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Internet-based acceptance and commitment therapy (iACT) improves professional psychological help-seeking attitudes: A randomized controlled trial.

BACKGROUND: Professional psychological help-seeking attitudes are crucial for addressing mental health challenges, yet the mechanisms underlying their improvement through internet-based interventions remain poorly understood. OBJECTIVE: This randomized controlled trial aimed to (1) evaluate the efficacy of Internet-based Acceptance and Commitment Therapy (iACT) in enhancing professional help-seeking attitudes, and (2) elucidate the longitudinal mediating roles of psychological rigidity and self-stigma. METHODS: A total of 91 male participants (Mean Age&#xa0;=&#xa0;21.09) were randomly assigned to either a 12-day iACT intervention group (n&#xa0;=&#xa0;46) using a self-developed mobile application or a waitlist control group (n&#xa0;=&#xa0;45). Psychological flexibility, rigidity, self-stigma, and help-seeking attitudes were measured at four time points: baseline, mid-intervention (Day 6), post-intervention (Day 12), and 1-month follow-up. Data were analyzed using repeated-measures ANOVA and latent growth modeling. RESULTS: Intention-to-treat analysis revealed the iACT group showed greater improvements in help-seeking attitudes than controls (F (3,87)&#xa0;=&#xa0;5.95, p&#xa0;<&#xa0;0.001), with medium-to-large between-group effects at post-test for reducing psychological rigidity (d&#xa0;=&#xa0;-0.77, 95% CI [-1.19, -0.34]) and self-stigma (d&#xa0;=&#xa0;-0.88, 95% CI [-1.31, -0.45]). Latent growth modeling revealed a sequential mediation effect: the iACT intervention reduced psychological rigidity (&#x3b2;&#xa0;=&#xa0;-0.53, SE&#xa0;=&#xa0;0.12), which in turn reduced self-stigma (&#x3b2;&#xa0;=&#xa0;0.61, SE&#xa0;=&#xa0;0.09) and improved help-seeking attitudes (&#x3b2;&#xa0;=&#xa0;0.47, SE&#xa0;=&#xa0;0.08). CONCLUSION: This study provides the first evidence that a self-guided iACT mobile intervention can effectively enhance professional help-seeking attitudes by reducing psychological rigidity, which in turn alleviates self-stigma. The developed app offers a scalable solution to overcoming stigma-related barriers to mental health care.

Humans

Piloting a community-academic partnership to deploy acceptance and commitment therapy via telehealth for caregivers of children with Angelman syndrome.

BACKGROUND: Caregivers of children with Angelman syndrome (AS) experience substantial stressors and often experience challenges accessing mental health providers with expertise in their unique family needs. PURPOSE: Community-academic partnerships have potential for ensuring such treatments are deployed in ways that maximally benefit the patient community. METHODS: This study examined the effectiveness of using a community-centered approach to training student clinicians to deploy telehealth acceptance and commitment therapy (ACT) with a pilot sample of caregivers (n&#x2009;=&#x2009;17) with young children diagnosed with AS. Prior to deploying the treatment, clinicians received community-led training on the unique needs of AS families. RESULTS: Upon completing the abbreviated 9-week protocol, caregivers reported decreases in depression and parenting stress and increases in parenting confidence across treatment, supporting future testing of ACT for AS in the context of randomized control trials. CONCLUSIONS: Our findings support the feasibility of leveraging community-academic partnerships to co-train graduate-level clinicians to deliver ACT to specialized populations. This is also the first study to document preliminary effectiveness of telehealth ACT in supporting caregivers of children with AS.

Humans

A strategy for patient teaching.

A theoretical model is described whose particular emphasis is directed towards operationalizing the statements: 'effective teaching bridges the gap between information and practice or 'teaching is more than telling'. It concentrates on nurse behaviours (facilitation) designed to actively engage the patient in learning whereby he accepts his diagnosis or situation, projects the effects of prescribed therapy on his future life, and commits his intentions to practice. It utilizes principles of learning derived from the perceptual (phenomenological) approach and indicates the nurses' responsibilities. The model identifies four critical elements in the engagement process--the patient's values, his perception of the disease threat, his perceived utility of prescription, and facilitating behaviours of the nurse. The strategy is adapted from a combination of the Health Belief Model and the Personal Choice Model.

Humans

Incidence of pituitary tumors following adrenalectomy. A long-term follow-up study of patients treated for Cushing's disease.

The long-term follow-up of 21 patients who had undergone bilateral adrenalectomy for Cushing's disease has revealed eight definite and two suspected cases of pituitary tumors. The average time from adrenalectomy to the diagnosis of the pituitary tumor was 6 1/2 years, with a range of 1 1/2 to 12 years. The incidence of tumors in this study (38%) is higher than that reported by others and may reflect (1) that none of these patients received pituitary irradiation in addition to adrenalectomy, (2) the length of follow-up, and (3) the high index of suspicion and early diagnosis of pituitary tumors in recent years. These data raise the question of whether bilateral adrenalectomy alone is an acceptable form of therapy for Cushing's disease. For patients treated in this way, a life-long commitment should be made to undergo annual reexamination for the possible occurrence of a pituitary neoplasm.

Adenoma

New dimensions in ocular pharmacology 1975.

Progress is painful. This is certainly true in drug therapy. No drug in clinical use is devoid of toxicity, and all ophthalmologists are aware that no human being should be exposed to needless risk. On the other hand, the potential harm done to present and future generations by lack of adequate therapy for many diseases makes it imperative that new drugs, despite their associated hazards,continue to be introduced into research and practice. If an ophthalmologist accepts these thoughts, he also must accept a commitment to understand the effect of drugs in disease, the predisposing factors leading to drug reactions and interactions, the effect of disease on drugs, before he uses them.

Age Factors

The new psychotherapies: the courage to be.

The past decade has seen the emergence of popular "new psychotherapies" such as Gestalt Therapy, Transactional Analysis, and Primal Therapy, each with substantial followings. This paper puts forward a hypothesis about what these divergent systems may possess in common. Certain aspects of these therapy systems, in particular the induction of new patients and trainees, are examined in terms of Paul Tillich's concepts of the universal necessity of a rationale for courage. The significance of Tillich's analysis of courage for various historical movements is reviewed. In each system an element of unconditional commitment to a particular world view is required, as evidenced in the writings of the proponents of these systems, for the patient to be accepted into the particular system. These theoretically divergent systems possess, in common, a factor of an initial commitment to and induction into a collective belief system comparable to what Tillich describes as "the courage to be as a part".

Gestalt Therapy

Sex, love, and commitment.

When a couple become erotically pair-bonded, whether for a night or a lifetime, they are by definition committed to each other erotically. That is the minimum. The degree varies. The commitment may be limited to the proceptive phase of solicitation or courtship, or it may include the acceptive phase of coitus, or it may extend to the conceptive phase of parenthood. People "fall in love with their fantasy" and project onto the partner a range of future commitments. If the partner fails to reciprocate, the pair-bond weakens and the partnership either dissolves or becomes eligible for marital counseling or sex therapy.

Animals

Don Pasquale, Fidelio, and psychiatry.

Donizetti's Don Pasquale and Beethoven's Fidelio are discussed in order to illustrate how two very different operas can illustrate the human quest for authenticity. Through their music and dramatic presentation they are able to convey experiential insights into profound philosophic and psychologic truths. Along with other experiential communications, such as myths, folklore, poetry, humor, and art, they can be especially helpful--not only but also--in psychotherapy, in providing access to potentials that ordinarily are sealed off, in enhancing the awareness of inauthentic attitudes, in facilitating the acceptance of seemingly paradoxical aspects of human existence, and in providing a deeper sense for life's meaningfulness. Music is invaluable in opening our soul to the story's thoughts, feelings, and commitments.

Drama

Overview: Ethical issues in contemporary psychiatry.

The authors survey the ethical problems confronting psychiatry today. They state that with rare exceptions psychiatric intervention can be morally justified only with the potential patient's informed consent. Within this framework, they discuss the fact that today nonpsychiatrists, particularly ethicists, lawyers, legislators, and social scientists, as well as psychiatrists are concerned about medical ethics, specifically regarding the right to be treated, the right not to be treated, the civil rights of psychiatric patients, the ethics of behavior control, the problem of conflicts of interest in therapeutic goals, privacy and confidentiality, the ethics of human experimentation, policy decisions, and psychiatry's relationship to the changing moral value structure of U.S. society.

Attitude to Health

Psychiatry residents in a milieu participatory democracy: a resident's view.

Psychiatry residents respond with a variety of coping mechanisms to the lack of traditional structure in a milieu participatory democracy. To incorporate themselves into the system they must accept such democratic ideals as equality among staff and patients, group decision making, and free self-expression and give up some of their traditional ideas about staff and patient roles, treatment modalities, and the therapeutic environment. The author was a first-year resident in psychiatry on a university hospital inpatient therapeutic community; he discusses the conflicts between residents, who often adopt a "we-they" attitude, and the permanent staff, whose protectiveness of the ward community reflects their personal commitment to its ideals.

Attitude of Health Personnel

Prompt haemopoietic reconstitution following hyperthermia purged autologous marrow and peripheral blood stem cell transplantation in acute myeloid leukaemia.

We report a case of acute myeloid leukaemia in a 35-year-old woman where marrow and chemotherapy-mobilized peripheral blood stem cells (PBSC) were obtained in first complete remission and heat treated at 42 degrees C for 1 h to minimize the likelihood of leukaemic relapse. Transplantation of marrow and PBSC was undertaken following busulphan/cyclophosphamide conditioning 9 months after diagnosis in CR1. Hyperthermic purging did not impair the rate of engraftment and the patient was independent of blood product support by day 21. Studies on this patient's committed normal granulocyte-macrophage progenitor cells (CFU-GM) on samples from marrow and peripheral blood following treatment at 42 degrees C for 1 h, showed minimal and acceptable loss of activity comparable with the loss seen in other marrow progenitor activity treated in a similar fashion in our laboratory. We conclude that hyperthermia-purged PBSC can be used to hasten recovery in autologous haemopoietic progenitor transplantation without compromising rate of engraftment. This is part of an ongoing pilot study to evaluate the role of hyperthermic purging to reduce the risk of leukaemic relapse.

Adult

Comparison of clinical benefits and outcome in patients with programmable and nonprogrammable implantable cardioverter defibrillators.

Technological advances in implantable cardioverter defibrillators (ICDs) have provided a variety of programmable parameters and antitachycardia therapies whose utility and impact on clinical outcome is presently unknown. ICDs have capabilities for cardioversion defibrillation alone (first generation ICDs), or in conjunction with demand ventricular pacing (second generation ICDs), or with demand pacing and antitachycardia pacing (third generation ICDs). We examined the pattern of antitachycardia therapy use and long-term survival in 110 patients with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Group I included 62 patients with nonprogrammable first generation ICDs that delivered committed shock therapy after ventricular tachyarrhythmia detection based on electrogram rate and/or morphology was satisfied. Group II included 48 patients with multiprogrammable ICDs (including second and third generation ICDs) that had programmable tachyarrhythmia detection based on rate and tachycardia confirmation prior to delivery of electrical treatment with either programmable shocks and/or, as in the third generation ICDs, antitachycardia pacing. Incidence and patterns of antitachycardia therapy use and long-term survival were compared in the two groups. The incidence of appropriate shocks in patients who completed 1 year of follow-up was significantly greater in group I (30 of 43 patients = 70% vs 11 of 26 patients = 42%; P less than 0.05). In the total follow-up period, a significantly larger proportion of group I patients as compared to group II patients used the shock therapies (46 of 62 patients = 74% vs 25 of 48 patients = 52%; P less than 0.01), with the majority doing so within the first year of implantation (96% and 92%, respectively). Although the frequency of antitachycardia therapy activation was similar, the number of shocks delivered per patient was lower in group II, particularly in the initial 3 months of follow-up (P = 0.06). No clinical variable aided in identifying users from nonusers of antitachycardia therapy. Arrhythmic mortality was virtually eliminated in both groups. Two-year actuarial cardiac survival in the two groups was similar (group I = 78% vs group II = 84%; P greater than 0.2). Survival from cardiac mortality in users and nonusers of antitachycardia therapies was also similar in both groups (P greater than 0.2) and in the total patient group (P greater than 0.2). We conclude that programmable ICDs continue to confer advantages in prevention of sudden death that were observed with nonprogrammable ICDs and can be expected to improve patient tolerance and physician acceptance of device therapy for VT/VF.

Adult

The pathological gambler as criminal offender. Comments on evaluation and treatment.

Over the past three decades, gambling has been the nation's fastest growing industry. Although there is now some leveling off, states are still turning to legalized gambling to address financial problems without having to raise taxes. In addition, there is new technology that produces more rapidly addicting games. States are accepting some responsibility and, as of this writing, 12 of them have funded some programs in public education, research, training, and treatment. Although there are only a half dozen inpatient programs and very few qualified counselors and therapists, we can anticipate the development of clinics, residential programs, halfway houses, and alternative sentencing programs. The National Council on Problem Gambling has developed guidelines for the certification of gambling counselors. In addition to the training of mental health professionals, workshops are needed for attorneys, judges, probation and parole officers, and prison administrators. Initially, the task of assessing and diagnosing the pathological gambler was left to a small number of experts. Starting with DSM-IV, there will be clear and reliable criteria available to the professional community. These criteria, which are the product of thorough testing, should easily discriminate the pathological gambler from other types of gamblers. Most of what we have learned about pathological gambling has come in the last 5 years. A major impetus for research has been the Journal of Gambling Studies, which began publication in 1985. A review of the nature and course of the disorder, including the studies of criminal behavior, leads one to conclude that the majority of pathological gamblers (at least 70% to 80%) commit offenses late in the disorder and that these offenses are strictly gambling related. This is a population which is essentially nonviolent and which turns to property crimes out of desperation over gambling losses and their sequelae. The minority (in one study 14%) of gamblers with antisocial personality disorder--the group for whom treatment would be least likely to be effective--can be recognized easily both by the pattern of offenses and by diagnostic criteria for antisocial personality. Once this group is excluded, treatment for the others, in combination with restitution, community service, and some form of monitoring, would seem beneficial both for the individual and for society. Once they have stopped gambling, pathological gamblers are frequently hard-working people, whose mathematical skills and intelligence, high energy, and need to excel make them extremely valuable at their jobs. The alternative, imprisonment, may very well reinforce the disorder.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent