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Children with Noonan syndrome-like RASopathies are at increased risk for developing feeding problems due to comorbid organic impairments at an early age, such as gastrointestinal problems or other organicity. Their feeding problems can ultimately often be classified as avoidant/restrictive food intake disorder, for which behavioral therapy is the first-choice treatment. The research question in this study is whether this treatment leads to similar results as in children without these RASopathies. We retrospectively investigated patients with a genetically confirmed Noonan syndrome-like RASopathy who were treated for their disordered eating in a tertiary center for avoidant/restrictive food intake disorder on characteristics and treatment outcomes and compared them to a matched case–control group of children with avoidant/restrictive food intake disorder without Noonan syndrome-like RASopathy in a ratio of 1:2. Both groups improved substantially on food intake measures and feeding skills/dysfunction between the start of therapy and immediately after the therapy and showed an increase in SDS weight/height and a decrease in tube dependency. We found no significant treatment outcomes between children with and without Noonan Syndrome-like RASopathy, nor for comorbid features. Conclusion: Patients with Noonan syndrome-like RASopathy and avoidant/restrictive food intake disorder benefit equally well from cognitive behavioral therapy, as patients without a Noonan syndrome-like RASopathy. What is Known: • More than 50% of the infants with Noonan syndrome-like RASopathy have serious feeding/eating problems. • Most of them temporarily need tube feeding. What is New: • Ultimately, these feeding/eating problems may develop into an avoidant/restrictive food intake disorder. • Behavioral therapy (SLIK program) can effectively manage complex feeding/eating problems such as avoidant/restrictive food intake disorder in patients with a Noonan syndrome-like RASopathy. • There were no significant differences found in the history of comorbid features, feeding skill (dys)function, avoidant/restrictive food intake disorder characteristics, or treatment outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Sleep disturbance is often observed in the context of chronic pain. We hypothesize that, by providing an immersive Virtual Reality (VR) experience with a serious game to chronic pain patients an hour before bedtime, attention can be diverted from the pain condition, consequently leading to improved sleep quality. The aim is to evaluate the efficacy of VR compared to usual care in reducing the number of awakenings during the night and increasing sleep efficiency in patients suffering from painful diabetic polyneuropathy (PDPN). Methods: Eight patients with PDPN were randomized to either two weeks of VR or two weeks of usual care, followed by a cross-over. The primary outcome measurements were sleep efficiency and number of awakenings during the night. As secondary outcomes, self-reported sleep quality, insomnia, pain catastrophizing, anxiety, depression, pain intensity, side effects and impression of change were evaluated. Results: Data of seven patients were analysed. Actigraphy data, self-reported sleep quality, insomnia, pain catastrophizing, anxiety, depression and pain intensity scores did not differ between usual care and VR. As for impression of change, more patients improved after VR compared to usual care (V = 21, p = 0.03). Conclusions: A 2-week period of pain neuroscience education through VR did not result in increased sleep efficiency or fewer awakenings compared to usual care in patients with PDPN. These pilot results indicate that patients subjectively experience an improvement, yet this is not substantiated by either self-reported or objective measurements. [ABSTRACT FROM AUTHOR]

Background: Behavioral therapy has proved effective as rumination therapy. Our objective was to treat rumination patients using multidisciplinary behavioral therapy aimed at reducing ≥2 of the rumination score. Methods: All patients fulfilled Rome IV criteria for rumination and were referred to speech therapy for psychoeducation, diaphragmatic breathing exercises and guided eating, physiotherapy for exercises to relax the thoracic and abdominal muscles, and consultation with the psychologist and the dietitian. Symptoms, depression, anxiety, health‐related quality of life (HRQoL), and functional capacity were evaluated by questionnaires (Rome IV, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), 15D, and World Health Organization Disability Assessment Schedule (WHODAS) 2.0) at baseline and at 6‐month control. Esophageal manometry was performed at 6‐month control. Key Results: The study enrolled 11 patients (19–64 years, 10 female). Rumination score: 6.5 (5–8) at baseline, 4.0 (3–5) at the 6‐month control, p = 0.005. BDI/8 (6–13), BAI/15 (8–29) at baseline; BDI/7 (4–8), BAI/15 (7–27) at the 6‐month control, NS. 15D score: 0.800 at baseline, 0.845 at the 6‐month control, NS. WHODAS 2.0 score: 15 (7–33) at baseline, 11 (7–26) at the 6‐month control, NS. Rumination could be evoked in manometry in six of nine (67%) patients at 6‐month control. Conclusions and Inferences: Behavioral multidisciplinary therapy significantly reduces the self‐assessed frequency of rumination. These patients have more depression, anxiety and a lower HRQoL compared to the normal population. [ABSTRACT FROM AUTHOR]

The epidemic of opioid overdose brought a major health crisis to the front line of public health in the United States. Early efforts have focused on the prevention of production, distribution, and consumption of the drugs. However, there is little information about youth populations at risk for opioid overdose and their response to targeted treatment plans. The San Bernardino County Youth Opioid Response (SBCYOR) coalition in collaboration with the San Bernadino County (SBC) Probation Department organized a safety net system for at-risk youth by improving communication among county resources. This program mainly focused on individuals aged 12 to 24 years in the county's detention centers along with educational and prevention projects such as naloxone programs for first responders in the region. To describe the impact of the SBCYOR program on at-risk youth, we compare the frequencies of patients referred and treated with medications for opioid use disorder (MOUD) at the SBC Probation Department, which was responsible for individuals from age 12 to less than 18 years, with those from the West Valley Detention Center (WVDC), which was responsible for adults (18 to 24 years of age), from September 2020 through June 2022. Similar proportions of youths were referred for treatment of opioid use disorder (OUD) at the respective sites (3.7% SBC Probation Department, 3.6% WVDC). Of these, however, 78.0% were treated with MOUD at SBC Probation Department compared with only 7.1% at WVDC. SBCYOR coalition partners were able to transform their services into a comprehensive medical and behavioral health program for the incarcerated youth population at risk for OUD. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral therapies are recommended as a first-line intervention for Tourette syndrome and persistent motor or phonic tic disorder. Areas covered: In this review, the authors summarize randomized controlled trials on the comprehensive behavioral intervention for tics (CBIT), habit reversal therapy (HRT), and exposure and response prevention (ERP). Studies of face-to-face treatment, treatment by video conferencing, group treatment, and internet delivered treatment were assessed, as well as evidence of treatment predictors, modifiers, and mediators. Expert opinion: There is high-quality evidence for face-to-face one-on-one treatment with CBIT, and data suggesting that one-on-one treatment by videoconference provides similar benefit. Limited data on group treatment with CBIT/HRT suggests inferiority to individual treatment, while internet-based CBIT programs appear more beneficial than wait list or psychoeducation. There is one face-to-face one-on-one treatment comparison of ERP to HRT, suggesting equal benefit. Internet-based ERP with minimal therapist support appears effective, although effect sizes are small. One study using behavioral therapy with ERP or HRT found similar benefit to medical treatment with antipsychotics. Data on predictors, modifiers, and mediators of treatment efficacy are emerging. In summary, behavioral therapies are an important treatment modality for tic disorders. Furthermore, important efforts to improve treatment accessibility are underway. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Few studies have examined the effectiveness and duration of mindfulness‐based therapies for tics in Tourette's syndrome. This study combined habit reversal therapy (HRT) with acceptance and commitment therapy (ACT).To evaluate the efficacy and response duration of HRT + ACT in reducing tic severity in adults with Tourette's Syndrome.Tic severity was assessed at baseline, post‐intervention, and at 6‐ and 12‐month follow‐ups using the Yale Global Tic Severity Scale (YGTSS) and video assessments. The intervention included eight weekly 1‐h sessions.Mixed‐effects regression showed significant reductions in tic severity post‐treatment (b = −10.36, P = 0.002), maintained at 6 months (b = −8.19, P = 0.012) and 12 months (b = −8.82, P = 0.009). Video assessments confirmed these findings.The HRT + ACT protocol effectively reduced tic severity, with benefits lasting 12 months. These results support further trials to compare HRT + ACT with HRT alone. [ABSTRACT FROM AUTHOR]

Simple Summary: Insomnia is prevalent in patients with cancer, with rates ranging from 30% to 60%. Addressing insomnia remains important in this population, as it can improve patient quality of life and reduce suffering. However, inconsistent methods of defining insomnia and evaluating potential interventions renders treatment difficult. Furthermore, many factors influence insomnia's presentation, requiring a specialized and individualized approach to its management for each patient. This review sought to use thorough and strict criteria to assess current psychological intervention for insomnia. To this end, we describe current psychological treatment options for insomnia, highlight gaps in the existing research, and offer suggestions for treating insomnia in patients with cancer. Background/Objectives: Insomnia is a frequent and distressing symptom with limited treatment in patients with cancer. Among the available treatments for insomnia, psychological interventions are some of the most assessed. While studies and reviews show promise of interventions improving insomnia in patients with cancer, inconsistent approaches to operationalizing and measuring insomnia combined with the heterogeneity of available treatments render comparisons and synthetization difficult. This review sought to rigorously synthesize psychological interventions for patients with cancer and insomnia by describing current therapies, identifying gaps in the literature, and offering supportive interventions. Methods: A comprehensive search of five databases—Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, EBSCO CINAHL Plus with Full Text, and Cochrane Library—was conducted through 1 August 2024. The review included randomized trials and non-inferiority trials evaluating psychological interventions for patients with various types of cancers. Twenty-one studies were included, and study quality ranged from good to excellent, according to the PEDro scale. Results: The current evidence supports the use of cognitive behavioral therapy (CBT) to treat insomnia over and above psychoeducation alone, mindfulness-based stress reduction, Brief Behavioral Therapy, the Benson Relaxation Technique, progressive muscle relaxation, mindfulness meditation, mind-body bridging, and home-based psychological nursing. Digital, minimal, and internet-based intervention modalities are effective, though professional-delivered CBT proved most effective. Conclusions: CBT remains the most effective psychological intervention for insomnia in this population. Challenges exist regarding the implementation of CBT, so further research is warranted to identify the best psychological interventions for specific settings and subsets of patients with cancer. [ABSTRACT FROM AUTHOR]

Objective: Overweight and obesity are health issues that are increasing worldwide. Patients with severe mental illness are particularly vulnerable for various reasons, including the intake of weight gain-associated drugs. In this pilot study, we targeted eating behavior as a predictor for medication-induced weight gain and developed a module of a prevention program ("Eating More Consciously") to be evaluated by psychiatric inpatients. Methods: Thirty-three patients participated in a behaviorally oriented group therapy program with 2 modules of 120 minutes each and weekly follow-up measurements over 4 weeks. Measures included weight, laboratory parameters, the German versions of the Three-Factor Eating Questionnaire (Fragebogen Essverhalten; FEV) and the Food Craving Inventory (FCI) as well as a questionnaire on the implementation of the strategies in everyday life. Results: Thirty-three participants completed both modules and felt that they had benefited from the module "Eating More Consciously." Fragebogen Essverhalten domain "cognitive restraint" scores increased significantly throughout the study (P = .039), and the FCI sum score decreased significantly (P = .003). Conclusion: We propose that the "Eating More Consciously" module is a promising approach to behavioral intervention in weight management in patients with severe mental illness. Prospective randomized controlled studies with a larger sample and a longer follow-up are needed. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Laryngopharyngeal symptoms such as cough, throat clearing, voice change, paradoxic vocal fold movement, or laryngospasm are hyper-responsive behaviors resulting from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy (LRT) guided by a speech-language pathologist (SLP) provides mechanical desensitization and cognitive recalibration to suppress hyper-responsive laryngeal patterns. The aim of this study was to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms undergoing evaluation of gastroesophageal reflux disease (GERD). METHODS: Adults with chronic laryngopharyngeal symptoms referred for evaluation ofGERD to a single center were prospectively followed. Inclusion criteria included ≥2 SLP-directed LRT sessions. Data from endoscopy, ambulatory reflux monitoring, and patient-reported outcomes were collected when available. The primary outcome was symptom response. RESULTS: Sixty-five participants completed LRT: mean age 55.4 years (SD 17.2), 46 (71%) female, mean body mass index 25.6 kg/m² (6.8), and mean of 3.7 (1.9) LRT sessions. Overall, 55 participants (85%) met criteria for symptom response. Specifically, symptom response was similar between those with isolated laryngopharyngeal symptoms (13/15, 87%) and concomitant laryngopharyngeal/esophageal symptoms (42/50, 84%). Among participants who underwent reflux monitoring, symptom response was similar between those with proven, inconclusive for, and no GERD (18/21 [86%], 8/9 [89%], 10/13 [77%]). DISCUSSION: Eighty-five percent of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation who underwent LRT-experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD and patients with or without concomitant esophageal reflux symptoms. SLP-directed LRT is an effective approach to incorporate into multidisciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease. [ABSTRACT FROM AUTHOR]

Introduction: Effective adjunctive therapeutic treatments for patients with opioid use disorder (OUD) on medication for OUD (MOUD) in primary care settings are needed to address high rates of mental illness and stress. Behavioral activation (BA) is a brief, evidence-based therapy that has potential to improve quality of life in people with OUD. The purpose of this pilot study was to evaluate the feasibility and acceptability of values-based BA (VBA) as an adjunct treatment for patients receiving MOUD in primary care. Methods: Participants were recruited for a single-arm pilot trial of BA in a primary care setting. VBA was adapted for people with OUD and included 4-6 sessions delivered over 12 weeks with a behavioral health consultant, either inperson or virtually. Feasibility was assessed as recruitment percent and pace and retention percent. Acceptability was assessed with the Client Satisfaction Questionnaire-8 (CSQ-8). Participants completed self-report measures of well-being, depression, substance use, and psychological processes of change at baseline, mid-intervention (6-weeks), and post-intervention (12-weeks). Participants engaged in a brief interview about their experiences at the end of the intervention. Results: Twenty-one participants enrolled in the intervention (66.7% female, M age = 44.0 years, 19% of those invited). Participants completed an average of 5.1 BA sessions (SD = 1.6) and most (90%) were retained through 12 weeks. Participants rated the intervention as highly acceptable on the CSQ-8 (M = 30.4/32.0, SD = 1.6). In qualitative interviews, participants reported that working with the therapist and setting values-based goals were helpful, while also recommending more tailoring to patients' needs and offering the program early in MOUD treatment. Preliminary efficacy data suggest the program was associated with small to moderate improvements in life satisfaction (Cohen's d = 0.25) and positive affect (d = 0.62), whereas there were no changes in depression (d = 0.09) or negative affect (d = -0.07) in a group with low depression at baseline. Discussion: VBA adapted for patients on MOUD in primary care was feasible to deliver and acceptable to participants. Minor modifications to the target population and treatment manual could increase the program's impact. Future studies will test the efficacy of the intervention in improving quality of life and OUD treatment outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. Methods: We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. Results: Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, p < 0.001). The result was more favorable after periurethral bulking than the midurethral sling (p < 0.001). Conclusions: This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence. [ABSTRACT FROM AUTHOR]

Introduction Smoking cessation remains a global challenge due to the complex and individualized nature of addiction. Understanding the interplay of psychological, social, and biological factors is crucial for developing effective, personalized cessation strategies. Aim: This study investigated the factors influencing the success of smoking cessation efforts among patients visiting thoracic surgery outpatient clinics. Material and methods: Between October 2022 and October 2023, 355 smokers sought assistance at thoracic surgery outpatient clinics, with 231 patients included in the study after exclusions. Data on demographics, comorbidities, cessation attempts, and Fagerström addiction scores were analyzed. Patients received nicotine replacement therapy (NRT), medical therapy (bupropion), and behavioral therapy. Follow-ups were conducted at 1, 3, and 6 months to assess cessation outcomes. Results: The cohort included 137 males and 94 females, with an average age of 45 years. Overall, 81 patients (35.06%) quit smoking in the first month, and 15 (6.49%) additional patients quit by the third month. Relapse occurred in 36 (15.58%) patients, and 99 (42.86%) patients failed to quit. Success rates were similar between genders and unrelated to age, comorbidities, previous attempts, or smoking intensity. The success rate was slightly higher among those who received pharmacotherapy, but the difference was not statistically significant. However, full adherence to behavioral suggestions was significantly associated with increased cessation success (p < 0.001). Conclusions: Behavioral therapy plays a critical role in smoking cessation success. Tailored behavioral strategies significantly enhance outcomes, highlighting the need for personalized approaches in cessation programs. Patients in thoracic surgery outpatient clinics benefit from comprehensive support, emphasizing behavioral adaptation to improve cessation rates. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco smoking represents a major cause for preventable death and morbidity. Results from non‐randomized studies suggest that smoking cessation therapy in a residential setting might be a new viable way to facilitate smoking abstinence. We aimed to test the effects of residential multicomponent group therapy for smoking cessation compared with outpatient group therapy. Design: Prospective parallel‐group open‐label randomized superiority trial, with assessments at baseline, 6 and 12 months. Setting: Recruitment throughout Germany via media advertisements. Participants: Adult smokers (≥10 cigarettes/day) randomly assigned to residential (n = 157) or outpatient (n = 158) therapy. 51.8% female; mean age 53.2 years; mean years of smoking 34.4. Intervention and Comparator: Residential 9‐day smoking cessation group therapy comprising six daily therapy sessions and supportive interventions for cessation and daily structure embedded in the routines of a somatic rehabilitation center, compared with weekly outpatient smoking cessation group therapy (3–7 weeks) provided in routine care courses close to the participants' places of residence, both including at least 9 h of behavioral therapy. Measurements Co‐primary outcomes were self‐reported continuous 6‐ and 12‐month abstinence (hierarchically ordered). Primary analyses were conducted in the therapy‐uptake population including participants who started therapy with sensitivity analyses in the intention‐to‐treat population of all randomized participants. Findings Intervention uptake rates were 87.3% (n = 137) in the residential and 60.1% (n = 95) in the outpatient group. In the therapy‐uptake population, abstinence rates were 46.7% in the residential versus 26.3% in the outpatient group at 6 months (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.39–4.33, P = 0.0019) and 39.4% versus 24.2% at 12 months (OR = 2.04, 95% CI = 1.14–3.64, P = 0.017). Biochemically validated abstinence rates at 12 months were 33.1% in the residential versus 17.4% in the outpatient group (OR = 2.35, 95% CI = 1.22–4.51, P = 0.011). In the intention‐to‐treat population, self‐reported and biochemically validated abstinence rates at 12 months were 34.4% in the residential versus 14.6% in the outpatient group (OR = 3.08, 95% CI = 1.77–5.34, P < 0.0001) and 28.6% versus 10.3% (OR = 3.48, 95% CI = 1.85–6.52, P = 0.0001), respectively. Conclusions: Residential therapy exclusively for smoking cessation is feasible and effective and could be a beneficial new treatment for smokers. [ABSTRACT FROM AUTHOR]

Introduction: Due to similarities in their pathophysiology and common psychological background, depressive disorders and obesity often occur simultaneously. The treatment of obesity can reduce the symptoms of comorbid depression and, conversely, treating depression can improve weight reduction outcomes. Purpose of this study: This review aimed to analyze the available literature on the subject of various methods of treating obesity and comorbid depression and to demonstrate the mutual correlation between the therapy of depressive disorders and the therapy of obesity. Method: The Pubmed and Cochrane databases were searched for original articles on the subject of simultaneous depression and obesity that had been published between 2014 and 2024, using the key words "depression", "depressive symptoms", "obesity", and "behavioral therapy". Results and conclusions: The successful treatment of depression can help in treating obesity, especially in motivating patients to adjust their lifestyle by changing dietary habits and increasing their physical activity, which contribute to both changes in body mass index scores and reductions in depressive symptoms. Changes in self-perception, reduced daily stress, and dietary changes, as well as increased physical activity, contribute to both weight loss and the reduction of depressive symptoms. Depression and obesity should be treated as one two-dimensional disorder to achieve better long-term treatment results. [ABSTRACT FROM AUTHOR]

Introduction: Urinary incontinence is a prevalent health issue that profoundly impacts the quality of life for patients worldwide. Traditional treatments, including pharmacotherapy and surgical procedures, often fall short, leaving many individuals struggling with bladder control issues that restrict physical and social activities and cause significant psychological distress. Recent advancements in therapeutic methods—encompassing behavioral therapies, cutting-edge medical technologies, innovative pharmacotherapy, and advanced surgical techniques—offer promising alternatives. By exploring the effectiveness and advantages of these novel approaches, we can enhance treatment accessibility and elevate the quality of care for those affected by urinary incontinence, ultimately improving their daily functioning and overall well-being. Abbreviated description of the state of knowledge:Current research on innovative treatments for urinary incontinence indicates significant advancements in enhancing patients' quality of life. These cutting-edge methods encompass behavioral therapies like pelvic floor muscle training, state-of-the-art medical technologies such as nerve stimulation, new pharmacological treatments with high efficacy and minimal side effects, and advanced surgical interventions, including artificial sphincter implants and urinary tract modifications. Conclusions: Urinary incontinence is a prevalent health issue that significantly deteriorates the quality of life, particularly affecting half of women and one-third of men over the age of 80. As our society ages and the number of individuals affected by this condition rises, understanding and advancing treatment methods become increasingly crucial. Ongoing research aims to discover new and improved therapeutic approaches with minimal side effects, offering hope for enhanced patient outcomes and better management of urinary incontinence in the future.

Abstract Background The treatment for atopic dermatitis (AD) has been the focus of clinical research, and behavioral intervention is considered an indispensable treatment method. To our knowledge, no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis. Objectives To evaluate the effects of behavioral interventions on atopic dermatitis. Methods The authors searched PubMed, EMBASE, and Cochrane CENTRAL to retrieve relevant RCTs (up to Feb 2022). The search strategy involved a combination of related keywords. The Cochrane Q and I2 statistics were used to assess heterogeneity. Results Six RCTs involving seven reports with 246 patients were included. The results suggested that behavioral interventions could relieve eczema severity (correlation coefficient [r = −0.39]; p < 0.001) and scratching severity significantly (r = −0.19; p = 0.017), while not affect itching intensity (r = −0.02; p = 0.840). A sensitivity analysis confirmed the robustness of the results. Study limitations An important limitation of this study was the insufficient number of RCTs and the limited sample size. In addition, the study lacked a control group receiving a type of intervention other than the experimental protocol. Another limitation was the short duration of follow-up. Conclusions This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity. Additionally, habit-reversal behavioral therapy may be more effective for treating atopic dermatitis.

Tourette syndrome (TS) is a neurodevelopmental disorder that cause sudden uncontrolled rapid and repeated vocal sounds or movements called tics. Herein, diffusion magnetic resonance imaging (dMRI) connectometry was implemented to evaluate the white matter connectivity differences among TS patients. A total of 63 TS and 77 typically developed (TD) individuals were enrolled in the present study. dMRI connectometry was utilized to identify differences in connectivity patterns of white matter tracts in TS patients based on quantitative anisotropy (QA). QA was compared between TS and TD patients and correlated with severity scores such as Yale Global Tic Severity Scale (YGTSS) and Premonitory Urge for Tics Scale (PUTS). Higher white matter connectivity of corpus callosum and bilateral cingulum as well as lower connectivity of corticothalamic and corticostriatal pathways were evident in TS relative to TD. The baseline YGTSS motor, YGTSS total, and PUTS were negatively correlated with corticostriatal pathway, corticothalamic pathway, and bilateral cingulum integrity, respectively. The changes in tic severity scores were also positively correlated with alterations in the white matter integrity of these brain regions following behavioral therapy. Patients with TS have several abnormalities in their white matter microstructure particularly in the cortico-striato-thalamo-cortical (CSTC) circuit, correlated with the severity of the disease. Besides, the post-behavioral therapy changes in the white matter integrity of these regions are demonstrated as response predictors. [ABSTRACT FROM AUTHOR]

Depression is highly comorbid among individuals with Parkinson's Disease (PD), who often experience unique challenges to accessing and benefitting from empirically supported interventions like Cognitive Behavioral Therapy (CBT). Given the role of reward processing in both depression and PD, this study analyzed a subset (N = 25) of participants who participated in a pilot telemedicine intervention of PD-informed CBT, and also completed a Reward- and Punishment-Learning Task (RPLT) at baseline. At the conclusion of CBT, participants were categorized into treatment responders (n = 14) and non-responders (n = 11). Responders learned more optimally from negative rather than positive feedback on the RPLT, while this pattern was reversed in non-responders. Computational modeling suggested group differences in learning rate to negative feedback may drive the observed differences. Overall, the results suggest that a within-subject bias for punishment-based learning might help to predict response to CBT intervention for depression in those with PD. Plain Language Summary Performance on a Computerized Task may predict which Parkinson's Disease Patients benefit from Cognitive Behavioral Treatment of Clinical Depression Why was the study done? Clinical depression regularly arises in individuals with Parkinson's Disease (PD) due to the neurobiological changes with the onset and progression of the disease as well as the unique psychosocial difficulties associated with living with a chronic condition. Nonetheless, psychiatric disorders among individuals with PD are often underdiagnosed and likewise undertreated for a variety of reasons. The results of our study have implications about how to improve the accuracy and specificity of mental health treatment recommendations in the future to maximize benefits for individuals with PD, who often face additional barriers to accessing quality mental health treatment. What did the researchers do? We explored whether performance on a computerized task called the Reward- and Punishment-Learning Task (RPLT) helped to predict response to Cognitive Behavioral Therapy (CBT) for depression better than other predictors identified in previous studies. Twenty-five individuals with PD and clinical depression that completed a 10-week telehealth CBT program were assessed for: Demographics (Age, gender, etc.); Clinical information (PD duration, mental health diagnoses, levels of anxiety/depression, etc.); Neurocognitive performance (Memory, processing speed, impulse control, etc.); and RPLT performance. What did the researchers find? A total of 14 participants significantly benefitted from CBT treatment while 11 did not significantly benefit from treatment. There were no differences before treatment in the demographics, clinical information, and neurocognitive performance of those participants who ended up benefitting from the treatment versus those who did not. There were, however, differences before treatment in RPLT performance so that those individuals that benefitted from CBT seemed to learn better from negative feedback. What do the findings mean? Our results suggest that the CBT program benefitted those PD patients with clinical depression that seemed to overall learn best from avoiding punishment rather than obtaining reward which was targeted in CBT by focusing on increasing engagement in rewarding activities. The Reward- and Punishment-Learning Task hence may be a useful tool to help predict treatment response and provide more individualized recommendations on how to best maximize the benefits of psychotherapy for individuals with PD that may struggle to connect to mental health care. Caution is recommended about interpretating these results beyond this study as the overall number of participants was small and the data for this study were collected as part of a previous study so there was no opportunity to include additional measurements of interest. [ABSTRACT FROM AUTHOR]

Standard treatments for nightmares focus on waking activities, with consequences for subsequent sleep. An alternative strategy may be to provide people with a novel way to learn to end a nightmare by waking up. People typically think of sleep as a state that they cannot control, but there are exceptions to this rule. For example, the ability to select dream content in a lucid dream might allow one to wake up deliberately, thus countering the typical helplessness of nightmares. However, documented evidence that this strategy can work is lacking. Therefore, we recruited healthy participants to complete a task during their next lucid dream; they were instructed either to attempt to wake up or to clench their fists. In the former case, we offered several options for how to wake up. After sleep, participants responded to a detailed survey about their dream and their subsequent awakening experience. Relative to those who clenched their fists, participants who attempted to wake up from the dream by closing their eyes reported waking up sooner after task completion. Furthermore, higher levels of lucidity and lucid-dream skills while dreaming were correlated with a quicker wake-up time and reduced negative emotions. This research showed that people can succeed in waking up from sleep intentionally while lucid dreaming. Because lucid dreaming is trainable, training for waking up in this way could constitute a viable therapeutic approach to relieve nightmare suffering. [ABSTRACT FROM AUTHOR]

Exposure therapy is a first-line, empirically validated treatment for anxiety, obsessivecompulsive, and trauma-related disorders. Extinction learning is the predominant theoretical framework for exposure therapy, whereby repeated disconfirmation of a feared outcome yields fear reduction over time. Although this framework has strong empirical support and substantial translational utility, extinction learning is unlikely to be the sole process underlying the therapeutic effects of exposure therapy. In our clinic, we commonly treat obsessive-compulsive disorder (OCD) patients successfully with exposure therapy even when some or all of their feared outcomes are not amenable to disconfirmation and, by extension, to extinction learning. Herein, we present a generic clinical vignette illustrating a commonly encountered feared outcome in OCD that cannot be disconfirmed through exposure (damnation resulting from blasphemous thoughts). We describe two specific non-extinction-based strategies we commonly employ in such cases, and we associate these strategies with known change mechanisms that might account for their effectiveness: (1) non-associative habituation to aversive stimuli, and (2) fear-memory elicitation and subsequent reconsolidation. We discuss the limitations inherent in the reverse-translational approach taken and its opportunities for expanding the framework of exposure therapy. [ABSTRACT FROM AUTHOR]

Biofeedback has Grade A evidence for the treatment of migraine, yet few studies have examined the factors associated with patients' decisions to pursue biofeedback treatment recommendations. We sought to examine reasons for adherence or non-adherence to referral to biofeedback therapy as treatment for migraine. Patients with migraine who had been referred for biofeedback by a headache specialist/behavioral neurologist were interviewed in person or via Webex. Patients completed an enrollment questionnaire addressing demographics and questions related to their headache histories. At one month, patients were sent a follow-up questionnaire via REDCap and asked if they had pursued the recommendation for biofeedback therapy, their reasons for their decision, and their impressions about biofeedback for those who pursued it. Nearly two-thirds (65%; 33/51) of patients responded at one month. Of these, fewer than half (45%, 15/33) had contacted biofeedback providers, and only 18% (6/33) completed a biofeedback session. Common themes emerged for patients who did not pursue biofeedback, including feeling that they did not have time, concern for financial obstacles (e.g., treatment cost and/or insurance coverage), and having difficulty scheduling an appointment due to limited provider availability. When asked about their preference between type of biofeedback provider (e.g., a physical therapist or psychologist), qualitative responses were mixed; many patients indicated no preference as long as they took insurance and/or were experienced, while others indicated a specific preference for a physical therapist or psychologist due to familiarity, or prior experiences with that kind of provider. Patients with migraine referred for biofeedback therapy face numerous obstacles to pursuing treatment. [ABSTRACT FROM AUTHOR]

Treatments for anorexia nervosa (AN) remain ineffective for many patients. Processes that can account for differential treatment outcomes remain mostly unknown. We propose that the field test the role of associative learning in current psychological treatments. We hold that this line of research could yield actionable information for understanding non‐response and improving long‐term outcomes. To make this argument, we define associative learning and outline its proposed role in understanding psychiatric disorders and their treatment. We then briefly review data exploring associative learning in AN. We argue that associative learning processes are implicitly implicated in existing treatments; by this rationale, baseline differences in learning may interfere with treatment response. Finally, we outline future research to test our hypotheses. Altogether, future research aimed at better understanding how associative learning may contribute to AN symptom persistence has the potential to inform novel directions in intervention research. Public Significance: There is a pressing need to improve outcomes in treatments for anorexia nervosa (AN). We propose that individual differences in associative learning—the ability to form and update associations between cues, contexts, behaviors, and outcomes—may account for differential response to existing treatments. Undertaking this research could provide an understanding of how current treatments work and inform new approaches for those who may be at risk of poor outcomes. [ABSTRACT FROM AUTHOR]

IntroductionEffective adjunctive therapeutic treatments for patients with opioid use disorder (OUD) on medication for OUD (MOUD) in primary care settings are needed to address high rates of mental illness and stress. Behavioral activation (BA) is a brief, evidence-based therapy that has potential to improve quality of life in people with OUD. The purpose of this pilot study was to evaluate the feasibility and acceptability of values-based BA (VBA) as an adjunct treatment for patients receiving MOUD in primary care.MethodsParticipants were recruited for a single-arm pilot trial of BA in a primary care setting. VBA was adapted for people with OUD and included 4–6 sessions delivered over 12 weeks with a behavioral health consultant, either in-person or virtually. Feasibility was assessed as recruitment percent and pace and retention percent. Acceptability was assessed with the Client Satisfaction Questionnaire-8 (CSQ-8). Participants completed self-report measures of well-being, depression, substance use, and psychological processes of change at baseline, mid-intervention (6-weeks), and post-intervention (12-weeks). Participants engaged in a brief interview about their experiences at the end of the intervention.ResultsTwenty-one participants enrolled in the intervention (66.7% female, M age = 44.0 years, 19% of those invited). Participants completed an average of 5.1 BA sessions (SD = 1.6) and most (90%) were retained through 12 weeks. Participants rated the intervention as highly acceptable on the CSQ-8 (M = 30.4/32.0, SD = 1.6). In qualitative interviews, participants reported that working with the therapist and setting values-based goals were helpful, while also recommending more tailoring to patients’ needs and offering the program early in MOUD treatment. Preliminary efficacy data suggest the program was associated with small to moderate improvements in life satisfaction (Cohen’s d = 0.25) and positive affect (d = 0.62), whereas there were no changes in depression (d = 0.09) or negative affect (d = −0.07) in a group with low depression at baseline.DiscussionVBA adapted for patients on MOUD in primary care was feasible to deliver and acceptable to participants. Minor modifications to the target population and treatment manual could increase the program’s impact. Future studies will test the efficacy of the intervention in improving quality of life and OUD treatment outcomes.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05262725, Unique ID: NCT05262725.

Aim The child's self-stimulating pleasure behavior is defined as childhood masturbation (CM). Diagnosis of CM is mainly based on behavior and analysis of video recordings. This study aims to investigate etiological factors, movement patterns, and treatment options. Medical records and video recordings of CM in our clinic between 2015 and 2020 were retrospectively reviewed. Results Ninety patients aged 8 months to 9 years were included in our study. The male-to-female ratio was 23/67. The mean age at onset of masturbation (mean ± standard deviation) was 21.42 ± 18.44 (6–107) months. Note that 27.7% (32) of the patients were taking antiepileptic drugs before admission. Eight of the 90 patients had abnormal electroencephalograms. The time of onset of CM was related to cessation of breast milk in 24.4%, separation from the mother in 43.3%, new siblings in 16.6%, initiation of toilet training in 7.7%, and parental divorce in 6.6%. Behavioral therapy was sufficient in 71.1%. Hydroxyzine hydrochloride in 19 (21.1%) and risperidone in 9 (10%) were given in the remaining cases. Overall, 23/28 of the cases receiving medication improved during follow-up. Conclusion Physicians may have difficulty identifying repetitive movements in CM. Misdiagnosis or delayed diagnosis may lead to unnecessary use of antiepileptic drugs, delayed initiation of treatment, and prolonged treatment duration. Video recordings are important in the differential diagnosis of CM. CM may have psychosocial causes and can often be effectively treated with behavioral therapy. Pharmacological treatment (hydroxyzine hydrochloride and risperidone) may be considered in cases that do not respond to behavioral treatment. [ABSTRACT FROM AUTHOR]

Purpose of Review: Trigeminal neuralgia (TN) and trigeminal autonomic cephalalgias (TACs) are both painful diseases which directly impact the branches of the trigeminal nerve, which supply the face. Patients who have experienced adverse effects, have not responded to mainstream treatments, or have a personal preference for nonmedication options, often turn to complementary and integrative medicine (CIM). The aim of this review is to discuss the efficacy and safety of CIM therapies available for the treatment of TN and TACs. Recent Findings: Not only are there limited therapeutic options for TN and TAC patients, but also is there a proportion of patients who are intolerant to standard medical treatments. Recent findings have illustrated that 86% of patients with headache disorders utilize CIM modalities in combination with mainstream medical therapy. Summary: CIM modalities can be helpful for these diseases and have primarily been studied in combination with standard medical therapy. There is limited evidence for CIM and behavioral therapies in managing these conditions, and more research is needed to confirm which therapies are safe and effective. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodResultsConclusionsIncorporating cognitive and behavioral strategies into harm reduction interventions for people who use cocaine is a promising avenue.The aim of this systematic review is to identify cognitive and behavioral strategies that have been used in effective harm reduction interventions for people who use cocaine.Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the search was performed on February 26, 2023 across databases including PsycInfo, PubMed, Scopus, and Web of Science. Studies were included if they (1) report the use of one cognitive or behavioral strategy, (2) have harm reduction as the objective, (3) involve participants who used cocaine as at least one of their substances, (4) be published within the last 10 years, and (5) have a randomized controlled trial design. The Cochrane RoB 2.0 Tool was used to assess risk of bias. The cognitive and behavioral strategies were extracted and organized based on their frequency of use in the studies and their corresponding outcomesThe final synthesis included k = 10 studies with N = 3,567 participants. Psychoeducation strategies, influence on social norms, personalized feedback, increased self-efficacy and motivational interviewing were the most frequently used promising strategies across studies.This review underscores the significance of incorporating cognitive and behavioral strategies within harm reduction interventions, as they represent a promising domain that could enhance the effectiveness of addressing cocaine use. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is the most common breathing-related sleep disorder with a considerable economic burden, low diagnosis and treatment rates. Continuous positive airway pressure (CPAP/PAP) is the principal therapy for OSA treatment; nevertheless, effectiveness is often limited by suboptimal adherence. The present network meta-analysis aims to systematically summarize and quantify different interventions' effects on CPAP/PAP adherence (such as mean usage CPAP or PAP in hours per night) in OSA patients, comparing Behavioral, Educational, Supportive and Mixed interventions in Randomized Control Trials (RCT). We conducted a computer-based search using the electronic databases of Pubmed, Psycinfo, Scopus, Embase, Chinal and Medline until August 2022, selecting 50 RCT. By means of a random effect model network meta-analysis, results suggested that the most effective treatment in improving CPAP/PAP adherence was the Supportive approach followed by Behavioral Therapy focused on OSA treatment adherence. This network meta-analysis might encourage the most experienced clinicians and researchers in the field to collaborate and implement treatments for improving CPAP/PAP treatment adherence. Moreover, these results support the importance of multidisciplinary approaches for OSA treatment, which should be framed within a biopsychological model. • CPAP treatment results highly effective in Obstructive Sleep Apnea patients (OSA). • CPAP treatment effectiveness is often limited by suboptimal adherence. • Supportive and Behavioral treatments are the most effective in improving adherence. • Our findings support a multidisciplinary approach to OSA treatment. • Network meta-analysis has proven to be very informative in the clinical setting. [ABSTRACT FROM AUTHOR]

Insomnia, impacting 6-10% of the global population, is a multifaceted challenge to health and productivity. Chronic insomnia, linked to various health issues, demands comprehensive management. Traditional pharmacotherapies, effective yet raising dependency concerns, contrast with the nonpharmacological alternative, Cognitive Behavioral Therapy for Insomnia (CBT-I), addressing root causes. This paper explores diagnostic criteria, etiological factors, and patient education in insomnia management, incorporating keywords like behavioral therapy, chronic insomnia, and general sleep disturbances. Discussion emphasizes the evolving landscape, where behavioral interventions, notably CBT-I, demonstrate lasting efficacy, urging a shift towards personalized and comprehensive solutions. Societal consequences, including reduced productivity, underscore the imperative for effective, diversified approaches beyond traditional medications. The intricate challenges of insomnia necessitate a nuanced, individualized approach, with behavioral therapies as pivotal components, aligning with keywords such as non-pharmacological therapy and pharmacological. [ABSTRACT FROM AUTHOR]

Aim: Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to discomfort and malfunction of the chewing function. The study's objective was to assess the effects of four distinct treatment approaches on temporomandibular disorder cases with anterior disc displacements focusing on their chewing efficiency. Materials and Methods: One hundred participants suffering from reducible TMJ disc displacement were selected for enrollment in the study. Subjects were divided equally into four groups: group I patients were treated with behavioral therapy; group II patients were treated with low-level laser therapy (LLLT); group III patients were treated with anterior repositioning splints; and group IV patients were treated with flat plane splints. Chewing efficiency was assessed utilizing the fractional sieving method and a synthetic food substitute was created using silicon impression material. The statistical analysis encompassed comparisons of chewing efficiency between groups and between baseline and posttreatment within each group, employing analysis of variance (ANOVA) and paired t tests, respectively. Results: Using the paired t test, a significant difference in chewing efficiency values as expressed by the median particle size was observed between the baseline and 6-month values in all groups (P < 0.05), except for group I where no significant change was noted over the 6 months (P > 0.05). The one-way ANOVA test revealed a statistically significant difference among groups following therapies (P < 0.05). The post hoc Tukey test was employed for pairwise comparisons and revealed statistically significant variances in the main values of chewing efficiency among all groups at a 95% confidence level (P < 0.05). Conclusion: The study's results suggest that occlusal splints and LLLT are more effective in improving chewing efficiency than behavioral interventions. [ABSTRACT FROM AUTHOR]

Study Design. Claims-based analysis of cohorts of TRICARE Prime beneficiaries. Objective. To compare rates of utilization of 5 low back pain (LBP) treatments (physical therapy (PT), manual therapy, behavioral therapies, opioid, and benzodiazepine prescription) across catchment areas and assess their association with the resolution of LBP. Summary of Background. Guidelines support focusing on nonpharmacologic management for LBP and reducing opioid use. Little is known about patterns of care for LBP across the Military Health System. Patients and Methods. Incident LBP diagnoses were identified data using the International Classification of Diseases ninth revision before October 2015 and 10th revision after October 2015; beneficiaries with "red flag" diagnoses and those stationed overseas, eligible for Medicare, or having other health insurance were excluded. After exclusions, there were 159,027 patients remained in the final analytic cohort across 73 catchment areas. Treatment was defined by catchment-level rates of treatment to avoid confounding by indication at the individual level; the primary outcome was the resolution of LBP defined as an absence of administrative claims for LBP during a 6 to 12-month period after the index diagnosis. Results. Adjusted rates of opioid prescribing across catchment areas ranged from 15% to 28%, physical therapy from 17% to 39%, and manual therapy from 5% to 26%. Multivariate logistic regression models showed a negative and marginally significant association between opioid prescriptions and LBP resolution (odds ratio: 0.97, 95% CI: 0.93-1.00; P = 0.051) but no significant association with physical therapy, manual therapy, benzodiazepine prescription, or behavioral therapies. When the analysis was restricted to the subset of only active-duty beneficiaries, there was a stronger negative association between opioid prescription and LBP resolution (odds ratio: 0.93, 95% CI: 0.89-0.97). Conclusions. We found substantial variability across catchment areas within TRICARE for the treatment of LBP. Higher rates of opioid prescription were associated with worse outcomes. [ABSTRACT FROM AUTHOR]

Background: Patients with Functional Neurological Disorder (FND) experience complex patterns of motor and/or sensory symptoms. Treatment studies of psychological interventions are promising but limited. Objectives: The aim of the current pilot study is to investigate the effect of treatment consisting of a combination of hypnosis and catalepsy induction on FND symptom severity. Methods: A within‐subject waiting list‐control design was used with 46 patients diagnosed with FND. The treatment consisted of 10 sessions. The primary outcome measure was FND symptom severity (The Psychogenic Movement Disorder Rating Scale; PMDRS). The secondary outcome measures were psychological distress and quality of life. Results: The repeated measures (RM) ANOVA for the PMDRS as outcome measure revealed a significant effect for time with a large effect size (η2 = 0.679). Pairwise comparisons indicated that the effect of time in the treatment period was significant for the measure of FND symptom severity, whereas the waiting list period was not. The effect remained stable even at 8 weeks post treatment. As for the additional measurement, general psychological distress and quality of life, no statistically significant differences between individual time points were found. Conclusions: This pilot study showed that eight sessions of treatment consisting of a combination of hypnosis and catalepsy induction was effective in reducing FND symptom severity. Some explanations and limitations are provided in the paper as well as several avenues of future research. [ABSTRACT FROM AUTHOR]

Background: Although buprenorphine is an effective treatment for opioid use disorder (OUD), much remains to be understood about treatment non-response and methods for improving treatment retention. The addition of behavioral therapies to buprenorphine has not yielded consistent benefits for opioid outcomes, on average. However, several studies suggest that certain subgroups may benefit from the combination of buprenorphine and behavioral therapy, highlighting the potential for personalized approaches to treatment. Furthermore, little is known about whether behavioral therapies improve buprenorphine retention or non-opioid (e.g., functional) outcomes. Methods: The objective of this project is to harmonize four previously conducted clinical trials testing the addition of behavioral therapy to buprenorphine maintenance for OUD and to use this larger dataset to answer critical clinical questions about the role of behavioral therapy in this population. Study aims include identifying potential moderators of the effect of the addition of behavioral therapy and quantifying the effect of behavioral therapy on buprenorphine retention and functional outcomes. Results: Analyses will consider outcomes of weeks of opioid use, weeks of retention in buprenorphine treatment, and functional outcomes as measured by the Addiction Severity Index. Analyses will include an indicator for each study to account for heterogeneity of samples and design. Conclusion: Results will help to inform clinical and research efforts to optimize the use of behavioral therapies in the treatment of OUD.

Exposure therapy is a first-line, empirically validated treatment for anxiety, obsessive-compulsive, and trauma-related disorders. Extinction learning is the predominant theoretical framework for exposure therapy, whereby repeated disconfirmation of a feared outcome yields fear reduction over time. Although this framework has strong empirical support and substantial translational utility, extinction learning is unlikely to be the sole process underlying the therapeutic effects of exposure therapy. In our clinic, we commonly treat obsessive-compulsive disorder (OCD) patients successfully with exposure therapy even when some or all of their feared outcomes are not amenable to disconfirmation and, by extension, to extinction learning. Herein, we present a generic clinical vignette illustrating a commonly encountered feared outcome in OCD that cannot be disconfirmed through exposure (damnation resulting from blasphemous thoughts). We describe two specific non-extinction-based strategies we commonly employ in such cases, and we associate these strategies with known change mechanisms that might account for their effectiveness: (1) non-associative habituation to aversive stimuli, and (2) fear-memory elicitation and subsequent reconsolidation. We discuss the limitations inherent in the reverse-translational approach taken and its opportunities for expanding the framework of exposure therapy.

Study objectivesTrauma-related nightmares are highly prevalent among veterans and are associated with higher-severity insomnia and posttraumatic stress disorder. Cognitive behavioral therapy for insomnia (typically 6-8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and nontrauma-related bad dreams using an active control group treated using progressive muscle relaxation therapy. In addition, we tested whether baseline trauma-related nightmare frequency and baseline nontrauma-related bad dream frequency moderated changes in insomnia severity.MethodsParticipants were 91 military veterans with insomnia disorder randomized to BBTI or progressive muscle relaxation therapy. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and nontrauma-related bad dream frequency on the Pittsburgh Sleep Quality Index-PTSD Addendum.ResultsWe found that BBTI significantly reduced trauma-related nightmares from baseline to posttreatment, whereas progressive muscle relaxation therapy did not. However, reductions in trauma-related nightmares were not maintained at the 6-month follow up. Neither BBTI nor progressive muscle relaxation therapy reduced nontrauma-related bad dreams from baseline to posttreatment. We also found that neither baseline trauma-related nightmare frequency nor baseline nontrauma-related bad dream frequency moderated changes in insomnia symptom severity.ConclusionsFindings from the current study suggest that BBTI may help reduce trauma-related nightmares. Further research is needed to better understand the potential mechanisms underlying how improved sleep may reduce trauma-related nightmares.Clinical trial registrationRegistry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); URL: https://clinicaltrials.gov/ct2/show/NCT02571452; Identifier: NCT02571452.CitationRanney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med. 2022:18(7):1831-1839.

Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child’s academic and social functioning if left untreated. Cognitive–behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16–22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.

The purpose of the present study was to conduct a process evaluation of intervention delivery for a randomized controlled trial (RCT) conducted during the COVID-19 pandemic (NCT 03915548). The RCT tested the effects of a telephone-delivered behavioral intervention on changes in breast cancer survivors’ satisfaction with social roles and activities, as compared to an attention control condition. This process evaluation examined (a) fidelity monitoring scores; (b) participants’ perceived benefit ratings for gaining confidence, reducing distress, adjusting habits and routines, setting goals, and increasing exercise; and (c) field notes, email communications, and transcripts of coach supervision and debriefing sessions. The behavioral and attention control conditions were delivered with a high degree of fidelity (global quality rating score for the BA/PS condition was M = 4.6 (SD = 0.6) and M = 4.9 (SD = 0.3) for the attention control condition, where “5” is the highest rating). The behavioral intervention participants perceived greater benefits than the control participants pertaining to goal setting, t(248) = 5.73, p = t(248) = 2.94, p = 0.0036, and increasing exercise, t(248) = 4.66, p =

Purpose We evaluated the therapeutic effects on overactive bladder (OAB) symptoms and sexual function of behavioral therapy with or without mirabegron in sexually active male patients with OAB. Mirabegron, a selective β3 adrenoceptor agonist for the treatment of OAB, has been shown to induce corpus cavernosum relaxation. Methods In this 4-site, randomized controlled trial, 150 sexually active men with OAB were enrolled between June 2020 and May 2022. Participants were randomly allocated (1:2) into 2 treatment groups: (1) behavioral therapy alone (n = 50) and (2) a combination of mirabegron 50 mg daily and behavioral therapy (n = 100). The evaluation was based on the overactive bladder symptoms score (OABSS), the International Index of Erectile Function, the ejaculatory domain short form, the International Prostate Symptom Score, patient perception of bladder condition, quality of life, and urodynamic parameters. The therapeutic outcomes were assessed at baseline, 4 weeks, and 12 weeks. Results There were 65 patients (65%) in the combination subgroup and 36 patients in the behavioral therapy who completed all 12 weeks of treatment. Both groups had a statistically significant improvement in OABSS after 12 weeks of treatment. The combination therapy group achieved a statistically significant improvement in all 4 subscores of OABSS, however, the urinary frequency (P = 0.120) and urinary incontinence (P = 0.234) subscores in the behavioral therapy only group did not show a significant change. Additionally, the combination group had a significant improvement in functional bladder capacity, which was not seen in the behavioral therapy group. However, both groups did not have a significant change in erectile or ejaculatory function. Conclusions Behavioral therapy combined with mirabegron had more significant impact on the improvement of OAB than behavior therapy alone. However, both groups did not have significant changes in erectile or ejaculatory function.

Background: Masturbation is a self-stimulating pleasurable behavior of the child, which occurs between the ages of 3 months and 5 years. Clonazepam was recorded to reduce the frequency of sexual behavior during sleep. Objective: This study aimed to investigate the benefits of adding clonazepam to the general behavioral treatment of infantile and childhood masturbation. Patients and Methods: This was randomized controlled trails (RCTs) conducted on a total number of 52 infants and pre-adolescent children with masturbation attending the Neurology Outpatient Clinic in Mansoura University Children Hospital (MUCH). Patients were classified into 2 groups: Group on behavioral therapy and clonazepam and group on behavioral therapy only. The response was observed in both groups as regards the frequency after treatment and duration till complete response Results: Masturbation was common among females, and cases with moderate socioeconomic level. Combined therapy was associated with a significant improvement in response compared to behavioral therapy only. Conclusion: Combined behavioral therapy and clonazepam is more effective and superior to behavioral therapy alone in ameliorating masturbation phenomena in infants and children. [ABSTRACT FROM AUTHOR]

The aim of the current pilot study is to depict the pattern of management of autism spectrum disorder (ASD) in Saudi Arabia, focusing on the efficacy of risperidone in reducing the target symptoms of ASD compared to only behavioral therapy. A cross-sectional study was conducted at two main centers for 10 months. On a convenience basis, prospective visits were scheduled for children, who had received regular behavioral therapy and/or antipsychotics? (mainly risperidone), and their parents to assess the efficacy and side-effects of the treatment. The improvement of symptoms of ASD was assessed using the Aberrant Behavior Checklist-Community Version (ABC-CV) including five subdomains: Irritability, Lethargy, Stereotypic behavior, Hyperactivity, and Inappropriate speech. Twenty-nine children (26 boys and 3 girls) with a mean age of 8.96 years (range: 5-15 years) were included in this study. The distribution of management strategy was: risperidone (11, 37.9%), behavioral therapy only (9, 31.0%), risperidone and behavioral therapy (9, 31.0%). The use of a combination of antipsychotics and psychostimulants (17.24%) was less common than in a previous American study (38%). Surprisingly, scores for all ABC subdomains were higher than those of previous studies, indicating less efficacy of risperidone in this group. Additionally, for the Lethargy subdomain, the score was 74.3±24.3. Interestingly, children who received behavioral therapy only, had lower scores compared to their counterparts who received risperidone only in all ABC subdomains and the total score. Consistent with other reports, this study highlighted the efficacy of risperidone alongside behavioral therapy on reducing hyperactivity symptoms and total ABC score. Despite the published data regarding the efficacy and safety of risperidone, supporting that it may have an important role in the management of ASD in children, further prospective design studies in Saudi Arabia are warranted to confirm the findings or encourage its continuous employment as long-term maintenance therapy. [ABSTRACT FROM AUTHOR]

AbstractObjective:Method:Results:Conclusions:There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery.PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT.PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms.PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Urethrovaginal reflux (UVR) secondary to vaginal urine entrapment is an unnoticed cause of daytime urinary leakage in toilet-trained girls. Our aim is to emphasize the diagnosis of UVR as a cause of urinary incontinence, its predisposing factors, early detection, and treatment. Methods: A total of 25 girls aged between 9 and 14 years presented with mixed daytime urinary incontinence from 2019 to 2021. They were evaluated by detailed history, vaginal examination, focused neurological examination, bladder diaries, urine analysis, uroflowmetry, and residual urine assessment. Micturating cystourethrography was also performed in those girls who did not show improvement with a conservative line of management. Results: The parents of these girls were educated about the cause of leakage. They were treated with behavioral modifications, urotherapy, correcting toilet postures, and reverse sitting on the commode. Urethrovaginal reflux was found in 6 of the 25 girls (24%). Their ages were 9, 10, 10, 11, 12, and 14 years respectively. Two girls (10 and 14 years old) had a body mass index more than 25. They all had a typical history of a small quantity of urine leakage 5–10 min (post-micturition dribble) after every void. At follow-up after 12 months, all of them were free from urinary incontinence. Conclusions: Urethrovaginal reflux should be considered in the differential diagnoses of girls with day-time incontinence. The key to diagnosis is an appropriate and detailed history as it is common for parents or girls to ignore symptoms or fail to report them. Proper voiding instructions and behavioral therapy often resolve the problem. [ABSTRACT FROM AUTHOR]