Psychotherapy and Psychosomatics最新文献

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.

Introduction: Patients with borderline personality disorder (BPD) suffer from severe social impairments and interpersonal problems. Social touch can provide comfort and facilitate the maintenance of social bonds, and preliminary evidence indicates a negative evaluation of social touch in patients with BPD. However, the neural mechanisms underlying aberrant touch processing in BPD and its role for social impairments are still unclear.

Methods: We recruited 55 BPD patients and 31 healthy controls and used functional magnetic resonance imaging to probe neural responses to slow (i.e., C-tactile [CT]-optimal; affective) and fast (i.e., CT-suboptimal; discriminative) touch before and after 4 weeks of a residential dialectical behavior therapy (DBT) program. In addition to assessing BPD symptoms and interpersonal problems, we evaluated touch allowance maps and the attitude toward social touch.

Results: BPD patients showed a comprehensive negative bias toward social touch before the DBT, evident in a significantly more negative attitude toward and reduced comfort zones of social touch compared to healthy controls. Activation in the posterior insular cortex in response to CT-optimal touch was significantly reduced and correlated with the severity of interpersonal problems in BPD patients. Despite significant improvements in overall BPD symptom load, dysfunctional social touch processing persisted after 4 weeks of DBT, indicating trait-like disturbances in BPD.

Conclusions: An impaired insula-mediated integration of affective and sensory components of touch may constitute a clinically relevant biological signature of the complex interpersonal problems in BPD.

Introduction: This study aimed to assess the benefit of integrating the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) into the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Specifically, it examined whether this integration enhances the understanding of psychopathologies and quality of life (QOL) in psychosomatic medicine.

Methods: In this cross-sectional study conducted in Taiwan, 277 patients from psychosomatic clinics and 225 community participants were included. Standardized interview tools based on DCPR-R and DSM-5 were used to assess the presence of various diagnoses. Participants also completed several scales related to persistent somatic symptoms, negative emotions, and QOL. Latent class analysis was used to explore the clustering of diagnoses, and multiple linear regression analysis was employed to investigate the relationship between diagnoses, psychopathologies, and QOL under conditions of possible comorbidity.

Results: Three classes were identified via latent class analysis: somatic symptoms, demoralization and stress, and insomnia. In the multivariate analysis considering multiple diagnoses simultaneously, the number of diagnoses significantly associated with psychopathologies and QOL was greatly reduced compared to the univariate analysis. Persistent somatization was more strongly associated with somatic distress than somatic symptom disorder. Several DCPR-R constructs showed significant associations with illness-related anxiety. The DCPR-R diagnoses with broader influences on QOL were demoralization, demoralization with hopelessness, and irritable mood.

Conclusions: The results suggest the potential clinical significance of integrating DCPR-R and DSM-5 in Eastern societies. The DCPR-R diagnoses with significant findings mentioned above may contribute to the personalized treatment plans for patients in psychosomatic medicine.

Introduction: Many physical complaints cause long-term bodily distress. Meta-analyses show that cognitive behavioral therapy (CBT) and acceptance- and mindfulness-based treatments (AMBT) reduce somatic symptom severity, but evidence on differential efficacy is limited. This study evaluates the efficacy of CBT and AMBT for bodily distress (e.g., somatoform disorders, functional somatic syndromes, and related disorders).

Methods: A network meta-analysis of randomized controlled trials on adults with bodily distress compared CBT and AMBT either directly or with nonspecific control groups. Cohen's d based on between-group effect sizes was aggregated using a random effects model. Primary outcome was somatic symptom severity; secondary outcomes included depression, anxiety, and perceived health status.

Results: Based on 74 studies (N = 8,277), CBT (d = -0.50, 95% CI, -0.70 to -0.29; between-group effect sizes vs. wait-list [WL]) and AMBT (d = -0.55, 95% CI, -1.06 to -0.23; between-group effect sizes vs. WL) were equally effective in reducing somatic symptoms at posttreatment. AMBT were more effective than CBT in reducing depression (d = -0.31, 95% CI, -0.58 to -0.04; between-group effect sizes) and anxiety (d = -0.42, 95% CI, -0.73 to -0.11; between-group effect sizes) posttreatment. At long-term follow-up, effects were partly maintained; AMBT remained more effective than CBT for anxiety, with no differential effects for other outcomes.

Conclusions: Both treatments showed benefits compared to various controls. Evidence suggests potential differential treatment effects, indicating some patient groups may benefit more from AMBT. Clinicians should view CBT as foundational but remain open to variations, especially for comorbid pathology.

Introduction: Impairments in social cognition in bipolar disorder (BD) have been extensively described in the last decade but few treatment strategies have been studied to address this issue. This study presents findings from a randomized controlled trial (RCT) investigating the efficacy of metacognitive training for bipolar disorder (MCT-BD) compared to Treatment as Usual (TAU) among individuals with BD in remission. The aim was to determine whether MCT-BD could improve social cognition and overall functioning in this population.

Methods: Participants (N = 56) were recruited via social media and an internal database at the University of São Paulo Medical School. Inclusion criteria included a confirmed BD diagnosis, current state of remission, and the presence of social functioning impairments. Exclusion criteria included any impairments that could hinder neuropsychological testing. Patients were randomly assigned to either MCT-BD or TAU, with assessments conducted at baseline and follow-up. The MCT-BD program consisted of nine sessions.

Results: The overall attendance rate across all MCT-BD intervention sessions was 96.6%. The MCT-BD program demonstrated added value in improving social cognition, specifically in emotion recognition reaction time. However, no significant changes were found in theory of mind, psychosocial functioning, or quality of life.

Conclusion: This RCT provides preliminary evidence for the efficacy of MCT-BD in improving emotion recognition latency, emphasizing the importance of targeted interventions in social cognition outcomes for individuals with BD. The study's strengths include high completion rates and comprehensive cognitive assessments. Future studies should explore long-term effects and personalized treatment approaches aiming to improve social-cognitive deficits in this population.