搜索结果：The Psychiatric clinics of North America

Anxiety disorders can emerge across the lifespan, causing significant distress and impairment. Although evidence-based treatments like cognitive behavioral therapy exist for anxiety disorders, several challenges exist when implementing these treatments in clinical practice that can impede treatment accessibility and/or effectiveness. Fortunately, several technological advancements have resulted in considerable innovative solutions. Here, we examine the evidence for augmenting evidence-based treatments for anxiety disorders using: (1) telehealth/telemedicine; (2) digital mental health interventions and mobile health applications; and (3) virtual reality, extended reality, and/or augmented reality. Despite the considerable promise of technological augmentation of evidence-based treatment, further research and technological advancements are needed.

This review summarizes the scientific literature and clinical practice recommendations for psychotherapies for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED). Cognitive-behavioral therapy (CBT), Maudsley anorexia nervosa treatment for adults, and specialist supportive clinical management are comparably efficacious and recommended first for adults with AN. Family-based treatment is superior to individual psychotherapies and should be the first-line treatment for children/adolescents with AN/BN. CBT is superior to other psychotherapies and is the recommended first-line treatment for adults with BN/BED. For children/adolescents with BED, CBT is likely efficacious based on growing evidence and is recommended by several practice guidelines.

Autism affects 2% to 3% of youth, approximately half of whom experience a co-occurring anxiety disorder. Left untreated, anxiety symptoms show a worsening trajectory into adulthood and increase the functional impact of the core autism symptoms. Innovative treatment approaches such as Internet-CBT adapted for autistic youth demonstrate preliminary effectiveness in symptom reduction while overcoming barriers and increasing accessibility. Insights and considerations regarding the development of the Learning to Understand and Navigate Anxiety for Adolescents (LUNA-Adolescent) program are presented as a promising approach to treatment for autistic adolescents and their families.

We provide critical considerations regarding the acceptance and commitment therapy (ACT) science. We discuss the reconsideration and potential dismissal of latent disease diagnoses in ACT science. We echo sentiments against employing standardized protocols. We identify concerns regarding the evidence of ACT process research. We also discuss measurement problems within the ACT literature and advocate for new and improved ACT measures. We conclude that there is considerable evidence for ACT, but that the underlying research has important growth areas. We also conclude that it is possible for ACT to demonstrate incremental and discriminant effects that are meaningful in real-world scenarios.

Avoidant/restrictive food intake disorder (ARFID) occurs in patients of all ages, with certain populations at increased risk. When diagnosing ARFID, it is important to assess a range of ARFID symptoms that result in diminished dietary variety and/or intake (eg, food selectivity, fears of eating-related physical sensations, low appetite) and associated consequences (eg, psychosocial impairment, malnutrition) as well as symptoms of other disorders that may better account for ARFID symptoms. Although there are currently no "gold-standard" ARFID treatments, existing treatments to date involve regularization of eating, exposure to physical sensations and/or novel/feared foods, and caregiver/familial involvement when appropriate.

Although research suggests that sleep problems are common among people with eating disorders, many eating disorder clinicians are less familiar with diagnosing and treating these conditions. The literature on sleep and eating disorders is relatively new, and there are few controlled trials testing if sleep disorder interventions work in populations with eating disorders. Furthermore, it is unknown how sleep disorder interventions can be adapted for clients with eating disorders. In this article, we provide an overview of sleep disorders that clinicians may encounter and an overview of evidence-based treatments for sleep disorders, with a focus on psychological and behavioral interventions.

Digital mental health tools-including telehealth, mobile applications, wearable devices, machine learning, and artificial intelligence-are changing the way patients and providers manage mental health care. This review summarizes the current research findings of digital interventions on patient access to care, the factors impacting personalized care, and overall patient engagement. Gaps of knowledge and future considerations are discussed, including careful observation of existing barriers to care. Clinical recommendations are discussed for clinicians who are considering implementing digital mental health tools into practice.

Outcome research on the efficacy of acceptance and commitment therapy (ACT) has established it as an evidence-based cognitive-behavioral approach in treatment of depression. Mediational and related research, however, has provided mixed support for the sensitivity and specificity of ACT's purported processes of therapeutic change according to model of psychological flexibility on which it is based. Whether an emerging idionomic approach to process-based interventions, such as ACT for depression that is more tailored to the lived experiences of individual clients enhances its efficacy, while also providing a more coherent understanding of its mechanisms of action, is currently an unanswered empirical question.

Limited available data indicate that glucagon-like peptide-1 (GLP-1) medications may significantly reduce weight and binge-eating symptoms among patients with binge-eating disorder. However, experts express concern about the potential for GLP-1 medications to cause unintended harm or be misused among some individuals with eating disorders (EDs). The present review describes the state of the science surrounding use of GLP-1 medications in EDs, identifies key knowledge gaps, offers a roadmap for future studies on this topic, and provides clinical guidance to support the careful assessment and treatment of patients with EDs who may be considering the use of a GLP-1 medication.

Wearable technology holds promise for improving mental health care by enabling continuous, objective monitoring of physiologic parameters. Building on decades of psychophysiology research, wearables can provide an additional source of measurement for implementing measurement-based care in learning mental health systems. This review describes wearable use across inpatient and outpatient settings, identifying gaps and opportunities in clinical care and research. While widely studied in outpatient, wearables hold immense potential for in inpatient settings. Advancements needed include user-centered design, better understanding of complex populations and settings, and use of modern analytical methods to generate clinically actionable mental health insights for all.

The Parents under Pressure program was developed for families with parental substance misuse, mental health, intergenerational trauma, and significant financial and social disadvantage. In this article, we provide an overview of the program, and a description of the training and implementation support process we adopted for the field. Drawing from implementation science, we describe the implementation strategies and outcomes that inform this work. We conclude with a description of training events for practitioners in (i) Central Australia working with Aboriginal families and (ii) with mothers in residential mother and child facility in the Republic of Ireland.

Acceptance and commitment therapy (ACT) emphasizes psychological flexibility as a key set of processes that improve mental and behavioral health outcomes. Our field needs to shift from syndrome-based interventions to a process-based approach, focusing on biopsychosocial change processes relevant to each particular person, couple, or family. ACT extends its 6 core processes to encompass all well-validated change mechanisms including those at the social or biophysiological levels. It is time to challenge the hegemony of traditional psychiatric classification in favor of a personalized precision psychiatry rooted in functional analysis, idionomic statistics, and multidimensional, multilevel evolutionary science.

Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that remains chronic unless intervened with evidence-based intervention. Cognitive behavioral therapy (CBT) with exposure and response prevention is the gold-standard psychological intervention for OCD, but many individuals do not receive this intervention due to barriers to accessing treatment. Mental health technology tools such as telehealth, computerized programs, internet-delivered CBT, and mobile applications have been adopted to expand the accessibility of CBT. An up-to-date summary of the evidence base of technology-mediated formats of CBT for OCD treatment is provided. Clinical benefits offered by such approaches, current limitations, and future research directions are discussed.

Acceptance and commitment therapy (ACT)-enhanced behavior therapy (A-EBT) is the most empirically supported treatment of trichotillomania. Support for A-EBT for excoriation disorder is budding. In this article, we review the A-EBT model, including support for targeting psychological inflexibility, as well as the use of traditional behavioral procedures to reduce non-focused behaviors. To date there are 17 studies investigating A-EBT for trichotillomania and skin picking across ages and treatment delivery methods (individual, group, telehealth, and asynchronous web-based delivery). The work has occurred by multiple research teams. Data on processes of change are reviewed. Future directions and limitations are discussed.

Acceptance and commitment therapy (ACT) for posttraumatic stress disorder (PTSD) is focused on reducing experiential avoidance and increasing psychological flexibility in the face of traumatic experiences. This approach involves using acceptance and mindfulness to help people who have experienced trauma to increase their commitment to values-based living. There is growing evidence for the potential efficacy of ACT for PTSD, with several pilot clinical trials showing reductions in PTSD symptoms and increases in quality of life, as well as improvements in ACT-associated processes. Future research should focus on larger clinical trials that evaluate the efficacy of ACT for people with PTSD.

Mental health is a burden on society globally, particularly for young people, leading to unprecedented demands for mental health services. Organized sport programs provide a unique opportunity to reach young people "where they are" with mental health and well-being programs. This article reviews the relevant literature on interventions that target the promotion of mental health and well-being among youth in organized sports programs, research that incorporates strengths-based approaches in sports, and studies that are more comprehensive, which include screening and intervention that target physical well-being, personal attributes and character strengths, and mental health symptom management within youth sports programs.

Acceptance and commitment therapy (ACT) is a third-wave cognitive-behavioral therapy, which focuses on acceptance, mindfulness, and values-based actions to support living a rich and meaningful life. ACT has been successfully applied to support recovery from psychosis across multiple contexts. This article provides an overview of ACT for psychosis, followed by an outline of how to effectively adapt ACT to support individuals experiencing psychosis, including various practical clinical tips for practitioners. Finally, an overview of the research literature supporting the efficacy of ACT for psychosis is presented, and consideration of next steps in research and clinical innovations.

Acceptance and commitment therapy (ACT) is a set of evidence-based principles designed to reduce human suffering and promote well-being via instantiating psychological flexibility. Situated within the broad family of cognitive-behavioral therapies, ACT conceptualizes psychopathology in terms of 6 inter-related psychological inflexibility processes. ACT is supported by a substantial body of research and recognized as an evidence-based intervention by numerous government and health care organizations. Due to its process-based nature, ACT has been adapted across a range of diverse areas. In this article, we provide an overview of ACT across conceptual, clinical, and research domains, and introduce this special issue.

Long-standing anorexia nervosa is presently conceptualized as a persistent symptomatic state associated with global functional and interpersonal impairments. Understanding of effective treatments is incomplete; psychological therapy is at the core, but also important are psychosocial and recovery support that includes significant others, tailored treatment targets such as improved quality of life, a collaborative and flexible approach to higher levels of care, and pharmacologic agents that augment therapy and address concurrent mental health problems. Research is needed to develop agreed-upon criteria (including specifiers for duration, severity, and treatment trajectory) and randomized controlled trials that can inform person-centered care.