Trends in Psychiatry and Psychotherapy最新文献

Background: With increased screen time among children and adolescents, concerns about the impact of loot boxes (LB) on gambling behaviors have grown. LBs, often included in video games as purchasable items with randomized rewards, resemble gambling mechanics, raising concerns about potential risks for youth.

Methods: This systematic review collected and analyzed all available studies on LB use and gambling in individuals under 18 years old. A literature search was conducted using Cochrane, SciELO, and PubMed databases up to March 30, 2024. The inclusion criteria focused on peer-reviewed empirical studies examining the association between LBs and gambling behaviors in minors, while studies on unrelated gambling behaviors or those involving adults were excluded.

Results: From 74 initial articles, 4 studies met the inclusion criteria. Findings consistently showed a positive association between LB engagement and gambling tendencies in adolescents. Results indicate that adolescents involved with LBs are at a higher risk of problematic gambling behaviors, with gender differences also observed, as male adolescents showed higher engagement with LBs and gambling risks.

Conclusions: The review suggests a clear association between LB use and gambling behaviors in youth, with potential for LBs to act as a "gateway" to gambling. The findings highlight the need for regulatory actions, including age restrictions and educational efforts to protect youth from these risks. Further research with representative samples is necessary to deepen understanding of the LB-gambling link in young populations.

Objective: Unipolar and bipolar depression severely impact millions of individuals worldwide, with a significant subset of cases remaining unresponsive to conventional treatments. Psilocybin-assisted psychotherapy (PAP) has demonstrated therapeutic efficacy; however, the optimal psychotherapeutic approach remains undefined, ranging from unstructured models rooted in historical practices to modern frameworks that are structurally tailored for depression. This narrative review proposes a conceptualization of psychotherapeutic models employed in existing interventional trials of PAP for depression and provides a preliminary comparison of their main characteristics and evidence for efficacy.

Methods: The online databases PubMed, PsycINFO, and Google Scholar were searched for interventional trials evaluating PAP for individuals with unipolar or bipolar depression.

Results: A total of 38 publications were reviewed, contributing to the conceptualization of two main types of psychotherapy models: 1) 'Specific' approaches (most commonly Acceptance and Commitment Therapy and Perceptual-Control Therapy) and 2) 'Non-specific' models of psychological support. Both models emphasize the critical role of the therapeutic alliance, yet differ in mechanistic focus, with specific models being developed to enhance psychological flexibility and non-specific models emphasizing the concept of the 'inner-healer.' Importantly, critical gaps in the literature were identified, including methodological limitations of current evidence and the need for standardized reporting guidelines.

Conclusion: Although each PAP model differs, both may have clinical relevance in depression treatment. Future work should explore the standardized reporting of psychological interventions in PAP and comparative study designs to better evaluate non-specific and specific models and inform treatment guidelines.

Objective: This study aimed to investigate the relationship between the frequency and duration of exercise and symptoms of depression and anxiety.

Methods: This is a household survey conducted with a sample of 2,297 adults living in the city of Rio de Janeiro. The frequency and duration of exercise were measured using two closed-ended questions. Symptoms of depression and anxiety were assessed using the PHQ-9 and the GAD-7, respectively. Additionally, sociodemographic and anthropometric information (weight and height) was obtained. Bivariate and multivariate regression models were used to estimate the odds ratios (OR) of the associations between the variables.

Results: A total of 2,201 (age= 38.3 years (SE = 0.4), 62% women) individuals were evaluated. Compared to the non-exercisers, individuals who exercised at least once a week showed significantly lower odds of presenting depressive symptoms, even after adjusting for sex and BMI (OR = 0.7 [95% CI: 0.50-0.96], p = 0.03). Similar results were observed for frequency (2-4 times per week) and duration (≥1 hour and <2 hours). However, after adjusting for sex and BMI, these associations were no longer significant. Finally, no association was found between exercise and anxiety symptoms.

Conclusion: Physical exercise was associated with a lower likelihood of presenting depressive symptoms. Additionally, a moderate frequency and duration of exercise, initially associated with reduced odds of depressive symptoms, was no longer significant after adjusting for sex and BMI. Thus, body weight and sex appear to mediate the relationship between physical exercise and depressive symptoms in our sample.

Objective: Cognitive-behavioral therapy (CBT) is a first-line treatment for anxiety and depressive disorders, but its preventive efficacy remains uncertain. This study systematically reviewed and meta-analyzed randomized controlled trials of universal CBT-based interventions across all age groups, evaluating their effects on anxiety, depression, and quality of life.

Methods: We included randomized controlled trials of universal CBT programs delivered to general populations without prior risk or symptom screening. Eligible outcomes were depressive and anxiety symptoms and quality of life. Risk of bias was assessed using the Cochrane Risk of Bias tool. Separate three-level meta-analyses were conducted for each outcome, and subgroup analyses were performed by participant age and provider profession.

Results: Seventeen RCTs (n = 10,809 participants) met inclusion criteria. Pooled effect sizes were SMD = -0.02 (95% CI: -0.12 to 0.09) for quality of life, SMD = -0.09 (95% CI: -0.20 to 0.01) for depressive symptoms, and SMD = -0.03 (95% CI: -0.18 to 0.13) for anxiety symptoms. None reached statistical significance. Subgroup analyses confirmed no significant effects in children/adolescents or adults. Interventions delivered by psychologists were more effective than those delivered by teachers (SMD = 0.18), although overall preventive effects remained negligible.

Conclusions: Universal CBT interventions did not demonstrate significant preventive benefits for anxiety, depression, or quality of life across age groups. These findings suggest that universal CBT should not be adopted as a population-wide prevention strategy, and future research should prioritize targeted, data-driven approaches.

Background: The increasing prevalence of anxiety disorders underscores the critical importance of effective assessment and management strategies. While established questionnaires like the Hamilton Anxiety Rating Scale (HARS) and the Beck Anxiety Inventory (BAI) are widely used, there remains a need for instruments that explore the nuanced, qualitative features of anxiety, which are essential for personalized treatment approaches.

Methods: This study presents findings based on the Brief Anxiety Structure Questionnaire (BASQ), which is designed to evaluate behavioral manifestations, cognitive aspects, and personality traits associated with generalized anxiety disorder (GAD). Data from a Phase III clinical trial of the anxiolytic Aviandr (maritupirdine) were analyzed using machine learning techniques to develop predictive models and construct an "ideal patient profile".

Results: Among the tested algorithms of machine learning, the decision tree model demonstrated the highest accuracy in identifying the most influential BASQ questions for therapy selection. The BASQ questionnaire revealed qualitative aspects of anxiety and personality traits, providing a deeper understanding of the structure of anxiety and supporting more personalized treatment strategies. Specific questions most strongly correlated with the effectiveness of Aviandr treatment were also identified.

Conclusion: The findings from this study suggest that integrating qualitative parameters into clinical assessment may optimize therapy for anxiety disorders. Future research will focus on further elucidating the relationship between patient anxiety characteristics and treatment effectiveness.

Objective: Sleep health has evolved from focusing on specific disorders, such as insomnia and sleep apnea, to a broader perspective that includes regularity, efficiency, and socio-environmental influences. Psychological flexibility, particularly the acceptance process, has been identified as a key protective factor for sleep health. Therefore, assessing acceptance of sleep difficulties is essential for both research and clinical practice, as it provides insights into adaptive coping and informs interventions. The Sleep Problem Acceptance Questionnaire (SPAQ) is the only validated instrument for assessing acceptance of sleep difficulties, making it a valuable tool for interventions based on Acceptance and Commitment Therapy (ACT). This study aimed to adapt the SPAQ for Brazilian Portuguese, ensuring both semantic and psychometric equivalence.

Methods: The adaptation process included translation, back-translation, expert review, and pilot testing. The final version was validated in a sample of 1,352 participants, including individuals with insomnia and healthy controls.

Results: Confirmatory factor analysis supported the original two-factor structure (Activity Engagement and Willingness) with good model fit indices. We found evidence for stability of measurement properties across 14 days, but inconclusive evidence regarding the structural invariance between groups of good and poor sleepers. Reliability was high for both factors. Convergent validity was confirmed, showing negative correlations between acceptance and insomnia severity, psychological inflexibility, anxiety, and depression.

Conclusion: The Brazilian adaptation of the SPAQ shows adequate psychometric properties and is a valuable tool for clinicians and researchers. However, caution is needed when comparing scores across groups of good and bad sleepers, as item-level differences may affect structural comparability.

Introduction: The COVID-19 pandemic has significantly impacted mental health, particularly among frontline professionals. In response to the associated social isolation, short-term and remote service alternatives became essential. This study aimed to investigate the predictors of perceived improvement following the single session intervention with enhanced psychoeducation (SSI-EP), which included support videos, for frontline professionals during the COVID-19 pandemic.

Methods: This study analyzed data from a large trial involving frontline workers conducted from April 2020 to December 2021. All participants were randomized to receive the SSI-EP with videos and were included in the analysis.

Results: The final sample included 709 participants - 82.8 % health‑care professionals and 87.8 % women. One month after the intervention, 558 individuals (78.7 %) showed improved emotional symptoms. Greater improvement was associated with viewing more intervention videos and self-medication. In contrast, excessive carbohydrate and fat intake was linked to poorer outcomes.

Conclusion: This study underscores the significance of the SSI and the role of psychoeducational videos in enhancing participants' perceptions of improvement. Further research is necessary to examine these elements and determine which individuals might gain from this cost-effective, scalable intervention.

Objective: This systematic review aims to assess the effects of transcranial electrical stimulation (tES) on adults with anxiety. It focuses on evaluating physiological markers like heart rate variability (HRV), electroencephalogram (EEG), cortisol, and Interleukin-6 (IL-6) levels alongside various rating scales.

Methods: The review process, adhering to PRISMA guidelines, involved a thorough literature search across databases such as Embase, Scopus, PsycINFO, PubMed, and Web of Science. The risk of bias and quality of studies was evaluated using the JADAD scale. In total, 34 articles were meticulously chosen and analyzed by independent reviewer pairs.

Results: The review included 34 studies, encompassing 1567 participants aged between 18 to 65. The findings were mixed: while 19 studies reported a reduction in anxiety symptoms, 10 found no significant differences, and 4 did not report changes in anxiety. Two studies were inconclusive.

Conclusions: The review highlights a lack of standardized protocols for using tDCS in treating anxiety. The methodological quality of most studies was critically low, per PRISMA guidelines. There was considerable variation in methodological approaches across the studies, indicating a need for standardization in the research of anxiety treatment using tES.

Background: Cognitive Behavioral Therapy (CBT) is an effective treatment for Skin Picking Disorder (SPD). However, since individuals have limited access to CBT, telepsychotherapy can overcome this barrier.

Objective: Evaluate the efficacy of a self-guided digital CBT intervention for SPD.

Methods: This controlled clinical trial randomized 163 patients with SPD to receive 4 weeks of online CBT (SOSkin) or a control intervention (videos about quality of life). Primary outcome was the improvement in the Skin Picking Scale-Revised (SPS-R) and secondary outcomes were the improvement in Dermatology Life Quality Index Scale (DLQI), Generalized Anxiety Disorder Assessment Scale (GAD-7), and Patient Health Questionnaire-9 Scale (PHQ-9). Instruments were applied at baseline, middle and end of intervention and at 1 and 3 months of follow up. SOSkin usability was evaluated using the System Usability Scale (SUS). Data were analyzed using the Generalized Estimating Equations model (GEE).

Conclusion: There was no difference between groups in completion rates. SOSkin has excellent usability. Both groups improved the SPS-R and the DLQI scores after treatment and at the follow-up assessments. We found a significant time*group interaction in favor of CBT on SPS-R. Effect size of the intervention compared to control over SPS-R was small after treatment and at the follow-ups; over the DLQI was moderate after treatment and small at the follow-ups. CBT was superior to control on SPS-R when we compared the percentage of change from baseline. CBT was superior to control condition over DLQI at the end of treatment and at 1 month follow-up.