Implementation of ACTION: A Case Example.

Introduction: Auditory hallucinations are a perceptual condition that causes sounds that do not actually exist to appear to be heard. One method for treating people with auditory hallucinations is one-way conversation therapy. Individual Conversation Therapy is a better alternative therapy for people who experience hallucinations because it provides more meaningful evaluation findings. Objective: Provide care and provide a thorough explanation regarding Individual Conversation Therapy therapy for reducing sensory perception disorders including auditory hallucinations. Method: This research uses a nursing care strategy, with a descriptive case study design, on Mr. R, 23 years old who experiences auditory hallucinations based on inclusion and exclusion criteria. The data collection process was carried out through interviews using Individual Conversation Therapy techniques, observation and documentation. Result: Based on the case study findings, the patient stated that he was able to improve his hallucinations during Individual Conversation Therapy treatment, indicating that the intervention was effective. Conclusion: The conclusion of nursing care for sufferers of sensory perception disorders (hearing) in patients with hallucinations, the implementation of Individual Conversation Therapy is recommended because the effect of this therapy can reduce hallucinatory sounds. Introduction: Auditory hallucinations are a perceptual condition that causes sounds that do not actually exist to appear to be heard. One method for treating people with auditory hallucinations is one-way conversation therapy. Individual Conversation Therapy is a better alternative therapy for people who experience hallucinations because it provides more meaningful evaluation findings. Objective: Provide care and provide a thorough explanation regarding Individual Conversation Therapy therapy for reducing sensory perception disorders including auditory hallucinations. Method: This research uses a nursing care strategy, with a descriptive case study design, on Mr. R, 23 years old who experiences auditory hallucinations based on inclusion and exclusion criteria. The data collection process was carried out through interviews using Individual Conversation Therapy techniques, observation and documentation. Result: Based on the case study findings, the patient stated that he was able to improve his hallucinations during Individual Conversation Therapy treatment, indicating that the intervention was effective. Conclusion: The conclusion of nursing care for sufferers of sensory perception disorders (hearing) in patients with hallucinations, the implementation of Individual Conversation Therapy is recommended because the effect of this therapy can reduce hallucinatory sounds.

The main current intervention for post-traumatic stress disorder (PTSD) in adult primary care is individual trauma-focused cognitive behavioural therapy (TF-CBT). Group TF-CBT for PTSD has been advocated in order to improve access and cost. Barriers to the development of group TF-CBT include the need for a large number of sessions and therapist input in order to manage high levels of affect, possible dissociation and secondary traumatisation. This case study was prompted via our community engagement project when local women who had been involved in a single road traffic accident requested group therapy. The aim was to develop a NICE guideline-compliant brief 8-session group TF-CBT intervention that circumvented the above-mentioned barriers and is described in detail. In order to improve access, the group was delivered in the community. Standard and PTSD-specific measures were administered pre-therapy and post-therapy. Eight clients were offered treatment: two dropped out and six completed treatment. At the end of treatment, 3/6 clients attained reliable improvement in their PTSD symptoms. Two of these three clients also reached recovery. This change was maintained at 3-month follow-up where 4/6 clients attained reliable improvement, with three maintaining recovery. The remaining two clients showed minimal change in their PTSD symptoms. Overall, clients reported high-level satisfaction with the treatment protocol. This case study demonstrates a potentially clinically effective and cost-effective group TF-CBT intervention for non-complex single-incident PTSD. Key learning aims It is hoped that the reader of this case study will increase their understanding of the following: (1) Use of a brief group TF-CBT protocol to treat homogeneous single incident trauma in adults. (2) Adaptations to overcome barriers to group TF-CBT in adults. (3) Implementation of individualised reliving based on written-narrative rather than spoken-narrative. (4) Focus on the processes of PTSD, whilst using content as a theme to contextualise the symptoms. (5) Emphasis on the use of homework in order to enhance group affect-modulation and individual learning.

BackgroundEmotional disorders, which include both anxiety and depressive disorders, are the most prevalent psychological disorders according to recent epidemiological studies. Consequently, public costs associated with their treatment have become a matter of concern for public health systems, which face long waiting lists. Because of their high prevalence in the population, finding an effective treatment for emotional disorders has become a key goal of today’s clinical psychology. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders might serve the aforementioned purpose, as it can be applied to a variety of disorders simultaneously and it can be easily performed in a group format.MethodsThe study is a multicenter, randomized, non-inferiority controlled clinical trial. Participants will be 220 individuals with emotional disorders, who are randomized to either a treatment as usual (individual cognitive behavioral therapy) or to a Unified Protocol condition in group format. Depression, anxiety, and diagnostic criteria are the primary outcome measures. Secondary measures include the assessment of positive and negative affect, anxiety control, personality traits, overall adjustment, and quality of life. An analysis of treatment satisfaction is also conducted. Assessment points include baseline, post-treatment, and three follow-ups at 3, 6, and 12 months. To control for missing data and possible biases, intention-to-treat and per-protocol analyses will be performed.DiscussionThis is the first randomized, controlled clinical trial to test the effectiveness of a transdiagnostic intervention in a group format for the treatment of emotional disorders in public settings in Spain. Results obtained from this study may have important clinical, social, and economic implications for public mental health settings in Spain.Trial registrationRetrospectively registered at https://clinicaltrials.gov/. Trial NCT03064477 (March 10, 2017). The trial is active and recruitment is ongoing. Recruitment is expected to finish by January 2020.

Anxiety and depressive disorders in adolescents have an enormous burden worldwide due to their high prevalence and disability. Despite the high comorbidity between these disorders, preventive interventions have often been developed separately for anxiety and depression. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al. in Unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents, Oxford University Press, New York, 2018), a transdiagnostic treatment that targets core dysfunctions associated with anxiety and depression within a single protocol, was adapted as a universal preventive anxiety and depression program for the purposes of this investigation. The subsequent study of this adapted protocol evaluated pre- to post-intervention changes across a range of primary and secondary outcome measures. The secondary aims of this study were to assess the acceptability and feasibility of the adapted UP-A. Twenty-eight students (mean age = 14.67; SD = 0.87) participated in this uncontrolled trial conducted in Madrid, Spain. The program included nine weekly 55-min sessions administered in a school setting by an advanced doctoral student in clinical psychology to two groups of 15 and 13 students, respectively. Intent-to-treat analyses revealed significant declines in self-reported anxiety symptoms, interference of anxiety and depression, and top problems’ mean severity. Moderate to high participant satisfaction was indicated. The initial promising findings suggest that future trials of the UP-A adapted as a school-based universal anxiety and depression prevention program using a larger sample size are warranted. However, the results of this study should be interpreted cautiously due to limitations regarding the small sample size as well as the lack of a control group and a follow-up period. Suggestions are provided as to how the intervention might be refined in content and delivery.

Cognitive Restructuring offers mathematics teachers a foundation and working philosophy for helping underachieving students. The philosophy centers on helping students become aware of and break out of a failure syndrome. Inability is not considered the reason for underachieving. This philosophy, shared by the developmental mathematics teachers at a four-year university in North Carolina, has yielded 80% success over the last 25 years. The intent of this paper is to discuss the failure syndrome, to define cognitive restructuring, to demonstrate its use in mathematics instruction, and to give dialogue and case studies taken from work with students. Using cognitive restructuring allows mathematics educators to focus on the evolving selfdevelopment of students as a co-objective with teaching mathematics.

Linking perception to decision point complexity for adaptive indoor wayfinding support

Anxiety and depression occur at higher rates among adults with type 2 diabetes (T2D) than in national samples. In addition, those with T2D may experience diabetes-related distress. Emotional distress is associated with poorer glycemic control, less engagement in diabetes self-management, and more diabetes complications. National guidelines recommend routine screening and addressing of anxiety and depression in diabetes treatment. However, evidence-based, integrative interventions targeting the affective components of diabetes are lacking. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-based, cognitive–behavioral intervention for anxiety, depression, and related emotional disorders that may fulfill this need in diabetes care. This chapter examines the potential application of the UP to address affective components of diabetes among adults with T2D, including emotional and behavioral challenges specific to diabetes. A case study is described to provide examples to guide the use of the UP among adults with T2D. Findings from the application of the UP in adults with T2D are expected to provide preliminary evidence for the UP as a viable treatment option for addressing emotional distress in diabetes care, which has the potential to positively impact health outcomes in the diabetes population.

In this research, extraction is carried out to change the text on an artifact to be processed through Text Mining to process and analyze the text whose results are validated, using the coefficient equation formula. There is a discrepancy between the flow in the Activity Diagram and the steps performed in the Use Case Description. Based on these problems, this study aims to extract an artifact to find similarities between the Activity Diagram and the actions taken in the Use Case Description and perform text analysis using the Text Mining method to obtain similarities, then validation and reliability are carried out. The extraction process is broken down into several documents according to the artifacts used, for Use Case Description, namely: UC01, UC02, UC03, UC04, and UC05. As for the Activity Diagram, namely: AD1, AD2, AD3, AD4, and AD5. The results obtained from this study are the highest similarity between activity diagrams and use case descriptions in sentences UC04 and AD4 with a total similarity of 0.51394086. The highest similarity between words lies in the words “request” and “application” with a complete similarity of 0.9231. Kappa's score with the Gwet's AC1 formula using Python programming is “Less than the Opportunity Agreement” with a number of −008583, while the questionnaire filled out by the Expert is “Almost perfect” with a score of 0.92246.

Enhancing treatment for school-age children who stutter: I. Reducing negative reactions through desensitization and cognitive restructuring

Olfactory neuroblastoma (ONB) is a rare malignant tumor arising from the olfactory neuroepithelium. The standard of care for ONB is surgical resection; however, detailed treatment protocols vary by institution. Our treatment protocol consists of endoscopic skull base surgery (ESBS) for endoscopically resectable cases and induction chemotherapy followed by craniotomy combined with ESBS for locally advanced cases, with postoperative radiotherapy performed for all cases. Chemoradiotherapy (CRT) is performed in unresectable cases. In this study, we evaluate our treatment protocol and outcomes for ONB. A retrospective review of patients with ONB was conducted. Outcomes included survival outcomes and perioperative data. Fifteen patients (53.6%) underwent ESBS, 12 (42.9%) underwent craniotomy combined with ESBS, and 1 (3.6%) received CRT. The 5- and 10-year overall survival rates for all patients were 92.9% and 82.5%, respectively, with a median follow-up period of 81 months. The 5- and 10-year disease-free survival rates were 77.3% and 70.3%, respectively, and the 5- and 10-year local control rates were 88.2% and 80.2%, respectively. Patients undergoing ESBS demonstrated a significantly shorter operating time, period from operation to ambulation, hospitalization period, and less blood loss than those undergoing craniotomy combined with ESBS. Our treatment protocol was found to afford favorable outcomes. Patients who underwent endoscopic resection showed lower complication rates and better perioperative data than those who underwent craniotomy combined with ESBS. With appropriate case selection, ESBS is considered a useful approach for ONB.

The present article reviews the current status of cognitive-behavioral therapy (CBT) interventions for anxiety and depression in Japanese youth. First, a literature review of youth CBT programs for anxiety and depression is provided. Through this process, we identify which program/protocol has been most researched within Japan. Second, through a systematic interview to the authors, the development process of four predominant programs is outlined. The programs included were a family CBT program for anxiety disorders (the Japanese Anxiety Children/Adolescents Cognitive Behavior Therapy program), two school-based prevention programs for anxiety and depression (Journey of the Brave and Phoenix Time), and a transdiagnostic protocol for anxiety and depression (Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents). Third, cultural adaptation and modification of the programs are discussed from the scope of user-centered design principles as described by Lyon and Koerner (Sci Pract 23:180-200, 2016). As a result, changes in program content and material, as represented by the use of culture-friendly program names, acronyms, illustrations, and characters were endorsed in all of the programs. Structured but flexible session formats helped increase learnability and efficiency while keeping the cognitive load of providers and consumers low. A careful selection of providers, as well as quality training and consultation are important factors to maximize competency and ensure appropriate implementation. Application of existing time frames and staff who work in each setting were effective ways to increase scalability. Overall, it was shown that many of the modifications adopted overlap among successful programs; these represent the most basic and essential requirements for a program to be applicable to a wide range of contexts. Implications and further directions are explored.

Indiana University-Purdue University Indianapolis (IUPUI)%%%%Little research has explored the degree to which specific intervention components predict improved health outcomes for cancer patients and their family caregivers. The present study examined relations of intervention components (i.e., coping skills) to symptoms in a telephone symptom management (TSM) intervention delivered concurrently to symptomatic lung cancer patients and their family caregivers. Guided by Social Cognitive Theory (SCT) and cognitive behavioral therapy (CBT) frameworks, patient-caregiver dyads were taught coping skills including: a mindfulness exercise (i.e., noticing sounds and thoughts), pursed lips breathing, guided imagery, cognitive restructuring, and assertive communication. Symptom measures were administered at baseline and 2 and 6 weeks post-intervention. The measures assessed patient and caregiver depressive and anxiety symptoms as well as patient pain severity, distress related to breathlessness, and fatigue interference. Data were examined from patient-caregiver dyads enrolled in TSM (N = 51 dyads). Patients and caregivers were predominantly female (55% and 73%, respectively) and Caucasian (87%). The average patient was 63 years of age (SD = 8) and the average caregiver was 56 years of age (SD = 14). Seven autoregressive panel models tested relations of coping skills to symptoms. All models had at least adequate fit to the data (χ2 ps > 0.05, RMSEA values < 0.06). For patients, more assertive communication practice during the intervention was related to less pain severity, fatigue interference, and depressive and anxiety symptoms at 6 weeks post-intervention. Additionally, more guided imagery practice during the intervention was related to less fatigue interference and anxiety at 6 weeks post-intervention. In contrast, more cognitive restructuring practice during the intervention was related to more distress related to breathlessness and depressive and anxiety symptoms at 6 weeks post-intervention. Similarly, more practice of a mindfulness exercise during the intervention was related to more fatigue interference and anxiety at 6 weeks post-intervention. For caregivers, more guided imagery practice was related to more anxiety at 2 weeks post-intervention. All other pathways from coping skills to symptoms at 2 and 6 weeks post-intervention were non-significant for both patients and caregivers. Findings suggest intervention effectiveness may have been reduced by competing effects of certain coping skills. For lung cancer patients, future studies should consider focusing on assertive communication and guided imagery, as these two coping skills were most consistently associated with reduced symptoms. However, more studies are needed to better understand these findings and particular caution should be used when applying CBT-based interventions that have not been validated in lung cancer populations.

LATA K. MCGINN & WILLIAM C. SANDERSON: Treatment of Obsessive-Compulsive Disorder. Northvale, NJ, Jason Aronson Inc. 1999, 296 pp., $40.00, ISBN 0-76-570-2118. Drs. Lata McGinn and William Sanderson have responded to the demands of the health care environment by producing an evidence-based cognitive-behavioral treatment (CBT) protocol for the Treatment of Obsessive-Compulsive Disorder Increasingly, clinicians are being required by managed care companies and other agencies to employ treatments that have empirical support. Unfortunately, few clinicians have formal training in these evidence-based treatments since limited numbers of doctoral programs in clinical psychology, psychiatry residency training programs, and psychology and social work internships employ faculty with expertise in these evidence-based treatment approaches. The age-old problem has been transporting these treatments developed in university laboratories to the real world. McGinn and Sanderson achieve this goal by presenting a detailed, session-by-session guide that helps clinicians carefully assess and systematically treat obsessive-compulsive disorder (OCD). These authors have developed a comprehensive treatment for OCD that creatively combines psychoeducation and cognitive restructuring, with traditional exposure and response prevention techniques. The techniques described in this book draw primarily from the previous work of Aaron Beck, Edna Foa, Gail Steketee, and Paul Salkovskis. McGinn and Sanderson describe a patient diagnosed with OCD and weave this clinical material throughout the book to highlight the specific techniques presented. The first chapter of the book offers a succinct review of a cognitive-behavioral model of OCD. The authors describe the integration of the recent advances in employing cognitive restructuring with the traditional behavioral strategies. Each of the remaining eight chapters in the book is considered a session. This structure helps clinicians organize their treatment around several content areas and stages. It is understood by the reader that this treatment is not actually completed in 8 sessions but rather each is typically extended over several visits. Each session has its goals outlined at the beginning of each chapter which, when used later as a reference, helps the reader quickly review the highlights. Session I involves the assessment of OCD which contains two primary components. First, the authors review how to establish the diagnosis and which common comorbid conditions to consider. Second, is a review of general elements of any initial assessment as well as key elements in the assessment of OCD. For example, onset and course of the disorder, prior treatments, degree of insight, are some of the general domains of any assessment, whereas anxiety triggers (internal and external), avoidance behaviors, and ritualized thoughts and behaviors, are specific assessment areas relevant to OCD. …

A cognitive-behavioral treatment program for panic disorder was delivered by staff members of a psychiatric center that traditionally utilizes pharmacological methods. Psychiatrists, a nurse practitioner, and psychologists not previously exposed to behavioral techniques were trained by a behavioral psychologist to utilize a treatment program consisting of breathing control, cognitive restructuring, and exposure to panic-eliciting somatic cues. Of the 24 patients treated as part of this training in panic control therapy, 14 were panic-free after treatment and three additional patients showed moderate improvement and decreased frequency of panic. A case example is presented to demonstrate the application of behavioral techniques to individual patients. Discussion is focused on issues surrounding training in behavioral methods and problems in exporting behavioral technology to centers that emphasize psychopharmacological approaches to treatment.

Narrative therapy techniques have been used extensively in family therapy, individual therapy, and social work. Surprisingly, these techniques have seen limited application to therapeutic and support groups and almost no application to education groups. This paper reports on the use of narrative therapy with an education group, specifically a parent-education group. The central question addressed was: How do results compare with those of traditional parent-education groups? Case examples were reviewed to see if using narrative therapy was beneficial to parents. Written feedback was used to compare groups which did not use narrative therapy to groups which used narrative therapy. The review indicated that the narrative groups reported learning more specific ‘helpful’ skills (especially the skill of ‘listening’) compared to the non-narrative groups.