Psychotherapy and Psychosomatics最新文献

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that frequently persists into adulthood. Pharmacotherapies are effective but have side effects and dropout risks. Videoconference-based cognitive behavioral therapy (vCBT) has emerged as a promising intervention, particularly for improving treatment accessibility. This study aimed to evaluate the efficacy of vCBT in adults with ADHD compared to treatment-as-usual (TAU) using a randomized, assessor-blinded, controlled trial design.

Methods: Thirty participants (aged 18-65 years) with ADHD were randomly assigned to either the 12-session individual vCBT intervention as an adjunct to TAU or TAU group. The primary outcome was the change in the total score on the ADHD Rating Scale-IV (ADHD-RS-IV) with adult prompts by a blinded assessor at 12 weeks from baseline. Secondary outcomes included self-reported measures of ADHD symptoms using the Conners' Adult ADHD Rating-Self-Report, quality of life (QOL) using the Euro QOL 5 Dimension-5 Level, functional impairment using the Sheehan Disability Scale, depression, anxiety, and self-esteem.

Results: All of the participants received pharmacotherapy. Participants in the vCBT group (n = 15) demonstrated a significantly greater reduction in ADHD-RS-IV total score than those in the TAU group (vCBT -9.02 vs. TAU 0.84, p = 0.0007, effect size -1.46). Significant improvements in self-reported inattention, hyperactivity, impulsivity, QOL, and work/school performance were observed in favor of vCBT.

Conclusion: This study highlights the efficacy of vCBT as a viable and accessible intervention for adults with ADHD, particularly in reducing core symptoms and enhancing QOL and functional outcomes. vCBT is an important alternative treatment, especially for patients who remain symptomatic after pharmacotherapy.

Introduction: Brief concentrated exposure and response prevention (cERP) has shown promise as an efficacious treatment for obsessive-compulsive disorder (OCD) with higher response and remission rates compared to the first-line treatment. However, the mechanisms driving this success remain unclear.

Methods: This longitudinal study included 56 patients with OCD who underwent cERP (Bergen 4-day treatment). Treatment mechanisms (e.g., willingness to engage in exposure and response prevention (ERP), confidence in future self-guided ERP, leaning into anxiety) were assessed before and after each of the 4 treatment days by the Pre- and Post-Session Questionnaire (PPSQ-cERP). Changes in the PPSQ-cERP were used to predict treatment response assessed from baseline to post-treatment and 3-month follow-up.

Results: All variables assessed by the PPSQ-cERP showed improvement throughout the cERP, as calculated using linear mixed models. Several variables, including willingness to engage in ERP and self-efficacy, improved after day 3, with small to medium effects (0.34-0.70). Confidence in future self-guided ERP improved on day 4 (the day on which it was addressed), with a small effect (0.31). Leaning into anxiety during ERP tasks on day 3 was identified as a predictor of OCD symptom improvement (β = 0.516, p = 0.050) by least absolute shrinkage and selection operator regression, while group cohesion reached trend level (β = 0.239, p = 0.081).

Conclusion: This study highlights day-specific effects across all treatment mechanism variables. Notably, leaning into anxiety during ERP tasks was a key predictor of symptom improvement, offering new insights into refining OCD treatment strategies and enhancing clinical outcomes.

Introduction: Guidelines recommend that benzodiazepines (BZDs) might be used as an add-on to antidepressant therapy during the first weeks of treatment of generalized anxiety disorder (GAD) or as a first-line and stand-alone. Our aim was to evaluate the comparative efficacy and safety of individual BZD in the treatment of patients with GAD.

Methods: In this systematic review and network meta-analysis, we included randomized controlled trials including adults (≥18 years) with GAD and comparing BZD against placebo or an active intervention. We assessed the certainty of evidence using the confidence in network meta-analysis (CINeMA) framework. This study is registered with PROSPERO (registration number CRD42022330264).

Results: We included 56 studies (7,556 participants). The certainty of the evidence for the primary outcomes, as measured with CINeMA, varied from high to very low (overall; 40 comparisons scored "very low," 7 scored "low," and 814 scored "high"). Regarding efficacy, all BZDs, in general, were significantly better than placebo, but there were no significant differences between the different BZDs (high heterogeneity and inconsistency were detected). Regarding treatment discontinuation, with some exceptions, no significant differences were observed in the comparisons against placebo or other BZD (no or low heterogeneity and inconsistency were observed in the different analyses). Regarding treatment tolerability, none of the BZD showed significant differences compared to placebo, except diazepam (RR = 1.61; 95% CI = 1.32; 1.96). Moderate heterogeneity and low inconsistency were observed in the treatment tolerability network meta-analysis.

Conclusion: BZDs are overall efficacious for the treatment of GAD and have a favorable safety profile. No distinctive differences were identified when comparing BZD among themselves.

Introduction: Acceptance and commitment therapy (ACT) may be as effective for treating obsessive compulsive disorder (OCD) as the gold standard treatment, cognitive behavioral therapy (CBT) with exposure response prevention (ERP), but ACT has never been directly compared to CBT/ERP in a randomized control trial. This study aimed to compare the efficacy of group-based ACT and CBT/ERP in two outpatient mental health service clinics for adults with OCD.

Methods: A total of 176 patients with OCD participated in a single-blinded, non-inferiority, block randomized controlled trial (RCT). Patients were assigned to either the ACT (n = 101) or CBT/ERP (n = 75) groups for 14 weekly sessions. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score at post-treatment and at the 6-month follow-up with prespecified non-inferiority criteria. Quality of life, measured using the Quality of Life Inventory (QOLI), was the secondary outcome.

Results: Linear mixed models showed that Y-BOCS scores in the ACT group were non-inferior to those in the CBT/ERP group both post-treatment and at 6, and 12 months of follow-up. QOLI scores also showed no significant differences in ACT compared to CBT/ERP across the three measurement points.

Conclusion: This RCT demonstrated that group-delivered ACT is non-inferior to CBT/ERP in reducing OCD symptoms and improving the quality of life of patients with OCD in outpatient mental health services. These findings suggest that ACT may serve as a viable alternative to CBT/ERP in adults with OCD in outpatient mental health settings, although further replication is necessary.