Evaluation of a training program to assist care staff to better recognize and manage depression among palliative care patients and their families

This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed pre-intervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions may be needed to ensure that training program gains are maintained.

The Modulatory Role of Internet-Supported Mindfulness-Based Cognitive Therapy on Extracellular Vesicles and Psychological Distress in People Who Have Had Cancer: A Protocol for A Two-Armed Randomized Controlled Study

BackgroundMindfulness-based interventions (MBIs) have been used in oncology contexts as a promising tool with numerous benefits for various health-related and psychosocial outcomes. Despite the increasing popularity of MBIs, few randomized controlled trials (RCTs) have examined their effects upon biological parameters. Specifically, no previous study has examined the effects of MBIs on extracellular vesicles (EVs), which are potentially important markers of health, disease, and stress. Moreover, the lack of RCTs is even more limited within the context of technology-mediated MBIs and long-term effects.MethodsThe current study protocol presents a two-arm, parallel, randomized controlled study investigating the effects of internet-supported mindfulness-based cognitive therapy (MBCT) compared with treatment as usual (TAU). Primary outcomes are psychological distress and EV cargo of distressed participants with previous breast, colorectal, or prostate cancer diagnoses. Secondary outcomes are self-reported psychosocial and health-related measures, and additional biological markers. Outcomes will be assessed at baseline, 4 weeks after baseline (mid-point of the intervention), 8 weeks after baseline (immediately post-intervention), 24 weeks after baseline (after booster sessions), and 52 weeks after baseline. Our goal is to recruit at least 111 participants who have been diagnosed with breast, prostate, or colorectal cancer (cancer stage I to III), are between 18 and 65 years old, and have had primary cancer treatments completed between 3 months and 5 years ago. Half of the participants will be randomized to the TAU group and the other half will participate in an 8-week online MBCT intervention with weekly group sessions via videoconference. The intervention also includes asynchronous homework, an online retreat after the fifth week, and 4 monthly booster sessions after completion of the 8-week program.DiscussionThis study will allow characterizing the effects of internet-based MBCT on psychosocial and biological indicators in the context of cancer. The effects on circulating EVs will also be investigated, as a possible neurobiological pathway underlying mind-body intervention effects. Trial registration: NCT04727593 (date of registration: 27 January 2021; date of record verification: 6 October 2021; https://clinicaltrials.gov/ct2/show/NCT04727593).

Adapting Psychotherapy for Comorbid Substance use and Bipolar Disorder in Older Sexual Minorities: A Case Study

Approximately 65 to 95% of individuals with bipolar disorder (BD) are diagnosed with an additional psychiatric condition (Kessler, 1999). Alcohol, the most commonly abused substance amongst individuals with BD (Xiao et al., 2016), has been linked to significant increases in suicide attempts, disability, hospitalizations, and mortality (Baldessarini et al., 2008; Goldberg et al., 1999; Mitchell et al., 2007; Nery & Soares, 2011). Despite these ill effects, little is known about how to effectively treat, or adapt existing treatment appropriately, for the growing numbers of individuals who are dually diagnosed with BD and alcohol use disorder (AUD) and hold the identity of lesbian, gay, bisexual, transgender, or queer (LGBTQ) in late life. Thus, the purpose of this study is to demonstrate how treatment was adapted to a self-identified gay man with comorbid BD and AUD from a relational, culturally sensitive perspective while simultaneously implementing two short-term interventions: cognitive behavioral therapy (CBT) and a behavioral substance use program. In line with Knight & Poon’s (2008) Contextual Life Span Theory for Adapting Psychotherapy with Older Adults (CALTAP) and a multicultural lens that incorporates relevant research on older LGBTQ individuals, modifications were made to the content, structure, language, and duration of therapy while cultivating a safe and empathic space. Idiographic data and progress monitoring measures suggests treatment resulted in substance use and distress reduction, as well as mood stabilization. However, additional booster sessions may be advantageous given the risk for substance abuse relapse and the compounding effect it may exert on persons with BD.

The effective interventions to improve long-term physiotherapy exercise adherence among patients with lower limb osteoarthritis. A systematic review

Introduction: Osteoarthritis (OA) is a chronic condition that severely effects work life balance impacting psychosocial and socio-economic aspects. Physiotherapy exercise is one of the intervention methods for the management of OA. Adherence to the exercise by patients is essential for the effective management of OA. Objectives: To determine different methods used to enhance physiotherapy exercise adherence for more than 12 months among patients with osteoarthritis and to report the effective method to enhance exercise adherence among people with lower limb osteoarthritis. Design: Systematic review Methods: PubMed, Pedro, Web of Science, and EMBASE databases searched for randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies published in the English language from 2000 to 2020. The date of data extraction was 04 September 2020. Two independent researchers conducted literature search, assessed eligibility, extracted data, conducted methodology quality assessment using the PEDro scale, and conducted risk of bias assessment. A narrative synthesis of key outcomes is presented; preferred Reporting Items for Systematic review was used to report the review. The study protocol was registered in the Prospero (Prospero ID: CRD42020205653). Results: The primary search strategy identified 5839 potentially relevant articles, of which 5157 remained after discarding duplicates. After screening based on title and abstract, 40 papers were potentially eligible for inclusion. Five of these papers met all predefined eligibility criteria. Introducing methods to enhance exercise adherence has caused a significant increase in exercise adherence for the short term (less than six months or 12 months). There were no significant differences, long-term adherence with different methods, reported. The results indicate that booster sessions (89.69%) and telephone-linked communication (86%) had higher percentages for the exercise adherence. Secondary outcomes such as pain, stiffness, function, show positive outcomes with increasing exercise adherence. However, there were no significant differences reported. Conclusion: The booster sessions and telephone-linked communication appear to enhance exercise adherence for more than 12 months among patients with osteoarthritis. However, a number of high-quality studies are inadequate to confirm our findings. Therefore, more studies with higher methodological quality are needed to determine the best strategies to enhance long-term exercise adherence among people with osteoarthritis. Key terms: Osteoarthritis, Long term, Exercise adherence

Terminating Therapy and Referrals

Cognitive behavioral therapy (CBT) is an efficacious and efficient intervention; as such, closure encompasses an essential part of intervention planning. Chapter 9 discusses closure: how to graduate clients from CBT, arrange booster sessions, ethically terminate CBT, and, if needed, progress clients to a higher level of care. It describes reasons for why clients may become demotivated for treatment and demystifies insurance coverage and co-pays. For clients with more severe issues, Chapter 9 explains the many referral options available, like in-home family services, outpatient clinics, intensive outpatient services, partial hospitalization, acute inpatient hospitalization, and residential treatment facilities. The chapter concludes with a discussion of psychopharmacology and incorporates a multidisciplinary, consultative approach throughout.