counseling

Importance: Cognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field.

Objective: To examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques.

Data sources: Major bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025.

Study selection: Randomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included.

Data extraction and synthesis: Basic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models.

Main outcomes and measures: The primary outcome was the standardized mean difference (Hedges g) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders.

Results: A total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (g) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (g > 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD.

Conclusions and relevance: In this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.

Author/s:

Pim Cuijpers, Mathias Harrer, Clara Miguel, Marketa Ciharova, Davide Papola, Djordje Basic, Cristina Botella

Clinical Approaches to the Prevention of Firearm-Related Injury

Erin Blanchette — Mon, 16 Sep 2024 13:17:52 +0000

Date Added:

September 16, 2024

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

September 12, 2024

Issue:

Volume:

391

Pages:

926-940

URL:

Clinical Approaches to the Prevention of Firearm-Related Injury

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2306867

Keywords

PMID (1):

39259896

MeSH

Firearm-related injuries are the second leading cause of death in children. If one our goals as PCPs is to prevent premature deaths, we need to make this issue a focus of attention during WCCs. James W. Mold, MD, MPH

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Firearm-related injuries are an urgent health crisis in the United States, with firearm-related deaths surpassing deaths from motor vehicle crashes in 2017.1 In contrast to other conditions for which clinicians have evidence-based solutions to reduce harm, the 25-year gap in federal research funding2,3 halted substantial advances in the science of firearm-related injury prevention. Yet renewed funding and emerging science continue to highlight the critical role clinicians have in prevention efforts.2,3 Similar to other complex health issues, firearm-related injury is heterogeneous, with multiple causes (Figure 1). Each of these causes has entry points within clinical encounters that represent opportunities to interact, interrupt, and prevent negative outcomes.

The lack of research has resulted in a generation of clinicians currently lacking the training necessary to implement the solutions generated by recent science. As a result, despite clinicians recognizing the need for prevention and agreeing that prevention of firearm-related injury is within their scope of practice,13 few deliver evidence-based interventions even though their patients find such measures acceptable within the context of clinical care.14 This lack of training is compounded by a shortage of adequate health care infrastructure necessary to support the integration of useful approaches into practice. Clinicians note multiple barriers, including a lack of knowledge, guidelines, time, clinical support, and reimbursement, as well as a fear of offending patients or encountering legal trouble.15-17

Clinicians routinely provide harm-reduction measures and anticipatory guidance for a range of complex health issues (e.g., substance use and vaccination), capitalizing on available evidence, their relationships with patients, and their community standing to promote health and safety. Although gaps exist, there remain opportunities to improve the current standard of care for the prevention of firearm-related injury. In this article, we review clinical approaches to prevention, ranging from ones implemented within individual clinical encounters to ones advanced by health care leaders within the systems and communities they serve.

Author/s:

Patrick M Carter, Rebecca M Cunningham

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Alex Haga — Tue, 20 Aug 2024 19:53:30 +0000

Date Added:

August 20, 2024

Journal/Publication:

Agency for Healthcare Research and Quality

Publication Date:

July 31, 2024

URL:

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

Cognitive Behavioral Therapy

counseling

Postpartum period

An evidence-based review of non-pharmocologic treatments for maternal mental health conditions. James W. Mold, MD, MPH

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Objectives. This systematic review evaluates nonpharmacologic treatments for mental health conditions during the perinatal period (pregnancy and up to 12 months postpartum). We evaluated nonpharmacologic treatments for perinatal individuals with depressive disorders, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).

Data sources and review methods. We searched MEDLINE®, PsycINFO®, Embase®, CINAHL®, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from January 1, 2000, to January 17, 2024, to identify relevant randomized controlled trials (RCTs). Nonpharmacologic interventions of interest included, among others, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), exercise, non-directive counseling, behavioral activation, bright light therapy, eye movement desensitization and reprocessing (EMDR), and acupuncture. Outcomes of interest were improvement in scores on psychological assessment tools, cure or resolution of symptoms, suicide-related outcomes, and adherence to treatment. PROSPERO registration number: CRD42023440650.

Results. We identified 103 RCTs. Nonpharmacologic treatments were compared to control or each other in 101 RCTs and to pharmacologic treatments in 2 RCTs. The risk of bias was moderate for the majority of included studies, mostly related to lack of blinding. For perinatal individuals with depressive disorders, CBT was more effective than treatment as usual (TAU) to reduce depressive and anxiety symptoms (both moderate strength of evidence [SoE]); IPT was more effective than TAU to treat depressive symptoms (moderate SoE) and anxiety symptoms (low SoE); and both behavioral activation (a CBT technique, with low SoE) and exercise interventions (moderate SoE) were more effective than TAU to reduce depressive symptoms. Remission rates for depressive symptoms were higher with CBT and IPT compared to TAU (both low SoE) and higher with specific acupuncture than nonspecific or sham acupuncture (low SoE). There were no differences between CBT and non-directive counseling (an active patient-led intervention), between counseling and TAU, and between bright light and placebo light therapy (all low SoE). CBT was more effective than TAU to reduce anxiety and depressive symptoms for individuals with combined depressive and anxiety disorders (low SoE). Few (or no) eligible studies evaluated individuals with anxiety disorder, PTSD, OCD, or bipolar disorders, precluding conclusions for these conditions. There was also insufficient evidence for suicide-related outcomes, potential harms of treatment, and adherence to treatment, and for comparisons of nonpharmacologic with pharmacologic treatments.

Conclusion. Several nonpharmacologic treatments are more effective than TAU for perinatal mental health conditions, with the strongest evidence for CBT and IPT to reduce depressive symptoms among perinatal individuals with depressive disorders or combined depressive and anxiety disorders. Future research is needed to evaluate the comparative effectiveness of lesser studied nonpharmacologic interventions and lesser studied perinatal mental health conditions.

A Hitchhiker's Guide to Worldwide COVID-19 Vaccinations: A Detailed Review of Monovalent and Bivalent Vaccine Schedules, COVID-19 Vaccine Side Effects, and Effectiveness Against Omicron and Delta Variants

Aubrey Delammermore — Sun, 09 Oct 2022 05:00:00 +0000

Date Added:

October 9, 2022

Journal/Publication:

Cureus

Publisher:

Cureus

Publication Date:

October 2, 2022

Issue:

Volume:

URL:

A Hitchhiker's Guide to Worldwide COVID-19 Vaccinations: A Detailed Review of Monovalent and Bivalent Vaccine Schedules, COVID-19 Vaccine Side Effects, and Effectiveness Against Omicron and Delta Variants

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7759/cureus.29837

Keywords

Cost-Benefit Analysis

PMID (1):

36204257

MeSH

Centers for Disease Control and Prevention, U.S.

delivery of health care

A summary of recommended dosing intervals and effectiveness of currently available COVID-19 vaccines. James W. Mold, MD, MPH

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For the primary prevention of coronavirus disease 2019 (COVID-19), there are currently four different vaccines available in the USA. These are Pfizer (messenger RNA [mRNA]), Moderna (mRNA), Novavax (recombinant protein), and Jansen/Johnson & Johnson (adenoviral vector). All individuals should get vaccinated, and the Centers for Disease Control and Prevention (CDC) has provided comprehensive guidelines on recommended doses, their frequency by age group, and vaccine types, all discussed in detail in this article. Vaccines are a critical and cost-effective tool for preventing the disease. Prior to receiving a vaccine, patients should get adequate counseling regarding any potential adverse effects post vaccination. Appropriate safety precautions must be taken for those more likely to experience adverse consequences. Healthcare professionals should be aware of the symptoms, indicators, and treatment of any adverse event post-vaccination. We have provided a comprehensive review of the different characteristics of COVID-19 vaccines available in the United States, including their effectiveness against various variants, adverse effects, and precautions necessary for healthcare professionals and the general population. This article also briefly covers COVID-19 vaccines available worldwide, specifically their mode of action and effectiveness.

Author/s:

Goyal, L., Zapata, M., Ajmera, K., Churasia, P., Pandit, R., Pandit, T.

Hepatitis B Management: Guidance for the Primary Care Provider

John Bayhi — Fri, 10 Apr 2020 14:22:26 +0000

Date Added:

April 10, 2020

Publisher:

Hepatitis B Online

Publication Date:

February 25, 2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

A very useful guide to the diagnosis and treatment of hepatitis B infections from AAFP. James W. Mold, MD, MPH

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The purpose of this document is to provide simplified, up-to-date, and readily accessible guidance for primary care medical providers related to the prevention, diagnosis, and management of hepatitis B virus (HBV) infection, including hepatocellular carcinoma surveillance.

Author/s:

Tang, AS, Thornton, K, HBV Primary Care Working Group

Preventing Firearm-Related Death and Injury

Brian Desmarais — Wed, 05 Jun 2019 19:32:12 +0000

Date Added:

June 5, 2019

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

June 4, 2019

Issue:

Volume:

170

URL:

Preventing Firearm-Related Death and Injury

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/AITC201906040

Keywords

MeSH

A comprehensive summary of what we know about firearm-associated injuries and firearm safety to support physician-initiated patient education. James W. Mold, MD, MPH

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Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.

Author/s:

Pallin, R., Spitzer, S.A., Ranney, M.L., Betz, M.E., Wintemute, G.J.

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Jeffrey Wilson — Wed, 02 Jan 2019 14:31:45 +0000

Date Added:

January 2, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 1, 1997

Issue:

Volume:

277

Pages:

1039-1045

URL:

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.1997.03540370029032

Keywords

PMID (1):

9091691

MeSH

In this RCT conducted in primary care settings, two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information was sufficient to reduce 7-day alcohol use from 19.1 to 11.5 at 12 months in the experimental group vs 18.9 at baseline to 15.5 at 12 months in controls (P<.001); episodes of binge drinking from 5.7 at baseline to 3.1 at 12 months in the experimental group vs 5.3 at baseline to 4.2 at 12 months in controls (P<.001), and percentage drinking excessively in previous 7 days from 47.5% at baseline to 17.8% at 12 months in the experimental group vs 48.1% at baseline to 32.5% at 12 months in controls (P<.001) at one year.

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OBJECTIVE:

Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers.

DESIGN:

Randomized controlled clinical trial with 12-month follow-up.

SETTING:

A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties.

PARTICIPANTS:

Of the 17695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures.

INTERVENTION:

The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information.

MAIN OUTCOME MEASURES:

Alcohol use measures, emergency department visits, and hospital days.

RESULTS:

There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), episodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls; t=2.81; P<.001), and frequency of excessive drinking (percentage drinking excessively in previous 7 days decreased from 47.5% at baseline to 17.8% at 12 months for the experimental group vs 48.1% at baseline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men (P<.01).

CONCLUSIONS:

This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.

Author/s:

Fleming, Michael F., Barry, Kristen L., Manwell, Linda B., Johnson, Kristen, London, Richard

Motivational Techniques and Skills for Health and Mental Health Coaching/Counseling

Jeffrey Wilson — Mon, 17 Dec 2018 15:32:06 +0000

Date Added:

December 17, 2018

Publisher:

Nova Southeastern University

Publication Date:

January 1, 2013

URL:

Guided Self-Change

Type:

Clinical Decision Aids

Format:

Article

Keywords

MeSH

This is a concise summary with examples of common motivational interviewing strategies.

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Guided Self-Change Healthy Lifestyles Program. The Guided Self-Change (GSC) Healthy Lifestyles outpatient program at Nova Southeastern University's (NSU) College of Psychology offers a unique short-term, evidence-based, non-12 step alternative treatment not available elsewhere in Florida. The GSC program has been recognized in the Surgeon General's report Facing Addiction in America (November 2016) as an appropriate treatment for individuals who have mild alcohol or drug problems. It also is included on the American Psychological Association's (APA) Division 12 (Society of Clinical Psychology) website listing of Empirically Supported Treatments.

Author/s:

Sobell, Mark B., Sobell, Linda, C.

Intimate Partner Violence Screening

Jeffrey Wilson — Thu, 18 Oct 2018 17:00:23 +0000

Date Added:

October 18, 2018

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

May 1, 2015

URL:

Intimate Partner Violence Screening

Type:

Clinical Decision Aids, Practice Management Research Results

Format:

Web Page

Keywords

intimate partner violence

IPV

counseling

MeSH

female

intimate partner violence

pregnancy

This is a summary of information about intimate partner violence and how to screen for it.

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Nearly 1 in 6 pregnant women in the U.S. have been abused by a partner.

Women who experience intimate partner violence prior to and during pregnancy are at increased risk of low maternal weight gains, infections, high blood pressure and are more likely to deliver pre-term or low birth weight babies.

Women who received prenatal counseling for IPV had fewer recurrent episodes of IPV during and post pregnancy, as well as better birth outcomessuch as lower rates of preterm birth and low birth weight.