Theories of Change and Mediators of Psychotherapy Effectiveness in Adolescents With Externalising Behaviours: A Systematic Review

BackgroundExternalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old).MethodsA systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis.ResultsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent–adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively.ConclusionsFamily variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified.Ethics and DisseminationEthical approval was not required. PROSPERO registration number: CRD42021231835.

Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis

Background T long-term effects of cognitive therapy and behavior therapy (CTBT) for menopausal symptoms are unknown, and whether the effects are different between natural menopause and treatment-induced menopause are currently unclear. Therefore, we sought to conduct an accurate estimate of the efficacy of CTBT for menopausal symptoms. Methods We conducted searches of Cochrane Library, EMBASE, PsycINFO, PubMed, and Web of Science databases for studies from 1 January 1977 to 1 November 2021. Randomized controlled trials (RCTs) comparing intervention groups to control groups for menopausal symptoms were included. Hedge's g was used as the standardized between-group effect size with a random-effects model. Results We included 14 RCTs comprising 1618 patients with a mean sample size of 116. CTBT significantly outperformed control groups in terms of reducing hot flushes [g = 0.39, 95% confidence interval (CI) 0.23–0.55, I2 = 45], night sweats, depression (g = 0.50, 95% CI 0.34–0.66, I2 = 51), anxiety (g = 0.38, 95% CI 0.23–0.54, I2 = 49), fatigue, and quality of life. Egger's test indicated no publication bias. Conclusions CTBT is an effective psychological treatment for menopausal symptoms, with predominantly small to moderate effects. The efficacy is sustained long-term, although it declines somewhat over time. The efficacy was stronger for natural menopause symptoms, such as vasomotor symptoms, than for treatment-induced menopause symptoms. These findings provide support for treatment guidelines recommending CTBT as a treatment option for menopausal symptoms.

New Developments in Virtual Reality-Assisted Treatment of Aggression in Forensic Settings: The Case of VRAPT

Aggression is a known problem in individuals being cared for in forensic settings, yet the evidence base for its treatment is scarce. Virtual Reality (VR) has been proposed as a promising addition to interventions in forensic settings, as it may increase the motivation among participants, bridge the gap between real life, therapeutic and laboratory experiences, and increase the ecological validity of psychological research. Recently, a new treatment for aggression using VR as the treatment environment, Virtual Reality Aggression Prevention Training (VRAPT), was developed to provide realistic and safe environments for participants to practice aggression management. In its current revised version, VRAPT is conceptualized as a form of cognitive behavioral therapy with its theoretical background in the General Aggression Model. Its purpose is to increase awareness of, and improve control over, one’s own aggression and that of others through social interactions in individually tailored virtual environments. This manuscript describes how the lessons learned from the first randomized controlled trial of VRAPT have been applied to further develop the method and discusses challenges and future directions for VR-assisted treatment of aggression in forensic settings. VRAPT is a new psychological treatment for aggression and the coming years will provide expanded scientific evidence for further developments and adaptations.

The Efficacy of Time Perspective Therapy in Reducing Symptoms of Post-traumatic Stress, Anxiety, and Depression in Females with Breast Cancer

Background: Breast cancer is the biggest risk factor that endangers women's health. It is considered the highest stress-causing disease due to the unpleasant effects of disease on different aspects of patients’ life. Breast cancer is commonly associated with the symptoms of post-traumatic stress and its comorbidities such as anxiety and depression. It appears that time perspective therapy (TPT), as a new psychological treatment, can reduce the symptoms of post-traumatic stress, anxiety, and depression in females with breast cancer. Methods: This is a randomized controlled trial conducted from February to September 2019. A total of 30 patients with breast cancer were selected through a convenience sampling technique and were randomly divided into the control and treatment groups. The latter group attended 6-week sessions (each session lasted 90 minutes long) to receive TPT. To conduct pretest and posttest, all participants in the two groups were asked to fill out the following questionnaires: (1) Zimbardo Time Perspective Inventory (ZTPI); (2) The Post-traumatic Stress Disorder Checklist (PCL); (3) Beck Anxiety Inventory (BAI); and (4) the second version of Beck Depression Inventory (BDI-II). The analysis of covariance (ANCOVA) was used to evaluate the effects of treatment. A P-value smaller than 0.05 was considered significant. Results: Data analysis of 28 patients from the experimental and control groups showed that TPT significantly reduced the symptoms of post-traumatic stress, anxiety, and depression in the treatment group (P < 0.001 for symptoms of post-traumatic stress and anxiety, and P = 0.002 for depression). Such a difference was not seen in the control group. Conclusions: TPT may be an effective approach to reduce symptoms of post-traumatic stress, anxiety, and depression in Iranian women with breast cancer. Further investigations are required to confirm these findings, which may in turn help heath care professionals use TPT to promote the mental health of females with breast cancer.

Effectiveness and cost-effectiveness of cognitive behavior therapy-enhanced compared with treatment-as-usual for anorexia nervosa in an inpatient and outpatient routine setting: a consecutive cohort study

Background For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This consecutive cohort study examined differential (cost-)effectiveness for adult inpatients and outpatients with anorexia nervosa, after implementing cognitive behavioral therapy-enhanced (CBT-E) throughout a routine setting. Methods Differences in remission, weight regain and direct eating disorder treatment costs were examined between one cohort (N = 75) receiving treatment-as-usual (TAU) between 2012–2014, and the other (N = 88) CBT-E between 2015–2017. The economic evaluation was performed from a health care perspective with a one-year time horizon, using EDE global score < 2.77, the absence of eating disorder behaviors combined with a BMI ≥ 18.5, as effect measure. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that CBT-E is cost effective compared to TAU. Results Using direct eating disorder treatment costs in the cost-effectiveness analysis, the cost-effectiveness plane of the base case scenario for all patients indicated a 84% likelihood of CBT-E generating better health gain at additional costs. The median ICER is €51,081, indicating a probable preference for CBT-E (> 50% probability of cost-effectiveness) assuming a WTP of €51,081 or more for each additional remission, On remission, no difference was found with 9.3% remission during TAU and 14.6% during CBT-E (p = .304). Weight regain was higher during CBT-E (EMD = 1.33 kg/m2, SE = .29, 95% CI [0.76–1.9], p < .001). Conclusions In this mixed inpatient and outpatient cohort study, findings indicate a probability of CBT-Ebeing more effective at higher costs. These findings may contribute to the knowledge of effectiveness and cost-effectiveness of specialized psychological treatments. Plain English Summary In this study, the effectiveness and treatment costs of a specialized psychological treatment for adult clients with anorexia nervosa were compared with a regular, non-specialist treatment. One group of inpatients and outpatients did receive non-specialist treatment, the next group of inpatients and outpatients received CBT-E, a specialized treatment, later on. CBT-E is recommended for clients with bulimia and with binge eating disorder, for clients with anorexia nervosa it is less clear which specialized psychological treatment should be recommended. Results indicate that at end-of-treatment, CBT-E was not superior on remission. When looking at weight regain, CBT-E seemed superior than the treatment offered earlier. Economic evaluation suggests that CBT-E generates better health gain, but at additional costs. This study contributes to the knowledge on the effectiveness and treatment costs of psychological treatments, as they are offered in routine practice, to adults with anorexia nervosa.

Lesbian and bisexual women's experiences of aversion therapy in England

This article presents the findings of a study about the history of aversion therapy as a treatment technique in the English mental health system to convert lesbians and bisexual women into heterosexual women. We explored published psychiatric and psychological literature, as well as lesbian, gay, and bisexual archives and anthologies. We identified 10 examples of young women receiving aversion therapy in England in the 1960s and 1970s. We situate our discussion within the context of post-war British and transnational medical history. As a contribution to a significantly under-researched area, this article adds to a broader transnational history of the psychological treatment of marginalised sexualities and genders. As a consequence, it also contributes to LGBTQIA+ history, the history of medicine, and psychiatric survivor history. We also reflect on the ethical implications of the research for current mental health practice.

Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence

Background: To protect women from Intimate partner violence (IPV), women’s shelters should not only provide emergency safety from IPV exposure, but also prolonged support that empowers women to build a life free from violence. The present study aims to investigate individual symptom development in association with residency at a women’s shelter. Method: Data were collected at four different timepoints, that is, enrolment (T1, N = 150), 3-months residency (T2, = 110), 6-months residency (T3, N = 68) and after relocation (T4, N = 63). Women were included from four Danish women’s shelters. The International Trauma Questionnaire (ITQ) was applied to test for post-traumatic stress disorder (PTSD) and Complex-PTSD (C-PTSD) at all timepoints. A paired sample t-test was used to test the mean symptom development, and a Latent Class Growth Analysis (LCGA) was applied to test for different classes of PTSD-trajectories. Logistic regression was applied to predict class membership from shelter-related variables and symptom severity, that is, length of residency, psychological counselling, revictimization and key symptoms of C-PTSD. Results: The prevalence of PTSD (31%) and C-PTSD (37.9%) was high at enrolment. Although t-tests suggested a significant decline in symptoms at follow-up, the LCGA revealed different classes of symptom development. The two-class model was found to be the best representation of data with low-symptom- and high-symptom profiles, respectively. Overall, the largest decline in symptoms occurred within the first 3 months of residency. Revictimization was high and was further found to predict class membership. However, when included in a multiple regression only symptom severity predicted the high-symptoms profile class. Discussion: Psychological treatment focussing on PTSD and C-PTSD is important for the women’s future well-being and safety. Reports on revictimization was alarmingly high, which emphasises a continuing need to protect women from psychological violence within the shelters. These findings should be replicated in larger samples before we can draw any conclusion.

Gender roles and women’s mental health: their influence on the demand for psychological care

The prevalence of certain diagnoses, such as eating disorders, depression, anxiety, and borderline personality disorder, is higher among women than among men. When it comes to women’s mental health, focusing on social aspects influencing the way women fall ill becomes crucial. Using a sample of 368 women, we studied the classification ability of a number of clinical variables and sociocultural factors (conformity to gender norms) in order to ascertain whether or not women were receiving psychological care and determine the importance of each of the variables when predicting which women were receiving therapy. Our results showed that women were more likely to be receiving psychological treatment when scoring high on certain clinical variables (such as Suicidal Ideation and Borderline Features) and on a number of variables related to conforming to gender norms (Care for Children, Nice in Relationships, and Sexual Fidelity). Therefore, we believe that integrating the gender perspective into educational, health-related, and psychological care programmes is essential so that gender roles can become more diverse and less constricting of people’s potential, resulting in improved health. La prevalencia de determinados diagnósticos –trastorno de la conducta alimentaria, depresión, ansiedad y trastorno límite– es superior en mujeres que en hombres. Considerando la salud mental en mujeres, resulta imprescindible poner el foco en los aspectos sociales que influyen en la forma de enfermar. Se estudia en una muestra de 368 mujeres la capacidad de clasificación de algunas variables clínicas y factores socioculturales (conformidad con las normas de género) para determinar si una mujer está recibiendo asistencia psicológica o no, así como la importancia de cada una de esas variables a la hora de pronosticar qué mujeres estarían recibiendo terapia. Los resultados mostraron que cuando las mujeres puntúan alto en algunas variables clínicas (como Ideaciones Suicidas y Rasgos Límites) y en algunas relacionadas con conformidad con las normas de género (Cuidadora de Niños/as, Agradable en las relaciones y la Fidelidad Sexual) era más probable que estén recibiendo tratamiento psicológico. Por lo tanto, se considera que la inclusión de la perspectiva de género en programas de educativos, de salud y atención psicológica es fundamental para que los roles de género puedan ser más diversos y constriñan menos las potencialidades de las personas, lo que influirá en que tengan una mejor salud.

PROFESSIONAL RETRAINING IN PRE-RETIREMENT ADULTS: CHALLENGES AND RISKS

The article addresses pre-retirement adults as a subject of retraining, while giving special consideration to the correlation between psychological wellbeing and successful education, as well as to the importance of psychological treatment for overcoming challenges at this stage of life. Purpose of our study is to find the prohibitory and contributory factors of pre-retirement professional retraining. Increased retirement age and, as a result, extended work life have become a burning question in Russian society. New pre-retirement adults are facing new challenges – they have to make choices to determine their future career. At the same time, occurring limitations (age, personality, experience, etc.) are causing risks and difficulties in further training. Crucial component of successful acquisition of new information, completion of professional retraining programs and subsequent employment is psychological well-being. National government has developed, implemented, and funded retraining programs. According to the Russian Ministry of Labor and Social Protection, 2019 exceeded the target for fulfilling retraining contracts. However, the statistics does not state if people are actually content with their retraining. Apart from age, there are other factors that can influence education efficiency. Pre-retirement is an important life stage having an array of aspects to be considered in work with this group as they can affect one's mental health. The study results might be used by specialists of employment centers, professional retraining educators, and pre-retirement psychologists.