmalen zu differenzieren und dabei insbesondere die Rolle von Bipolar-1- und Bipolar-2-Störung sowie den Einfluss der rezidivprophylaktischen Interventionen im Rahmen einer randomisierten, kontrollierten Therapiestudie zu klären. Es konnten 274 der ursprünglich 305 eingeschlossenen Personen untersucht werden. Patienten nahmen entweder an einer kognitiv-verhaltenstherapeutischen (SEKT) oder unterstützenden, patientenzentrierten (FEST) Gruppentherapie teil, welche sich über 4 Therapietage (entspricht 16 Doppelstunden) in monatlichem Abstand erstreckte. Depressive und manische Symptomatik wurde anhand des LIFE jeweils für die zurückliegenden 6 Monate bezogen auf jede Woche vor und nach der Interventionsphase sowie 6 und 12 Monate katamnestisch beurteilt. Die Effekte beider Gruppentherapien erwiesen sich als vergleichbar. Statistisch signifikant wurden in einem multivariaten Proportional-Hazards-Modell jedoch der Faktor Bipolar 1 und 2 sowie die Interaktion von Therapie mit Bipolar 1 und 2. Insbesondere profitierten Bipolar-2-Patienten von der SEKT-Intervention deutlich schlechter als von FEST. Es ergaben sich 3 Cluster, die Bipolar 1 (SEKT, keine Komorbidität, mehrheitlich keine Rezidive, jüngere Patienten) von Bipolar 2 (FEST, keine Komorbidität, mindestens 1, oft 2 Rezidive, ältere Patienten) und von einer heterogenen Gruppe (beide Interventionen, Komorbidität) trennten. Die Unterscheidung von Bipolar-1- und Bipolar-2-Störung ist wichtig und bislang unzureichend berücksichtigt. Bipolar-2-Störungen zeigen generell einen schlechten Verlauf und sprechen auf eine kognitive Verhaltenstherapie (SEKT) besonders schlecht an. Eine offene, unstrukturierte, unterstützende, patientenzentrierte Psychotherapie (FEST) ist generell wirksam.

Shame is one of the leading barriers to successful recovery in substance use treatment settings. This secondary analysis study examined measurement invariance of the Internalized Shame Scale (ISS) and explored changes in shame during treatment. Participants (N=105) in the parent study were recruited from a nonprofit residential treatment center for justice-involved women and were randomized to receive mindfulness-based relapse prevention or relapse prevention treatment. A series of confirmatory factor analyses were used to assess measurement invariance in a one-factor measurement model of the ISS. Latent growth curve modeling was used to examine change in shame over time. Our findings support the assumption of measurement invariance across multiple time points and across treatment conditions, supporting comparisons of stigma scores across groups and over time. Although we observed significant reductions in shame from pre- to post-treatment, there were no differences across treatment conditions. Additional research is needed to determine how distinct treatment components relate to reductions in shame among individuals receiving treatment for a substance use disorder.

BACKGROUND: Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders.
METHODS: We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources.
RESULTS: Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions.
CONCLUSIONS: Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.

This retrospective study analysed 106 acute myeloid leukaemia (AML) patients undergoing autologous haematopoietic stem cell transplantation (ASCT) to assess the impact of multiple small-dose infusions of granulocyte-colony-stimulating factor (G-CSF)-mobilized haploidentical lymphocytes as post-ASCT maintenance therapy. Among them, 50 patients received lymphocyte maintenance therapy, 21 received alternative maintenance therapy, and 35 received no maintenance therapy. Patients receiving lymphocyte maintenance therapy demonstrated significantly higher overall survival (OS) and disease-free survival (DFS) compared to those without maintenance therapy, with 4-year OS and DFS rates notably elevated. While there were no significant differences in recurrence rates among the three groups, lymphocyte maintenance therapy showcased particular benefits for intermediate-risk AML patients, yielding significantly higher OS and DFS rates and lower relapse rates compared to alternative maintenance therapy and no maintenance therapy. The study suggests that multiple small-dose infusions of G-CSF-mobilized haploidentical lymphocytes may offer promising outcomes for AML patients after ASCT, particularly for those classified as intermediate-risk. These findings underscore the potential efficacy of lymphocyte maintenance therapy in reducing disease relapse and improving long-term prognosis in this patient population.

Objectives. Cognitive-Behaviorally Based Interventions (CBIs) are evidence-based treatments for alcohol and other drug (AOD) use with potential variable effectiveness by population sub-groups. This study used evidence synthesis to examine treatment effect by demographic and study context factors in clinical trials of CBI for AOD. Methods. Studies were systematically identified, and their characteristics and outcome data were extracted and summarized. Standardized mean differences were calculated for within- and between-condition effects on substance use outcomes. Demographic and study context moderators were identified during data acquisition and several sensitivity analyses were conducted. Results. The sample included K = 29 trials and a total of 15 study-level moderators were examined. Information on participants\' age, biological sex, and race were reported in at least 26 trials, but information on gender identity, sexual orientation, and ethnicity were reported infrequently or in non-inclusive ways. The mean between-condition effect size was small and moderately heterogenous (d = 0.158, 95% CI = 0.079, 0.238, I2 = 46%) and the mean within-condition effect size was large and showed high heterogeneity (dz = 1.147, 95% CI = 0.811, 1.482, - I2 = 96%). The specific drug targeted in the study and whether biological assay-based outcomes were used moderated between-condition CBI efficacy and the inclusion of co-occurring mental health conditions and study publication date moderated within-condition CBI effects. Conclusions. Results provide preliminary data on study context factors associated with effect estimates in United States based clinical trials of CBI for AOD.

Aim: This exploratory study analyses the interplay between the treatment philosophies of Alcoholics Anonymous (AA) and Relapse Prevention (RP) in personal stories of addiction. While the basic ideas of AA and RP are compatible in many ways, they also carry some fundamental differences. Methods: The data consisted of interviews with 12 individuals recovering from substance use problems, who had experience of both AA and RP. The analysis drew on a dialogical narrative perspective, and the concept polyphony was used to shed light on the interplay between different treatment philosophies in personal stories of relapse. Findings: Although sometimes resulting in incoherence, the treatment philosophies were combined idiosyncratically, in ways that appeared productive for the participants\' self-images and recovery journeys. Conclusion: The combination of AA and RP philosophies in narratives of relapse and recovery may reflect a new treatment discourse where individualisation and responsibilisation stand in a complicated relationship with collectivism and surrendering to so-called addicting processes.

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