scholarly journals The Role of Practice-Based Evidence and Feedback Informed Treatment for Improving Therapy Outcomes

2020 ◽  
Author(s):  
Daryl Mahon
Keyword(s):  
Routine Practice ◽  
Therapy Outcomes ◽  
Attrition Rates ◽  
Psychological Therapies ◽  
Empirically Supported ◽  
Informed Treatment ◽  
Poor Outcomes ◽  
Psychotherapy Clients ◽  
Feedback Informed Treatment

Attrition rates and deterioration of counselling and psychotherapy clients are two major concerns for those delivering psychological therapies across differential modalities. While a variety of correlations are said to contribute to attrition and deterioration such as, client, therapist and clinical level, identifying and improving outcomes for this cohort of people in routine practice is difficult. Even with the addition of hundreds of empirically supported treatments added to the profession, outcomes have not improved in line with these new approaches. Methods to limit the extent of poor outcomes has been established in the extent literature, thus, practice-based evidence is put forward focusing on Feedback Informed Treatment (FIT).

scholarly journals Introducing Feedback Informed Preference Accommodation (FIPA): A Case Study in Clinical Practice

2020 ◽  
Author(s):  
Daryl Mahon
Keyword(s):  
Clinical Practice ◽  
Routine Practice ◽  
Attrition Rates ◽  
Extant Literature ◽  
Case Load ◽  
Initial Preference ◽  
Process And Outcome ◽  
Informed Treatment ◽  
Feedback Informed Treatment

Psychotherapy is a successful modality for those who engage in and complete a course of treatment. However, attrition rates and negative outcomes make up a significant and under discussed proportion of clinicians’ case load in routine practice. Innovative and novel methods to address these issues have been identified within the extant literature. However, their uptake can be impacted by issues such as utility and brevity. The present paper seeks to establish a framework for integrating Feedback Informed Treatment (FIT) and the Cooper-Norcross Inventory of Preferences (C-NPI) in clinical practice. That is, using the C-NPI for initial preference accommodation and following this up on a session to session basis to monitor the process and outcome of therapy. An overview of both approaches is provided, and a rationale for their integration elucidated. The author terms this integration, Feedback Informed Preference Accommodation (FIPA). A Case Study is put forward to demonstrate this process in clinical practice.

Feedback informed treatment: An empirically supported case study of psychodynamic treatment

2017 ◽  
Vol 73 (11) ◽  
pp. 1499-1509 ◽  
Author(s):  
Stephanie Winkeljohn Black ◽  
Jesse Owen ◽  
Norah Chapman ◽  
Kelly Lavin ◽  
Joanna M. Drinane ◽  
...  
Keyword(s):  
Psychodynamic Treatment ◽  
Empirically Supported ◽  
Informed Treatment ◽  
Feedback Informed Treatment

scholarly journals Evaluating Mechanisms: Mapping Weekly Dynamics between Experiential Avoidance and SAD Symptoms

2021 ◽  
Author(s):  
Laurel D. Sarfan ◽  
Joshua C. Magee ◽  
Elise M. Clerkin
Keyword(s):  
Experiential Avoidance ◽  
Change Score ◽  
Avoidance Task ◽  
Symptom Change ◽  
Empirically Supported ◽  
Task Training ◽  
Clinical Questions ◽  
Pilot Intervention ◽  
Future Work

AbstractWidely-used, empirically-supported treatments focus on reducing experiential avoidance (EA) as a mechanism of social anxiety disorder (SAD) symptom change. However, little is known about how EA and SAD symptoms bidirectionally interrelate from session to session, or throughout the course of an intervention—a gap that raises significant theoretical and clinical questions about the mechanistic role of EA. Participants (N = 78) with elevated EA and SAD symptoms completed a 3-session pilot intervention (Approach-Avoidance Task training plus psychoeducation) designed to target EA. Bivariate latent change score modeling was then used to map the bidirectional, temporal interrelationships between EA and SAD symptoms from session to session. Analyses accounted for the overall trajectory of change in both variables (i.e., EA and SAD) and both variables’ preceding measurement. Findings suggested that changes in SAD symptoms preceded and predicted changes in EA from session to session. Contrary to hypotheses, this effect was not bidirectional, as changes in EA did not precede and predict changes in SAD symptoms from session to session. The use of a relatively small analogue sample limit the external validity of the present findings. Nevertheless, these novel findings advance our understanding of the dynamic interrelationships between EA and SAD symptoms throughout treatment. Moreover, given that many leading treatments target EA, this study highlights a need for future work to continue evaluating whether EA is indeed a mechanism of SAD symptom change.

scholarly journals Mediterranean Diet for the Prevention of Gestational Diabetes in the Covid-19 Era: Implications of Il-6 In Diabesity

2021 ◽  
Vol 22 (3) ◽  
pp. 1213
Author(s):  
Anna Lucia Fedullo ◽  
Antonio Schiattarella ◽  
Maddalena Morlando ◽  
Anna Raguzzini ◽  
Elisabetta Toti ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Mediterranean Diet ◽  
Viral Infections ◽  
High Body Mass Index ◽  
Omega 3 ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Gestational Weight ◽  
Poor Outcomes

The aim of this review is to highlight the influence of the Mediterranean Diet (MedDiet) on Gestational Diabetes Mellitus (GDM) and Gestational Weight Gain (GWG) during the COVID-19 pandemic era and the specific role of interleukin (IL)-6 in diabesity. It is known that diabetes, high body mass index, high glycated hemoglobin and raised serum IL-6 levels are predictive of poor outcomes in coronavirus disease 2019 (COVID-19). The immunopathological mechanisms of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include rising levels of several cytokines and in particular IL-6. The latter is associated with hyperglycemia and insulin resistance and could be useful for predicting the development of GDM. Rich in omega-3 polyunsaturated fatty acids, vitamins, and minerals, MedDiet improves the immune system and could modulate IL-6, C reactive protein and Nuclear Factor (NF)-κB. Moreover, polyphenols could modulate microbiota composition, inhibit the NF-κB pathway, lower IL-6, and upregulate antioxidant enzymes. Finally, adhering to the MedDiet prior to and during pregnancy could have a protective effect, reducing GWG and the risk of GDM, as well as improving the immune response to viral infections such as COVID-19.

scholarly journals TET2 mutations as a part of DNA dioxygenase deficiency in myelodysplastic syndromes

2021 ◽  
Author(s):  
Carmelo Gurnari ◽  
Simona Pagliuca ◽  
Yihong Guan ◽  
Vera Adema ◽  
Courtney E Hershberger ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Prognostic Significance ◽  
Age Groups ◽  
Feedback Mechanism ◽  
Dna Demethylation ◽  
Compensatory Mechanisms ◽  
Poor Outcomes ◽  
Relationship Of ◽  
The Impact

Decrease in DNA dioxygease activity generated by TET2 gene family is crucial in myelodysplastic syndromes (MDS). The general down-regulation of 5-hydroxymethylcytosine (5-hmC) argues for a role of DNA demethylation in MDS beyond TET2 mutations, which albeit frequent, do not convey any prognostic significance. We investigated TETs expression to identify factors which can modulate the impact of mutations and thus 5-hmC levels on clinical phenotypes and prognosis of MDS patients. DNA/RNA-sequencing and 5-hmC data were collected from 1,665 patients with MDS and 91 controls. Irrespective of mutations, a significant fraction of MDS patients exhibited lower TET2 expression, while 5-hmC levels were not uniformly decreased. In searching for factors explaining compensatory mechanisms, we discovered that TET3 was up-regulated in MDS and inversely correlated with TET2 expression in wild-type cases. While TET2 was reduced across all age-groups, TET3 levels were increased in a likely feedback mechanism induced by TET2 dysfunction. This inverse relationship of TET2 and TET3 expression also corresponded to the expression of L-2-hydroxyglutarate dehydrogenase, involved in agonist/antagonist substrate metabolism. Importantly, elevated TET3 levels influenced the clinical phenotype of TET2-deficiency whereby the lack of compensation by TET3 (low TET3 expression) was associated with poor outcomes of TET2 mutant carriers.

scholarly journals The Role of Cytokine profile detection in Myelomatous pleural effusions

2021 ◽  
Author(s):  
Junhui Xu ◽  
Liang Gao ◽  
Miao Yan ◽  
Bingjie Wang ◽  
Zhengyang Song ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Pleural Effusion ◽  
Cytokine Profile ◽  
Pleural Effusions ◽  
Case Presentation ◽  
Cytokine Detection ◽  
Tnf Α ◽  
Tumor Load ◽  
Poor Outcomes

Abstract Background: Myelomatous pleural effusion (MPE), as a presentation of extramedullary infiltration of multiple myeloma (MM), is rare and associated with poor outcomes without comparatively effective treatment now. The value of the cytokine detection in pleural effusions to MPE has not been reported at present. Case presentation: We herein report a case of refractory and relapsed multiple myeloma which developed bilateral MPE due to disease progression caused by intolerance to various chemotherapy regimens. The cytomorphology and flow cytometry is adopted in the diagnosis confirmation. The chemotherapy containing immunomodulators combined with thoracic catheterization drainage is applied to the patient, showing a certain therapeutic effect. During the course of disease, the changes of cytokine profile in pleural effusion were monitored by Biolegend CBA technology, revealing that the cytokines such as IL-6 and IL-10 related to the tumor load in pleural effusion decreased with the improvement of the disease, while IL-2, IL-4, IL-17A, TNF - α, INF - γ, granzyme A, Granzyme B, perforin and granulysin increased with the improvement of the disease. Conclusions: There is a prospect that the cytokines level in pleural effusion becomes an indication to evaluate treatment response of MPE, and in the light of our finding, immunomodulators, IL-2 and INF - γ may be utilized in treating patients suffering MPE.

scholarly journals Evaluation of a Trauma-Focused CBT Training Programme for IAPT services

2017 ◽  
Vol 45 (5) ◽  
pp. 467-482 ◽  
Author(s):  
Hannah Murray
Keyword(s):  
Training Programme ◽  
Behavioural Therapy ◽  
Routine Practice ◽  
Post Traumatic Stress ◽  
Training Interventions ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Co Morbidity ◽  
Early Life Trauma ◽  
Post Traumatic

Background: Therapists in Improving Access to Psychological Therapies (IAPT) services are often expected to treat complex presentations of post-traumatic stress disorder (PTSD), such as individuals with multiple, prolonged or early life trauma histories and significant co-morbidity, for which they have received minimal training. Although high recovery rates for PTSD have been demonstrated in randomized controlled trials, these are not always replicated in routine practice, suggesting that training interventions are required to fill the research–practice gap. Aims: This study investigated the outcomes of a therapist training programme on treating PTSD with trauma-focused cognitive behavioural therapy (TF-CBT). Method: Twenty therapists from ten IAPT services participated in the training, which consisted of workshops, webinars and consultation sessions over a 6-month period. Results: Feedback indicated that participants found the training highly acceptable. PTSD knowledge and self- and supervisor-rated competence on TF-CBT measures improved following the training and improvements were maintained a year later. Client outcomes on a PTSD measure improved following the training. Participants reported attempts to disseminate learning from the course back to their teams. Conclusions: The findings indicate that the training programme was successful in improving TF-CBT knowledge, skills and outcomes for IAPT therapists. Tentative support for training ‘trauma experts’ within IAPT services was found, although institutional constraints and staff turnover may limit the sustainability of the model.

The role of perfectionism in cognitive behaviour therapy outcomes for clinically anxious children

2013 ◽  
Vol 51 (9) ◽  
pp. 547-554 ◽  
Author(s):  
Jennifer H. Mitchell ◽  
Carol Newall ◽  
Suzanne Broeren ◽  
Jennifer L. Hudson
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Therapy Outcomes ◽  
Behaviour Therapy ◽  
Cognitive Behaviour
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