Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial

2021 ◽  
pp. 108705472110569
Author(s):  
Stephen P. Becker ◽  
Kara M. Duraccio ◽  
Craig A. Sidol ◽  
Chaya E. M. Fershtman ◽  
Kelly C. Byars ◽  
...  
Keyword(s):  
Sleep Problems ◽  
Controlled Trial ◽  
Preliminary Evidence ◽  
Post Treatment ◽  
Open Trial ◽  
Post Intervention ◽  
Sleep Diaries ◽  
Adolescent Parent ◽  
Pre Treatment

Objective: An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD. Method: Fourteen adolescents (ages 13–17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up. Results: Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively. Conclusion: This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.

Personalized attention control therapy for PTSD: effectiveness and moderators of outcome in a randomized controlled trial

2020 ◽  
pp. 1-11
Author(s):  
Adva Segal ◽  
Daniel S. Pine ◽  
Yair Bar-Haim
Keyword(s):  
Treatment Outcome ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
Post Treatment ◽  
Attention Control ◽  
Randomized Controlled ◽  
Control Therapy ◽  
Pre Treatment ◽  
Attentional Interference

Abstract Background Previous randomized controlled trials (RCTs) suggest that attention control therapy (ACT), targeting aberrant fluctuations of attention toward and away from threats in patients with PTSD, may be effective in reducing symptoms. The current RCT examined whether the use of personalized-trauma stimuli enhances ACT efficacy in patients with PTSD. Additional moderators of treatment outcome were tested on an exploratory basis. Methods Sixty patients with PTSD were randomly assigned to either personalized ACT, non-personalized ACT, or a control condition. Changes in symptoms were examined across pre-treatment, post-treatment, and a 3-month follow-up. Attentional interference was examined pre- and post-treatment. Baseline clinical and cognitive indices as well as the time elapsed since the trauma were tested as potential moderators of treatment outcome. Results A significant reduction in clinical symptoms was noted for all three conditions with no between-group differences. Attention bias variability decreased following ACT treatment. Personalized ACT was more effective relative to the control condition when less time had elapsed since the trauma. Baseline clinical and cognitive indices did not moderate treatment outcome. Conclusions In this RCT of patients with PTSD, ACT was no more effective in reducing PTSD symptoms than a control condition. The data also suggest a potential benefit of personalized ACT for patients who experienced their trauma more recently.

A Comparison of Acupuncture with Advice and Exercises on the Symptomatic Treatment of Osteoarthritis of the Hip – a Randomised Controlled Trial

2001 ◽  
Vol 19 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Roisin Haslam
Keyword(s):  
Controlled Trial ◽  
Randomised Trial ◽  
Symptomatic Treatment ◽  
Post Treatment ◽  
Control Group ◽  
Group A ◽  
Pre Treatment ◽  
Group B ◽  
Randomised Controlled

Acupuncture is becoming a common technique within the physiotherapy profession as a treatment modality for pain relief; however, few randomised controlled trials have been undertaken to assess the effectiveness of acupuncture, particularly in the treatment of osteoarthritis (OA) of the hip. Therefore, a randomised trial to compare the effectiveness of acupuncture with advice and exercises on the symptomatic treatment of OA of the hip was carried out. Thirty-two patients awaiting a total hip arthroplasty were randomly allocated to either the experimental group, (A), to have six sessions of acupuncture each lasting up to 25 minutes, or the control group, (B), to be given advice and exercises for their hip over a six week period. Group A consisted of three men and 13 women, and group B consisted of four men and eight women. The average age in group A was 66 years and in group B it was 68 years. Patients were assessed for pain and functional ability, using a modified version of the WOMAC questionnaire, pre-treatment, immediately post-treatment and at eight weeks post-treatment. The pre-treatment WOMAC scores in the two groups were similar (p=0.85). There was a significant improvement in group A (decrease in WOMAC score) immediately post-treatment (p=0.002) and this was maintained at the eight-week follow-up (p=0.03). There were no significant changes in group B. When the changes in WOMAC scores were compared between groups, a significantly greater improvement was found between pre-treatment and immediately post-treatment in group A, compared with group B (p=0.02). The changes between pre-treatment and the eight-week follow-up also showed a significant improvement in group A compared with group B (p=0.03). In conclusion, this trial supports the hypothesis that acupuncture is more effective than advice and exercises in the symptomatic treatment of OA of the hip.

345 Preliminary efficacy of CBT-I for psychosis in a Veteran sample

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A138-A138
Author(s):  
Mary Katherine Howell ◽  
Elizabeth A Klingaman
Keyword(s):  
Functional Impairment ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Controlled Trial ◽  
Post Treatment ◽  
Psychotic Symptoms ◽  
Control Group ◽  
Efficacy Study ◽  
Treatment Comparison

Abstract Introduction Sleep dysfunction is pervasive in people with psychosis. Insomnia worsens psychotic symptoms and functioning, though treating insomnia can improve functioning. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment, but there has been limited research on CBT-I in persons with psychosis. There is mounting evidence that sleep disturbances in people with psychiatric disorders do not improve with treatment of psychiatric illness. The present study 1) developed empirical guidelines for tailoring CBT-I to the needs of people with psychosis and insomnia; 2) conducted a preliminary efficacy study of CBT-I with these novel guidelines for psychosis; and 3) utilized objective and subjective insomnia and functional measures. Methods Novel psychosis guidelines were developed in response to illness-related, environmental, and practical challenges for engaging in traditional components of CBT-I, identified via a series of 25 qualitative interviews and an uncontrolled acceptability trial. A preliminary efficacy study of CBT-I with novel psychosis guidelines was conducted against an active treatment comparison group. Forty-seven Veterans with insomnia and co-occurring psychotic-spectrum disorder completed sleep measures, including the Insomnia Severity Index (ISI), at baseline, post-treatment, and 3-month follow-up. Results Psychosis guidelines for CBT-I included supporting integrated care (e.g., with case managers, prescribers, etc.), simplifying instructions on all treatment materials, reminder handouts, reality testing with sleep-related experiences, cognitive restructuring guidance for common sleep-related cognitions held by people with psychosis, techniques for use during psychotic experiences at bedtime. At post-treatment and follow-up, there was a large effect of CBT-I on ISI scores (d = 1.00, 1.18, respectively). Further, a clinically significant reduction in mean ISI score of participants was observed in the CBT-I condition (> 6), but not in the control condition. Participants in the CBT-I group reported reductions in daily functional impairment due to sleep problems (from 89% to 50%), while the control group reported a slight increase in functional impairment (from 86% to 88%). Conclusion CBT-I delivered with guidelines for psychosis should be further investigated with a larger randomized controlled trial over a longer time period of 6 months. Support (if any) Time on this project was supported by the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2RX001836, PI: Elizabeth A. Klingaman.

Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial

2020 ◽  
Vol 38 (6) ◽  
pp. 396-406
Author(s):  
Kamma Sundgaard Lund ◽  
Volkert Siersma ◽  
Christine Winther Bang ◽  
John Brodersen ◽  
Frans Boch Waldorff
Keyword(s):  
Treatment Effect ◽  
Acupuncture Treatment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Post Treatment ◽  
Menopausal Symptoms ◽  
Scale Scores ◽  
Pre Treatment ◽  
Randomised Controlled

Background Our objective was to investigate whether the effect of a brief and standardised acupuncture approach persists after the end of the acupuncture treatment (post-treatment effect) and whether the anticipation of future acupuncture treatment affects menopausal symptoms (pre-treatment effect). Method This study is a post hoc analysis of data from a randomised controlled trial where women with moderate to severe menopausal symptoms were offered weekly acupuncture treatment over five consecutive weeks and randomised (1:1) to an early intervention group that received treatment immediately and a late intervention group with a 6-week delay. The acupuncture style was Western medical, administered at CV3, CV4 and bilateral LR8, SP6 and SP9. Acupuncturists were general practitioners. The effect was evaluated repeatedly during and after the interventions using scales from the validated MenoScores Questionnaire (MSQ) for hot flushes (HF), day and night sweats (DNS), general sweating (GS) and menopausal-specific sleeping problems (MSSP) with a 26-week follow-up period (corresponding to 21 or 15 weeks post-treatment for the early and late intervention groups, respectively). Multivariable linear mixed models were used to analyse the extent and duration of effects. Results Seventy participants were included in the study. Four participants dropped out. Furthermore, one participant was excluded from the short- and long-term follow-up analyses after the insertion of a hormonal intrauterine device, and nine participants were excluded from the long-term follow-up analysis due to the initiation of co-interventions. For each of the four outcomes, the effect was sustained up to 21 weeks post-treatment with an effect size that was only slightly diminished. A small, but significant, pre-treatment effect was observed in the HF scale scores. The same trend, although not significant, was observed in the DNS and MSSP scale scores. No serious harms were reported. Conclusion This study demonstrated that the overall effect of a brief and standardised acupuncture treatment on menopause-relevant outcomes was sustained up to 21 weeks post-treatment and that there was a small pre-treatment effect.

An integrated sleep and anxiety intervention for anxious children: A pilot randomized controlled trial

2020 ◽  
Vol 25 (4) ◽  
pp. 945-957 ◽  
Author(s):  
Michelle A Clementi ◽  
Candice A Alfano
Keyword(s):  
Sleep Problems ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Case Series ◽  
Post Treatment ◽  
Sleep Onset Latency ◽  
Randomized Controlled ◽  
Small Effect Size

Sleep-related complaints hold complex reciprocal relationships with anxiety and are a pervasive, distressing feature of childhood generalized anxiety disorders (GAD). Although evidence suggests purely anxiety-focused treatments reduce some sleep problems of anxious children, interventions that directly target both anxiety and sleep might produce superior outcomes in both domains. Targeted Behavioral Therapy (TBT), developed for co-morbid sleep and anxiety problems, demonstrated initial efficacy in a small case series but has not been directly compared to anxiety-focused treatment. The current pilot study used a randomized controlled design to compare TBT to “gold standard” cognitive-behavioral therapy (CBT) for anxiety among n = 20 children (ages 6–12) with primary GAD. Multi-informant measures of anxiety and sleep (including actigraphy) were obtained at baseline, post-treatment, and 6-month follow-up. Results indicated significant improvements (based on moderate to large effect sizes) in anxiety and subjective sleep in both treatment groups at post-treatment. Improvements were maintained at 6-month follow-up. Objective sleep onset latency also decreased marginally for both groups at post-treatment (based on small effect size). Findings provide preliminary support for the feasibility and potential utility of anxiety-focused interventions for improving some sleep-related problems among anxious youth. Future studies including large samples are needed.

Web-based Oral Reading for Language in Aphasia (Web ORLA®): A pilot randomized control trial

2021 ◽  
pp. 026921552098847
Author(s):  
Leora R Cherney ◽  
Jaime B Lee ◽  
Kwang-Youn A Kim ◽  
Sarel van Vuuren
Keyword(s):  
Oral Reading ◽  
Controlled Trial ◽  
Post Treatment ◽  
Control Group ◽  
Web Based ◽  
End Of Treatment ◽  
Significant Difference ◽  
Pre Treatment ◽  
The Web

Objective: To investigate an intensive asynchronous computer-based treatment delivered remotely with clinician oversight to people with aphasia. Design: Single-blind, randomized placebo-controlled trial. Setting: Free-standing urban rehabilitation hospital. Participants: Adults with aphasia (at least six months post-onset). Interventions: Experimental treatment was Web ORLA® (Oral Reading for Language in Aphasia) which provides repeated choral and independent reading aloud of sentences with a virtual therapist. Placebo was a commercially available computer game. Participants were instructed to practice 90 minutes/day, six days/week for six weeks. Main measures: Change in Language Quotient of the Western Aphasia Battery-Revised from pre-treatment to post-treatment and pre-treatment to six weeks following the end of treatment. Results: 32 participants (19 Web ORLA®, 13 Control) completed the intervention and post-treatment assessment; 27 participants (16 Web ORLA®, 11 Control) completed the follow-up assessment six weeks after treatment had ended. Web ORLA® treatment resulted in significant improvements in language performance from pre-treatment to immediately post-treatment ( X = 2.96; SD = 4.32; P < 0.01; ES = 0.68) and from pre-treatment to six weeks following the end of treatment ( X = 4.53; SD = 3.16; P < 0.001; ES = 1.43). There was no significant difference in the gain from pre-treatment to post-treatment for the Web ORLA® versus Control groups. However, the Web ORLA® group showed significantly greater gains at the six-week follow-up than the control group ( X = 2.70; SD = 1.01; P = 0.013; ES = 1.92). Conclusion: Results provide evidence for improved language outcomes following intensive, web-based delivery of ORLA® to individuals with chronic aphasia. Findings underscore the value of combining clinician oversight with the flexibility of asynchronous practice.

scholarly journals Computer-Assisted Avatar-Based Treatment for Dysfunctional Beliefs in Depressive Inpatients: A Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Martin Kocur ◽  
Martin Dechant ◽  
Christian Wolff ◽  
Caroline Nothdurfter ◽  
Thomas C. Wetter ◽  
...  
Keyword(s):  
Cognitive Therapy ◽  
Symptom Severity ◽  
Controlled Trial ◽  
Post Treatment ◽  
Computer Assisted ◽  
Dysfunctional Beliefs ◽  
Treatment As Usual ◽  
Pre Treatment ◽  
The University

Dysfunctional cognitions are a crucial part of depression. Cognitive therapy aims to modify dysfunctional beliefs. Typically, dysfunctional beliefs are questioned, and patients are trained to think of alternative functional beliefs. We developed a computer-assisted, avatar-based adjunct for cognitive therapy that aims to reduce dysfunctional beliefs and symptom severity. Besides, it aims to promote alternative functional beliefs. In a randomized controlled trial with 34 patients diagnosed with major depression currently undergoing inpatient treatment at the university psychiatric hospital in Regensburg, Germany, participants were randomly assigned to receive either treatment as usual (TAU) or computer-assisted avatar-based treatment for dysfunctional beliefs (CAT-DB) in addition to TAU. In CAT-DB participants are faced with a virtual avatar expressing their personal dysfunctional beliefs. Participants are asked to contradict these and express alternative functional beliefs. Assessments of conviction of dysfunctional beliefs, functional beliefs and symptom severity were done shortly before the intervention (pre-treatment), right after the intervention (post-treatment) and 14 days later (follow-up). The reduction in conviction of dysfunctional beliefs and symptom severity, and the increase in conviction of alternative functional beliefs at post-treatment and follow-up were significantly greater for the group receiving CAT-DB. Our study provides an indication in favor of the effectiveness of CAT-DB for depressive patients. It is a simple tool that could support classical cognitive therapy. Further studies at different centres, with larger sample sizes and varying therapeutic contexts are required to prove the effectiveness of our intervention.

Coping long term with active suicide in adolescents: Results from a pilot randomized controlled trial

2019 ◽  
Vol 24 (4) ◽  
pp. 847-859 ◽  
Author(s):  
Shirley Yen ◽  
Anthony Spirito ◽  
Lauren M Weinstock ◽  
Katherine Tezanos ◽  
Antonija Kolobaric ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Suicide Attempts ◽  
Controlled Trial ◽  
Open Trial ◽  
Randomized Controlled ◽  
Phone Calls ◽  
Adolescent Parent ◽  
Pilot Randomized Controlled Trial

Background: To adapt the Coping Long Term with Active Suicide Program (CLASP) for use with adolescents (CLASP-A) and to assess its feasibility and acceptability on an inpatient psychiatric unit. CLASP-A entailed three individual sessions and one family session, followed by a series of outpatient phone calls to adolescent and a designated parent/guardian over 6 months of follow-up. Methods: The open trial phase involved 17 adolescent/parent pairs, followed by a pilot randomized controlled trial (RCT) in which adolescent/parent pairs were randomized to CLASP-A ( n = 25) or enhanced treatment as usual (ETAU; n = 25). Assessments were completed at baseline, 3- and 6-month follow-ups. Results: In the open trial, average in-person session attendance was 67%, and study treatment satisfaction was high. To enhance feasibility, we adapted CLASP-A to be completed in three individual sessions for the RCT; 77% of the sessions were completed and study satisfaction remained high in adolescents (3.32/4.0) and parents (3.62/4.0). There were no significant differences between groups in number of suicide attempts or readmissions during follow-up. Conclusion: Data indicate feasibility and acceptability of CLASP-A. However, the absence of treatment effects between groups raises questions regarding CLASP’s potential efficacy with adolescents or the need for more extensive adaptations for adolescents.

scholarly journals Compassion-Focused Intervention for Highly Self-Critical Individuals: Pilot Study

2018 ◽  
Vol 46 (5) ◽  
pp. 583-600 ◽  
Author(s):  
Alexandra Rose ◽  
Ruth McIntyre ◽  
Katharine A. Rimes
Keyword(s):  
Pilot Study ◽  
Treatment Approach ◽  
Controlled Trial ◽  
Self Esteem ◽  
Preliminary Evidence ◽  
Post Intervention ◽  
Randomized Controlled ◽  
Weekly Treatment ◽  
Compassion Focused Therapy

Self-criticism is a transdiagnostic process associated with a range of psychological problems. This uncontrolled pilot study evaluated the feasibility and acceptability of a six-session intervention using methods from compassion-focused therapy to reduce self-criticism, as well as investigating changes in a range of outcome measures. Twenty-three university student participants with significant impaired functioning associated with high levels of self-criticism received six individual weekly treatment sessions and a 2-month follow-up appointment. Acceptability was assessed through participant feedback. The intervention appeared to be feasible in terms of recruitment and retention of participants, and participant feedback indicated that overall the intervention seemed acceptable. There were statistically significant improvements between pre- and post-intervention for self-criticism, functional impairment, mood, self-esteem and maladaptive perfectionism with medium to large effect sizes at both post-intervention and follow-up. Gains were maintained or increased between post-treatment and 2-month follow-up. The study showed preliminary evidence of effectiveness of a compassion-focused intervention for self-critical students which appeared to be a feasible and acceptable treatment approach. This intervention now requires investigation in a randomized controlled trial.

scholarly journals Relationship between metamorphopsia and inner retinal microstructure following intravitreal ranibizumab injection for branch retinal vein occlusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoshimi Sugiura ◽  
Fumiki Okamoto ◽  
Tomoya Murakami ◽  
Shohei Morikawa ◽  
Takahiro Hiraoka ◽  
...  
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Post Treatment ◽  
Intravitreal Ranibizumab ◽  
Vein Occlusion ◽  
Treatment Naïve ◽  
Pre Treatment ◽  
Number Of Injections

AbstractTo evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO), and to assess the relationship between metamorphopsia and inner retinal microstructure and other factors. Thirty-three treatment-naïve eyes of 33 patients with macular edema caused by BRVO with at least 12 months of follow-up were included. The degree of metamorphopsia was quantified using the M-CHARTS. Retinal microstructure was assessed with spectral-domain optical coherence tomography. Disorganization of the retinal inner layers (DRIL) at the first month after resolution of the macular edema (early DRIL) and at 12 months after treatment (after DRIL) was studied. Central retinal thickness (CRT), and status of the external limiting membrane as well as ellipsoid zone were also evaluated. IVR treatment significantly improved best-corrected visual acuity (BCVA) and CRT, but the mean metamorphopsia score did not improve even after 12 months. Post-treatment metamorphopsia scores showed a significant correlation with pre-treatment metamorphopsia scores (P < 0.005), the extent of early DRIL (P < 0.05) and after DRIL (P < 0.05), and the number of injections (P < 0.05). Multivariate analysis revealed that the post-treatment mean metamorphopsia score was significantly correlated with the pre-treatment mean metamorphopsia score (P < 0.05). IVR treatment significantly improved BCVA and CRT, but not metamorphopsia. Post-treatment metamorphopsia scores were significantly associated with pre-treatment metamorphopsia scores, the extent of DRIL, and the number of injections. Prognostic factor of metamorphopsia was the degree of pre-treatment metamorphopsia.

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