Treatment Motivation in Lung Tuberculosis Patients at Public Health Centres in Denpasar City during COVID-19 Pandemic

Treatment motivation among patients were heavily influenced by duration of therapy and existing side effects. TB supervisors motivated patients in their therapy. Limited communication from TB supervisors due to COVID-19 pandemic risked lowering treatment motivation in TB patients. Objective: get a general description of treatment motivation in TB patients from PHC in Denpasar. Method: descriptive observational with cross-sectional design in March – August 2021 at five PHC in Denpasar area. This study was done online using questionnaire with Google Forms application. Motivation is grouped into low, moderate, and high based on scores from internal factors, external factors, confidence in treatment, and interpersonal help seeking. Results: 86% of patients (43 people) had high treatment motivation, 12% of patients (6 people) have moderate treatment motivation, and two percent of patients (1 people) had low treatment motivation. Summary: Most of TB patients had high treatment motivation (86%). Communication between TB supervisors and patients are highly advised to motivate patients and increase success rate of therapy. Keywords: [Anti tuberculosis drugs, Lung tuberculosis, Treatment motivation].

Virtual Reality Biofeedback in Health: A Scoping Review

Over the past decades, virtual reality (VR) has found its way into biofeedback (BF) therapy programs. Using VR promises to overcome challenges encountered in traditional BF such as low treatment motivation, low attentional focus and the difficulty of transferring learnt abilities to everyday life. Yet, a comprehensive research synthesis is still missing. Hence, this scoping review aims to provide an overview over empirical studies on VR based BF regarding key outcomes, included samples, used soft- and hardware, BF parameters, mode of application and potential limitations. We systematically searched Medline, PsycINFO, Scopus, CINAHL, Google Scholar and Open Grey for empirical research. Eighteen articles met the inclusion criteria. Samples mostly consisted of healthy (44.4%) and/or adult (77.7%) participants. Outcomes were mainly anxiety (44.4%), stress (44.4%) or pain reduction (11.1%), which were reduced by the VR-BF interventions at least as much as by classical BF. Participants in VR-BF interventions showed higher motivation and involvement as well as a better user experience. Heart rate or heart rate variability were the most frequently used BF parameters (50.0%), and most VR-BF interventions (72.2%) employed a natural environment (e.g., island). Currently, there is no clear evidence that VR-BF is more effective than traditional BF. Yet, results indicate that VR-BF may have advantages regarding motivation, user experience, involvement and attentional focus. Further research is needed to assess the specific impact of VR and gamification. Also, testing a broader range of clinical and younger samples would allow more far-reaching conclusions.

Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders

INTRODUCTION: The limited practice of depot antipsychotics and psychoeducation use, recommended for overcoming the noncompliance of patients with severe mental disorders, is linked to a high incidence of treatment violation. Therefore, the development of personalized mental healthcare approaches is a crucial healthcare task. AIM: To describe and differentiate the role of clinical, social and psychological factors that lead to different level of treatment engagement of psychiatric inpatients. METHODS: Secondary analysis of findings from 91 inpatients, based on the Treatment Motivation Assessment Questionnaire and Medication Compliance Scale, as well as the Scale of Internalized Stigma of Mental Illness and Perceived Discrimination and Devaluation Scale. Factorial analysis, cluster analysis and analysis of variance with p-level=0.05 and the calculation of the effect size (ES) according to Cohens d and Cramers V were used. RESULTS: The nature of therapy compliance in various categories of patients is mediated differentially, including: the severity of negative symptoms (ES=0.29), the global level of functioning and work maladjustment (ES=0.230.26), various motivational and behavioral styles (ES0.74) and the intensity of psychiatric stigmatization (ES0.88). CONCLUSIONS: Consideration of the clinical, social and psychological factors should empirically determine the strategies for the personalized use of prolonged antipsychotics and socio-psychotherapeutic interventions when developing an individual treatment plan for psychiatric in-patients.

Effects of a virtual reality-based training program for adolescents with disruptive behaviour problems on cognitive distortions and treatment motivation: Protocol for a multiple baseline Single-Case Experimental Design (Preprint)

BACKGROUND Serious disruptive behaviour among adolescents is a prevalent and often persistent problem. This highlights the importance of adequate and effective treatment to help adolescents with disruptive behaviour problems react less hostile and aggressive. In order to create a treatment environment in which behavioural change can actually be enhanced, treatment motivation plays an essential role. Regarding treatment itself, a focus on challenging self-serving cognitive distortions in order to achieve behavioural change is important. Street Temptations (ST) is a new training program that was developed to address both treatment motivation and cognitive distortions in adolescents with disruptive behaviour problems. One of the innovative aspects of ST is the use of virtual reality (VR) techniques to provide adolescents during treatment with visually presented daily social scenarios to activate emotional engagement and dysfunctional cognitions. By using the VR scenarios as an integral starting point of ST’s sessions and transferring the power of the VR experience into playful and dynamic exercises to practice social perspective-taking, adolescents are encouraged to reflect on both their own behaviour as on that of others. This focus on reflection is grounded in ST’s main treatment mechanism to influence treatment motivation and cognitive distortions, namely mentalizing (i.e., reflective functioning). OBJECTIVE Describing the research protocol to evaluate the effects of ST on treatment motivation and cognitive distortions. We take a closer look at the use of ST and the methodology used, namely the repeated Single-Case Experimental Design (SCED). METHODS The effects of ST are studied through a multiple baseline Single-Case Experimental Design, using both quantitative and qualitative data. In total, 18 adolescents from secure residential youth care and secondary special education are randomly assigned to one of three different baseline conditions. Throughout a baseline phase (1, 2, or 3 weeks), intervention phase (4 weeks) and follow-up phase (1, 2 or 3 weeks), daily measurements on treatment motivation and cognitive distortions are conducted. Secondary study parameters are assessed before baseline, after intervention and after follow-up. Qualitative data is collected after intervention, as wells as 3 and 6 months after intervention. RESULTS Data collection for this study is planned to be completed by June 2023. The results will be published in peer-reviewed journals and presented at national and international conferences. CONCLUSIONS ST aims to improve disruptive behaviour problems of adolescents. The study described in this article will be the first to gain insight into the effectiveness of ST. Strengths of this study include its thorough and individually focused design (SCED), the focus on a residential as well as a secondary special education setting, and the ecological validity. Implications for practice are discussed. CLINICALTRIAL The study is registered at the Central Committee on Research Involving Human Subjects (NL75545.029.20, 24-06-2021) and the Netherlands Trial Register NL9639; https://www.trialregister.nl/trial/9639 (11-08-2021).

Applied Improvisation Enhances the Effects of Behavioral Activation on Symptoms of Depression and PTSD in High School Students Affected by the Great East Japan Earthquake

BackgroundThe education system can serve as a community-based resource to support the provision of long-term follow-up care after large-scale disasters. While school-based interventions conducted after a disaster have been confirmed to reduce symptoms of depression and posttraumatic stress disorder (PTSD), adolescents often exhibit low treatment motivation. Traditional methods used to encourage treatment motivation include fun activities, such as applied improv (AIM). This study evaluated the intervention effects and improved motivation of an intervention program combining AIM with the behavioral activation approach (BAA).MethodsParticipants were 253 tenth graders, who were in fifth grade at the time the Great East Japan Earthquake of 2011, and 239 students were included in the analyses. Participants were divided into two groups: the BAA and AIM + BAA groups. Students in each group participated in one class-wide intervention session, which lasted 60 min. Depression, PTSD symptoms, behavioral activation, avoidance, and resilience were evaluated using psychological scales. A participant’s evaluations of the intervention were confirmed using the impression sheet consisting of six items that measure comprehension, difficulty, efficacy, generalization, confirmation of a specific situation, and motivation.ResultsA two-way analysis of variance (ANOVA) conducted using data from the psychological scale did not reveal a significant effect from the intervention program. However, the Mann-Whitney U-test, which used data from the impression sheet, showed a significant effect on comprehension (p = 0.001), generalization (p = 0.023), and motivation (p = 0.025).ConclusionThis study did not confirm the effectiveness of the BAA in reducing symptoms of depression and PTSD in adolescents. Regarding treatment motivation, the AIM + BAA group reported higher motivation than the BAA group. Thus, one session of AIM may contribute to improved treatment motivation in adolescents. AIM creates a safe environment and encourages engagement and participation in interventions. Treatment motivation is an important issue in adolescent therapy, and AIM may help solve this problem.

The influence of therapy alliance and treatment motivation in patients with Cluster B personality disorders on incidents in forensic hospitals

Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

Effects of an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS): study protocol for a randomised controlled trial

IntroductionIn May 2019, the WHO classified internet gaming disorder (IGD) as a mental disorder in the upcoming International Classification of Diseases 11th Revision. However, individuals affected by IGD or internet use disorders (IUDs) are often not provided with adequate therapy due to a lack of motivation or absence of adequate local treatment options. To close the gap between individuals with IUDs and the care system, we conduct an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS).Methods and analysisWithin the randomised controlled trial, a total of n=162 participants will be allocated by sequential balancing randomisation to the OMPRIS intervention or a waitlist control group. The study includes an extensive diagnostic, followed by a 4-week psychological intervention based on motivational interviewing, (internet-related) addiction therapy, behavioural therapy techniques and additional social counselling. The primary outcome is the reduction of problematic internet use measured by the Assessment of Internet and Computer Game Addiction Scale. Secondary outcomes include time spent on the internet, motivation for change (Stages of Change Readiness and Treatment Eagerness Scale for Internet Use Disorder), comorbid mental symptoms (Patient Health Questionnaire-9, Generalized Anxiety Disorder Screener-7), quality of life (EuroQoL Standardised Measure of Health-related Quality of Life–5 Dimensions, General Life Satisfaction-1), self-efficacy (General Self-Efficacy Scale), personality traits (Big Five Inventory-10), therapeutic alliance (Helping Alliance Questionnaire) and health economic costs. The diagnosis of (comorbid) mental disorders is carried out with standardised clinical interviews. The measurement will be assessed before (T0), at midpoint (T1) and after the OMPRIS intervention (T2), representing the primary endpoint. Two follow-up assessments will be conducted after 6 weeks (T3) and 6 months (T4) after the intervention. The outcomes will be analysed primarily via analysis of covariance. Both intention-to-treat and per-protocol analyses will be conducted.Ethics and disseminationParticipants will provide written informed consent. The trial has been approved by the Ethics Committee of the Faculty of Medicine, Ruhr University Bochum (approval number 19-6779). Findings will be disseminated through presentations, peer-reviewed journals and conferences.Trial registration numberDRKS00019925.

Psychological Problems among Patients Suffer in HIV/AIDS in Pakistan

This study examines the treatment motivation, stigma, and disclosure in 287 HIV-infected patients in Pakistan. Four validation scales were applied to assess treatment motivation, stigma and disclosure of patients. The results showed that female patients had significantly higher levels of stigma and disclosure than male patients. Unmarried patients had significantly higher levels of stigma and disclosure than married patients. Moreover, the treatment motivation significantly positively correlated with self-disclosure. Stigma significantly positively correlated with disclosure. Stigma and self-disclose could predicate the treatment motivation. The study concluded that female and unmarried patients with HIV positive had more stigma and disclosure. Stigma, and disclosure affect the treatment motivation of patients with HIV positive.