An evaluation of the skills group component of DBT-A for parent/guardians: a mixed methods study

2020 ◽  
pp. 1-9
Author(s):  
Daniel Flynn ◽  
Conall Gillespie ◽  
Mary Joyce ◽  
Ailbhe Spillane
Keyword(s):  
Mixed Methods ◽  
Family Relationships ◽  
Parental Stress ◽  
Self Report ◽  
Subjective Burden ◽  
Behaviour Therapy ◽  
Post Intervention ◽  
Comparison Groups ◽  
National Public Health ◽  
Skills Group

Objectives: Previous research indicates that dialectical behaviour therapy for adolescents (DBT-A) is effective in treating emotionally dysregulated adolescents with self-harm and/or suicidal ideation. As part of the DBT-A programme, parents attend the weekly skills group with their child. However, few studies have evaluated parental outcomes in DBT-A. This multi-site study aims to explore the outcomes and experiences of parents who participated in a 16-week DBT-A programme in Ireland. Methods: This study was conducted in community-based child and adolescent mental health services (CAMHS) in the national public health system in Ireland. Participants were parent/guardians of adolescents attending a DBT-A programme in their local CAMHS. Participants attended the group skills component of the DBT-A programme. This study utilised a mixed methods approach where both quantitative and qualitative data were collected from participants. Self-report measures of burden, grief and parental stress were completed at pre-intervention, post-intervention and 16-week follow-up. Qualitative written feedback was obtained at post-intervention. The data were analysed using multi-level linear mixed-effects models and content analysis. Results: One hundred participants (76% female) took part in this study. Significant decreases were reported for objective burden, subjective burden, grief and parental stress from pre- to post-intervention (p < 0.01). Participants reported that the skills component of DBT-A was useful in meeting their own needs and the needs of their child. Discussion: DBT-A shows promise for parents as well as their adolescent child. Future studies should evaluate changes to family relationships following completion of the programme and also include controlled comparison groups.

scholarly journals The efficacy of a resilience-enhancement program for mothers in Japan based on emotion regulation: study protocol for a randomized controlled trial

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiromi Tobe ◽  
Mariko Sakka ◽  
Kiyoko Kamibeppu
Keyword(s):  
Emotion Regulation ◽  
Child Maltreatment ◽  
Parental Stress ◽  
Controlled Trial ◽  
Intervention Group ◽  
Well Being ◽  
Self Report ◽  
Baseline Survey ◽  
Control Group ◽  
Post Intervention

Abstract Background The demands of daily life often cause mothers high levels of distress and other negative emotions. Anger, including harsh verbal discipline, has been linked to child maltreatment, with long-term adverse effects on a child’s well-being. It is critically important to teach mothers stress management and emotion regulation in addition to parenting skills, but this is yet to be conducted in a formalized manner. Strengthening the multiple protective factors that constitute resilience helps reduce distress. The aim of this study is to evaluate the efficacy of a resilience-enhancement program for mothers. Methods We designed a two-arm, parallel, randomized trial with an active control. Mothers and their partners with children between three and six years old will be recruited. Following an online baseline survey, 140 mothers will be randomly allocated to either an intervention or control group. Self-report assessment will be conducted online post-intervention and at a two-month follow-up. The control group will participate in a serious of group discussions. The intervention group will participate in four bi-weekly 120-min sessions of a Cognitive Behavior Therapy-based program designed to enhance resilience, focusing on emotion regulation through cognitive reappraisal. Participants will be encouraged to apply and share the skills they acquire with their partner and children at home. Partners will also be assessed to explore their indirect influence from the mothers. Intention-to-treat analysis will be conducted and the two groups will be compared, applying covariate analysis. The primary outcome of the intervention is improved resilience. Secondary outcomes include improved anger control, self-esteem, cognition of children’s misbehavior, and reduced parental stress. Discussion To the best of our knowledge, this study will evaluate the first resilience-enhancement program focused on emotion regulation for mothers in Japan. It will contribute to the existing body of knowledge on building emotional resilience. If the program is found to be effective, it will provide an alternative means to enhance mothers’ resilience against stress and improve their ability to regulate emotion. In so doing, it will offer a way to prevent child maltreatment and protect the mental health of children and families. Trial registration UMIN000027232, May 3, 2017.

scholarly journals Anxiety Gremlins: mixed methods sequential explanatory evaluation of a CBT group intervention for children

2020 ◽  
Vol 13 ◽  
Author(s):  
Christopher Meek ◽  
Lucy Redstone ◽  
Nima Moghaddam
Keyword(s):  
Mixed Methods ◽  
Outcome Measures ◽  
Group Intervention ◽  
Childhood Anxiety ◽  
Anxiety Symptoms ◽  
Self Report ◽  
Routine Practice ◽  
List Type ◽  
Post Intervention ◽  
Co Morbidity

Abstract Although research evidence supports the efficacy of cognitive behavioural therapy (CBT) for anxiety in children, it is important to examine practice-based evidence of effectiveness in typical clinical contexts. This study evaluated a CBT group intervention – ‘Anxiety Gremlins’ – for childhood anxiety. Participants were 36 children (19 boys, 17 girls) aged 8–13, referred for anxiety symptoms at a UK NHS service. The 8-session intervention included six child sessions (2 h) and two parent sessions (1 h). Self-report outcome measures of anxiety symptoms, life functioning and therapeutic relationships were used to measure change pre- and post-intervention. Semi-structured interviews were conducted with group facilitators and analysed through deductive content analysis to identify barriers and facilitators to change. No substantive differences were found between aggregated scores on pre- versus post-intervention outcome measures. Reliable change in anxiety symptoms was identified in 10 children (31%), with five improvers and five deteriorators. Interviews with facilitators identified disruption in group flow, lack of facilitator time to prepare and reflect, and the complexity of clients as hindering factors. Children meeting like-minded peers to share their stories and high engagement in the therapeutic process were helpful factors. Anxiety Gremlins did not demonstrate effectiveness on outcome measures, and this contrasted with clinical opinion. Recommendations were made for the service to revisit the intervention content and the method for recruiting children to the group – as complexity/co-morbidity was linked to poorer outcomes. Future research could explore fidelity to an adapted intervention and include interviews with children and their parents. Key learning aims After reading this paper the reader should be able to: (1) Understand how instances of CBT practice can be robustly evaluated using a mixed-methods approach, including analyses of change at both group and individual levels. (2) Understand critical considerations when adapting ‘evidence-based’ CBT interventions for routine practice. (3) Appreciate that aggregative group-level analyses can mask clinically important differences in individual CBT outcomes.

scholarly journals Feasibility and Effect of Adding a Concurrent Parental Component to a School-Base Wellness Program Using Two Modes of Mobile-Based Technology – Mixed Methods Evaluation of RCT

2021 ◽  
Author(s):  
Moria Golan ◽  
Shakked Benifla ◽  
Aviv Samo ◽  
Noa Alon ◽  
Maya Mozeikov
Keyword(s):  
Mixed Methods ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Feasibility Studies ◽  
Smartphone Application ◽  
Self Report ◽  
Structured Interviews ◽  
Post Intervention ◽  
Staff Members ◽  
Small Effect Size

Abstract Background: This study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents.Methods: Two three-armed, randomized, controlled feasibility studies were conducted. Participants were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. In the parental component, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent through WhatsApp and in the following year via the specially designed smartphone application. Students and parents filled out questionnaires at three measure points: pre and post intervention and at three months follow-up. Mixed-methods assessments were performed using semi-structured interviews with parents and school staff members, as well as a computerized self-report questionnaire.Results: The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the specially designed application demonstrated superior improvement compared to those in the youth & parental component arm.Conclusions: Although the addition of the concurrent parenting component was praised by the actively participating parents, overall, this intervention was not statistically superior to the youth-only arm. Only a few variables demonstrated statistically significant improvement, usually with a small effect size. The use of WhatsApp had higher feasibility and uptake than the use of the specially designed application. Under the chosen structure and population, it seems that the program did not have the intended impact. Parents who expressed specific resistance may have negatively affected their children, causing them to be less engaged. A cost-benefit analysis of programs with parental components as well as the development of strategies to enhance parent-school partnership are warranted.Trial registrations: NCT04129892 (1.11.2017) and NCT03540277 (26.4.2018)

scholarly journals Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis

2017 ◽  
Vol 12 ◽  
pp. 117863371771645 ◽  
Author(s):  
Nancy Ames ◽  
Rebecca Shuford ◽  
Li Yang ◽  
Brad Moriyama ◽  
Meredith Frey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Mixed Methods ◽  
Self Report ◽  
Control Group ◽  
Music Listening ◽  
Post Intervention ◽  
Significant Difference ◽  
Numeric Rating

Background: Music listening may reduce the physiological, emotional, and mental effects of distress and anxiety. It is unclear whether music listening may reduce the amount of opioids used for pain management in critical care, postoperative patients or whether music may improve patient experience in the intensive care unit (ICU). Methods: A total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours) during the 48 hours of patients’ ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention. Results: There was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS) for pain between the music and the control groups ( P = .037). The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group’s interviews were analyzed for themes. Conclusions: Despite the limited sample size, this study identified music listening as an appropriate intervention that improved patients’ post-intervention experience, according to patients’ self-report. Future mixed methods studies are needed to examine both qualitative patient perspectives and methodology to improve music listening in critical care units.

Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study

2019 ◽  
Vol 28 (3) ◽  
pp. 660-672
Author(s):  
Suzanne H. Kimball ◽  
Toby Hamilton ◽  
Erin Benear ◽  
Jonathan Baldwin
Keyword(s):  
Mixed Methods ◽  
Verbal Behavior ◽  
Coping Strategies ◽  
Mixed Methods Study ◽  
Self Report ◽  
Anxiety And Depression ◽  
Negative Consequences ◽  
Emotional Tone ◽  
Explanatory Mixed Methods ◽  
Quantitative Results

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred “initial” and 200 “reply” Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

Examining perceptions of stress, wellbeing and fear among Hungarian adolescents and their parents under lockdown during the COVID-19 pandemic

2020 ◽  
Author(s):  
Gabor Csikos ◽  
Krisztina Dr Törő ◽  
Judit Mokos ◽  
Sandor Rozsa ◽  
Hadházi Éva ◽  
...  
Keyword(s):  
Family Relationships ◽  
Parental Stress ◽  
Significant Negative Correlation ◽  
Post Traumatic Stress ◽  
Natural Catastrophes ◽  
Parents And Children ◽  
Wellbeing Index ◽  
The Family ◽  
Post Traumatic ◽  
Open Question

Intensified anxiety responses and even symptoms of post-traumatic stress are commonly observed under quarantine conditions. In this study, the effects on fear, anxiety and wellbeing of the recent pandemic caused by SARS-CoV-2 were investigated in a sample of otherwise healthy Hungarians. Taking the family as a microsystem, differences in gender, age, family relationships and time spent in isolation were the main focus of this investigation. 346 parent-child dyads were examined; the children were 11-17 years of age. Standard psychological questionnaires (Perceived Stress Scale, WHO Wellbeing Index), and an open question test (the Metamorphosis test) were used, and the results analysed with the aid of basic statistical methods. Stress levels and wellbeing displayed a significant negative correlation with each other in both parents and children. Parental stress and levels of wellbeing had a weak but significant impact on the wellbeing of their children. Among the demographic variables examined, none of them was found to explain the wellbeing or stress level of parents. Natural catastrophes, such as pandemics, create a stressful social environment for parents, and therefore directly impact the psychological wellbeing of all family members.

scholarly journals Inducing moral elevation in veterans with PTSD: An experimental investigation using a mixed methods approach

2021 ◽  
Vol 12 (1) ◽  
pp. 204380872098241
Author(s):  
Adam P. McGuire ◽  
Joseph Mignogna
Keyword(s):  
Mixed Methods ◽  
State Level ◽  
Self Report ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Trauma Narrative ◽  
Study Task ◽  
Level Elevation ◽  
Moral Elevation ◽  
Psychosocial Benefits

Moral elevation is a positive emotion described as feeling inspired by others’ virtuous actions. Elevation has several psychosocial benefits, some of which may be relevant to trauma-related distress; however, past studies have primarily examined elevation in nonclinical, civilian populations or in naturalistic studies. This experimental study used mixed methods to assess if veterans with post-traumatic stress disorder (PTSD) experience elevation when exposed to elevation stimuli in a controlled setting. Participants included 47 veterans with significant PTSD symptoms. Following baseline measures and a written trauma narrative, veterans were randomized to an elevation or amusement condition where they viewed two videos intended to elicit the condition emotion. Veterans also provided a written journal response describing their reaction to the videos. Self-report measures were administered after each study task to assess state-level elevation and amusement. Veterans randomized to the elevation condition reported significantly higher levels of elevation after videos compared to veterans in the amusement condition. Qualitative results offered further support for differences between groups and identified unique themes related to the experience of elevation. Overall, findings indicate it is possible to induce elevation in veterans with significant PTSD symptoms. Additionally, qualitative results highlight specific benefits of elevation and potential targets for treatment integration and future exploration.

scholarly journals Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Emily R. Bemmer ◽  
Kelsie A. Boulton ◽  
Emma E. Thomas ◽  
Ben Larke ◽  
Suncica Lah ◽  
...  
Keyword(s):  
Young Adults ◽  
Social Anxiety ◽  
Social Functioning ◽  
Autism Spectrum ◽  
Self Report ◽  
Post Intervention ◽  
Adults With Autism ◽  
Adolescents And Adults ◽  
Adults With Asd ◽  
Young Adults With Asd

Abstract Background There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress. Method Ten groups of participants completed an eight-week, modified group CBT intervention targeting both social anxiety and social functioning, that included social skills training, exposure tasks and behavioural experiment components. Seventy-eight adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 38 (M = 22.77; SD = 5.31), were recruited from the community, Headspace centres and the Autism Clinic for Translational Research at the Brain and Mind Centre, University of Sydney. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires (administered either online or through the return of hard-copy booklets), and participants were invited to provide anonymous feedback on the intervention (at the mid-point and end of the intervention). Results Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p < .001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation (p = .032) and restricted interests and repetitive behaviours (p = .025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p < .05). All improvements demonstrated small effect sizes. Participant feedback was positive and indicated strong satisfaction with the program. Limitations The absence of a control group and follow-up measures, reliance on self-report instruments as outcome measures and the exclusion of those with intellectual disability represent significant limitations to this study. Conclusions These findings indicate that a group CBT intervention appears to be a beneficial intervention for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The stand-alone nature of the intervention combined with positive participant feedback indicates it was well tolerated, has potential clinical utility and warrants further study in a randomised-controlled, follow-up design.

scholarly journals Impact of a patient-specific national programme aimed at increasing the use of emollient moisturisers to reduce the risk of skin tears: a longitudinal cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039579
Author(s):  
Anna K Moffat ◽  
Kerrie P Westaway ◽  
Jemisha Apajee ◽  
Oliver Frank ◽  
Russell Shute ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Self Report ◽  
Additional Patient ◽  
Patient Specific ◽  
Department Of Veterans Affairs ◽  
National Programme ◽  
Sustained Effect ◽  
Skin Tears ◽  
Comparison Groups ◽  
The Impact

ObjectivesTo evaluate the impact of a patient-specific national programme targeting older Australians and health professionals that aimed to increase use of emollient moisturisers to reduce to the risk of skin tears.DesignA prospective cohort intervention.ParticipantsThe intervention targeted 52 778 Australian Government’s Department of Veterans’ Affairs patients aged over 64 years who had risk factors for wound development, and their general practitioners (GPs) (n=14 178).Outcome measuresAn interrupted time series model compared the rate of dispensing of emollients in the targeted cohort before and up to 23 months after the intervention. Commitment questions were included in self-report forms.ResultsIn the first month after the intervention, the rate of claims increased 6.3-fold (95% CI: 5.2 to 7.6, p<0.001) to 10 emollient dispensings per 1000 patients in the first month after the intervention. Overall, the intervention resulted in 10 905 additional patient-months of treatment. The increased rate of dispensing among patients who committed to talking to their GP about using an emollient was six times higher (rate ratio: 6.2, 95% CI: 4.4 to 8.7) than comparison groups.ConclusionsThe intervention had a sustained effect over 23 months. Veterans who responded positively to commitment questions had higher uptake of emollients than those who did not.

scholarly journals Promoting Problem Solving About Health Management: A Mixed-Methods Pilot Evaluation of a Digital Health Intervention for Older Adults With Pre-Frailty and Frailty

2021 ◽  
Vol 7 ◽  
pp. 233372142098568
Author(s):  
Annie T. Chen ◽  
Frances Chu ◽  
Andrew K. Teng ◽  
Soojeong Han ◽  
Shih-Yin Lin ◽  
...  
Keyword(s):  
Older Adults ◽  
Mixed Methods ◽  
Health Literacy ◽  
Problem Solving ◽  
Self Efficacy ◽  
Health Management ◽  
Digital Health ◽  
Post Intervention ◽  
Problem Solving Skills ◽  
Health Related

Background: There is a need for interventions to promote health management of older adults with pre-frailty and frailty. Technology poses promising solutions, but questions exist about effective delivery. Objectives: We present the results of a mixed-methods pilot evaluation of Virtual Online Communities for Older Adults (VOCALE), an 8-week intervention conducted in the northwestern United States, in which participants shared health-related experiences and applied problem solving skills in a Facebook group. Methods: We performed a mixed-methods process evaluation, integrating quantitative and qualitative data, to characterize the intervention and its effects. We focus on four areas: health-related measures (health literacy and self-efficacy), participation, problem solving skills enacted, and subjective feedback. Results: Eight older adults with pre-frailty and frailty (age = 82.7 ± 6.6 years) completed the study. There was an upward trend in health literacy and health self-efficacy post-intervention. Participants posted at least two times per week. Content analysis of 210 posts showed participants were able to apply the problem solving skills taught, and exit interviews showed participants’ increased awareness of the need to manage health, and enjoyment in learning about others. Conclusion: This mixed-methods evaluation provides insight into feasibility and design considerations for online interventions to promote health management among vulnerable older adults.

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