Tag: cognitive behavioural therapy

Categories : Mental HealthTags :

Largest Study Reveals Best Treatment Options for ADHD

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The most comprehensive review to date of ADHD treatments has found that medication for children and adults, and cognitive behavioural therapy for adults, remain the most effective approaches, backed by the strongest short-term trial evidence.

Researchers led by the Université Paris Nanterre (France), Institut Robert-Debré du Cerveau de l’Enfant (France), and the University of Southampton (UK) analysed over 200 meta-analyses covering different treatment types, participant groups, and clinical outcomes in a study published in The BMJ.

The research was funded by public and peer-reviewed research grants from Agence Nationale de la Recherche (France), France 2030 program (France), and National Institute for Health and Care Research (UK).

To help people with attention deficit hyperactivity disorder (ADHD) and their clinicians make more informed, shared decisions, the team has created an interactive website that clearly presents the findings and the evidence behind each treatment based on the review (ebiadhd-database.org ).

“We know that people with ADHD and their families are often overwhelmed by conflicting messages about which treatments work,” says Professor Samuele Cortese , an NIHR Research Professor at the University of Southampton and senior lead author on the paper.

“We believe this study and the accompanying website provide the most authoritative, evidence-based, and accessible guidance currently available.

“The Evidence-Based Interventions for ADHD website provides freely available, evidence-based, and continuously updated information in an easy-to-understand way. To the best of our knowledge, this is the first platform in the world to do so based on such a rigorous synthesis of the available evidence.”

Overall, five medications in children and adolescents, and two medications and cognitive behavioural therapy (CBT) in adults were shown to be effective while supported by a relatively robust evidence base. Critically, all this evidence was limited to the short-term, despite long-term treatment being common in clinical practice.

Treatments like acupuncture, mindfulness and exercise showed promise, but the evidence supporting their use was of a low quality due to small numbers of participants and risk of bias. The limitations applied to studies evaluating cognitive behavioural therapy in children and adolescents, as well as research on the long-term effects of mindfulness in adults, although mindfulness was the only intervention to demonstrate large beneficial effects at extended follow-up.

Dr Corentin Gosling, Associate Professor at the Paris Nanterre University and first lead author of the study, says: “Long waiting lists for mental health services are a major issue. Having incorrect information about treatments can make people’s journeys even more difficult, by wasting time and money on non-evidence-based approaches, for example.

“By contrast, taking the time to review all treatment options within a shared decision-making process using the web app we developed can empower people with ADHD, leading to better treatment adherence, improved outcomes, and an overall better patient experience.”

The findings generally complement current international clinical guidelines, not only by providing convenient access to current high-quality evidence, but also by covering interventions not usually mentioned in clinical guidelines.

The team hope this new project will achieve a similar impact in influencing clinical guidelines and practice as their previous project (ebiact-database.com), which looked at treatments for autism.

Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making is published in The BMJ and is available online.

Source: University of Southampton

Categories : Cancer Mental HealthTags :

Does Cognitive Behavioural Therapy Benefit Cancer Survivors?

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A recent analysis of all relevant published studies reveals clear benefits of Cognitive Behavioural Therapy (CBT) for improving mental health and quality of life in cancer survivors. The findings, which are published in Cancer Medicine, extend CBT’s effects beyond what has long been known in the general population.

For the analysis, investigators uncovered 132 clinical trials comparing CBT with controls, including standard therapy, waitlist control, or active/alternative therapy.

Across the trials, CBT moderately improved mental health and quality of life in people with past or current cancer, regardless of cancer type. It seemed to have stronger effects in younger individuals. In-person CBT also appeared more effective than delivering CBT through technology such as web-based videoconference platforms.

“In addition to confirming the general benefit of CBT for individuals with cancer, this study unveiled important nuances of how CBT can be most effective and for which populations. This has major clinical implications for supportive oncology providers,” said corresponding author Anao Zhang, PhD, of the University of Michigan.

Source: Wiley

Categories : Mental Health Obstetrics & GynaecologyTags :

Simple Cognitive-behavioural Intervention Reduces Postpartum Depression

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Results from a large clinical trial published in Nature Medicine show that an intervention for anxiety provided to pregnant women living in Pakistan significantly reduced the likelihood of the women developing moderate-to-severe anxiety, depression, or both six weeks after birth. The unique intervention was administered by non-specialised providers who had the equivalent of a bachelor’s degree in psychology – but no clinical experience. The results suggest this intervention could be an effective way to prevent the development of postpartum mental health challenges in women living in low-resource settings.

“In low resource settings, it can be challenging for women to access mental health care due to a global shortage of trained mental health specialists,” said Joshua A. Gordon, MD, PhD, Director of the National Institute of Mental Health, part of the National Institutes of Health.

“This study shows that non-specialists could help to fill this gap, providing care to more women during this critical period.”

Led by Pamela J. Surkan, PhD, ScD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab Province of Pakistan between April 2019 and January 2022.

Pregnant women with symptoms of at least mild anxiety were randomly assigned to receive either routine pregnancy care or a cognitive behavioral therapy (CBT)-based intervention called Happy Mother-Healthy Baby. The researchers assessed the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.

The researchers found that 9% of women in the intervention group developed moderate-to-severe anxiety compared with 27% of women in the routine care group.

Additionally, 12% percent of women in the intervention group developed depression compared with 41% of women in the routine care group.

“Postpartum depression not only harms mothers, it is also associated with poorer physical growth and delayed cognitive development in their children,” said Dr Surkan.

“The link between maternal and child health highlights the critical importance of developing effective ways to address postpartum anxiety and depression.”

The Happy Mother-Healthy Baby intervention was created using input from pregnant women in a hospital in Rawalpindi, Pakistan.

Pregnant women took part in six intervention sessions where they learned to identify anxious thoughts and behaviors, such as thoughts about possible miscarriage, and to practice replacing them with helpful thoughts and behaviors.

The first five sessions were conducted in early to mid-pregnancy, and the sixth session occurred in the third trimester.

Prior research suggests that up to 30% of women in the Global South, which includes South America, Africa, and most of southern Asia, report experiencing anxiety during pregnancy.

Anxiety during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a prime target for intervention.

However, it can be challenging for women living in low-resource settings to access trained clinical care.

The findings from this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where specialist clinical care may be hard to access.

“In the future, we can build on these findings through implementation research. Having identified an intervention that works, the next step is to figure out the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” said Dr Surkan.

Source: NIH/National Institute of Mental Health

Categories : Mental HealthTags :

Cognitive Behavioural Therapy over The Internet is Effective for PTSD

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In a large-scale randomised controlled trial, researchers from the UK and Sweden have shown that internet-mediated cognitive behavioural therapy (CBT) can provide results for post-traumatic stress disorder (PTSD) that are in line with conventional face-to-face care. The article, which was recently published in Lancet Psychiatry, also shows that the time required for therapists is greatly reduced, which could mean that more patients can be treated and have access to the right help.

Common symptoms include reliving the trauma, overexcitement, avoidance and emotional and cognitive consequences, such as depression and difficulty concentrating. Psychological treatment in the form of CBT has been shown to have good effects in PTSD, but access to care is limited and varies between different places.

Post-traumatic stress disorder (PTSD) is a psychiatric diagnosis that affects about 5-10% of the population. PTSD occurs as a result of experiencing – or witnessing – severe, life-threatening and traumatic events, such as abuse, war, accidents and mistreatment.

The study recruited 217 participants through the NHS or self-referral. Mean age was 36·36 years, with a range 18–71 years; 158 (73%) self-reported as female, 57 (26%) as male, and two (1%) as other. Of these, 52 (24%) participants met self-reported criteria for ICD-11 complex PTSD.  The advantages in outcome for internet-mediated therapy were greater for participants with high dissociation or complex PTSD symptoms, and mediation analyses showed both treatments worked by changing negative meanings of the trauma, unhelpful coping, and flashback memories. No serious adverse events were reported.

Source: Karolinska Institutet