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Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach.

ABSTRACT: BACKGROUND:The community reinforcement approach (CRA) is an evidence-based practice for the treatment of substance use disorders and achieving and maintaining abstinence, but few studies have systematically explored the effect of CRA on secondary, yet also important outcomes, such as social functioning. OBJECTIVES:The purpose of this study was to examine whether an internet-based version of the CRA plus contingency management is associated with improved social functioning of individuals seeking substance use disorder treatment in a multi-site clinical effectiveness trial. METHODS:Social functioning was measured using the 54-item Social Adjustment Scale assessing role performance in six domains (work, social and leisure activities, extended family relationships, marital relationship, parenting, and immediate family). Generalized linear mixed models tested the effects of treatment, time, sex, baseline abstinence, baseline social functioning and baseline psychological distress on overall social functioning and across social functioning subscales at the end of the 12-week treatment phase and 3 and 6 months post treatment. RESULTS:Results showed no significant association between treatment and total social functioning score or any subscale scores. Being male was significantly associated with better social functioning overall at the end of treatment (p = .024). Higher levels of psychological distress at baseline predicted significantly worse social functioning at the end of treatment overall (p = .037). CONCLUSIONS:The addition of an internet-based version of the CRA was not associated with greater improvements in social functioning compared to standard outpatient care after 12?weeks of treatment. Implications for internet-delivered CRA are discussed.

SUBMITTER: Marino LA

PROVIDER: S-EPMC6483877 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach.

Marino L A LA Campbell A N C ANC Pavlicova M M Hu M M Nunes E V EV

Substance use & misuse 20190308 7

<h4>Background</h4>The community reinforcement approach (CRA) is an evidence-based practice for the treatment of substance use disorders and achieving and maintaining abstinence, but few studies have systematically explored the effect of CRA on secondary, yet also important outcomes, such as social functioning.<h4>Objectives</h4>The purpose of this study was to examine whether an internet-based version of the CRA plus contingency management is associated with improved social functioning of indiv ...[more]

PMID: 30849925

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Project description:ObjectiveSocial impairment is a long-recognized core feature of schizophrenia and is common in other psychotic disorders. Still, to date the long-term trajectories of social impairment in psychotic disorders have rarely been studied systematically.MethodsData came from the Suffolk County Mental Health Project, a 20-year prospective study of first-admission patients with psychotic disorders. A never-psychotic comparison group was also assessed. Latent class growth analysis was applied to longitudinal data on social functioning from 485 respondents with schizophrenia spectrum disorders and psychotic mood disorders, and associations of the empirically derived trajectories with premorbid social adjustment, diagnosis, and 20-year outcomes were examined.ResultsFour mostly stable trajectories of preserved (N=82; 59th percentile of comparison group sample distribution), moderately impaired (N=148; 17th percentile), severely impaired (N=181; 3rd percentile), and profoundly impaired (N=74; 1st percentile) functioning best described the 20-year course of social functioning across diagnoses. The outcome in the group with preserved functioning did not differ from that of never-psychotic individuals at 20 years, but the other groups functioned significantly worse. Differences among trajectories were already evident in childhood. The two most impaired trajectories started to diverge in early adolescence. Poorer social functioning trajectories were strongly associated with other real-world outcomes at 20 years. Multiple trajectories were represented within each disorder. However, more participants with schizophrenia spectrum disorders had impaired trajectories, and more with mood disorders had better functioning trajectories.ConclusionsThe results highlight substantial variability of social outcomes within diagnoses-albeit overall worse social outcomes in schizophrenia spectrum disorders-and show remarkably stable long-term impairments in social functioning after illness onset across all diagnoses.

Project description:BackgroundPersonality disorders (PDs) form a substantial part of the mental health disease burden. Effective therapies to treat PDs exist, but they are time-consuming, costly, and difficult to scale up. Delivery through the internet could facilitate the scalability of effective treatment methods.ObjectiveThis review summarizes existing evidence on internet-delivered psychotherapy for personality disorders.MethodsBecause few randomized controlled trials (RCTs) have been carried out, we conducted a scoping review. We performed a systematic literature search in PubMed, Embase, MEDLINE, CINAHL, PsycInfo, and Cochrane. Studies were selected if they conveyed research findings on internet-delivered PD interventions.ResultsEleven studies were included. The majority (n = 8) focused specifically on borderline personality disorder (BPD) and the other three on PD in general. The most frequently used form of intervention (n = 7) was the addition of a mobile app to a conventional evidence-based face-to-face treatment such as dialectical behavioral therapy (DBT). Most interventions (n = 8) were still in the development and piloting phase; only two RCTs were found. Usability and patient satisfaction were moderate to high in all studies. Three studies demonstrated significant decreases in borderline personality disorder symptoms.The majority of the studies found were pilot or feasibility studies, most involving mobile apps offered in addition to face-to-face treatment. The add-ons were rated feasible, acceptable, and useful by patients. Reported challenges involved technical difficulties such as programming errors and bugs. Only 45% of the included studies reported on changes in PD symptoms, all showing reduction of symptoms and absence of adverse effects.ConclusionsThis scoping review found that internet interventions for PD are still under-researched, although initial outcomes show promise. The outcomes also encourage future research in terms of developing internet interventions as an add-on to existing treatments, as well as working toward the creation and testing of more encompassing internet-delivered treatments for PD.

Project description:BackgroundAmple studies have shown the effectiveness of internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. These studies recruited their participants mainly from the community and, to a lesser extent, from within routine care services. Little is known about whether different recruitment strategies lead to different treatment effects.ObjectiveThis meta-analysis compared clinical results obtained in trials with recruitment from the community versus results obtained in trials with clinical service recruitment and explored factors that may mediate differences in treatment outcome.MethodsWe included randomized controlled trials in which the clinical effects of iCBT for anxiety disorders were compared with a control condition (waitlist controls or face-to-face cognitive behavioral therapy). We classified trials as open recruitment trials (recruitment from the community) or clinical service recruitment trials (recruitment through outpatient clinics). Pooled effect sizes based on measures examining anxiety symptoms, depressive symptoms, and quality of life were computed for each type of trial. Subgroup analyses examined whether clinical results from open recruitment trials differed from those obtained in clinical service recruitment trials. Additional analyses explored which demographic, clinical, and treatment-related factors contributed to differences in effect sizes of open recruitment versus clinical service recruitment trials.ResultsWe included 42 studies with 53 comparisons (43 open recruitment comparisons and 10 clinical recruitment comparisons). Analyses of anxiety measures revealed, first, that iCBT open recruitment studies with waitlist control comparators showed a significantly higher effect size for decrease in anxiety symptoms than did those with clinical recruitment (Q=10.09; P=.001). This association between recruitment method and effect size was no longer significant in a multivariate metaregression with treatment adherence and exclusion of patients with depressive symptoms entered as additional predictors of effect size. Second, effect size for decrease in anxiety symptoms did not differ significantly between clinical recruitment and open recruitment studies with face-to-face cognitive behavioral therapy comparators. The effects of open recruitment trials and clinical recruitment trials did not differ significantly for the secondary outcomes, compared with face-to-face cognitive behavioral therapy and waitlist controls.ConclusionsiCBT was effective in samples recruited in clinical practice, but effect sizes were smaller than those found in trials with an open recruitment method for studies with waitlist control comparators. Hence, for patients with anxiety disorders in routine care, the impact of iCBT may not be as positive as for study participants recruited from the community. The difference between open recruitment trials and clinical service recruitment trials might be partly explained by patients' greater therapy adherence in open recruitment trials and the stricter exclusion of patients with severe depressive symptoms in these studies. Since most trials in this meta-analysis applied an open recruitment method, more studies with routine care populations are needed to further validate these findings.

Project description:BACKGROUND/AIMS:Contingency management (CM) interventions have gained considerable interest due to their success in the treatment of addiction. However, their implementation can be resource-intensive for clinical staff. Mobile telephone-based systems might offer a low-cost alternative. This approach could facilitate remote monitoring of behaviour and delivery of the reinforcer and minimize issues of staffing and resources. This systematic review and meta-analysis assessed the evidence for the effectiveness of mobile telephone-delivered CM interventions to promote abstinence (from drugs, alcohol and tobacco), medication adherence and treatment engagement among individuals with substance use disorders. DESIGN:A systematic search of databases (PsychINFO, CINAHL, MEDLINE PubMed, CENTRAL, Embase) for randomized controlled trials and within-subject design studies (1995-2019). The review was conducted in accordance with the PRISMA statement. The protocol was registered on PROSPERO. SETTING:All included studies originated in the United states. PARTICIPANTS:Seven studies were found, including 222 participants; two targeted alcohol abstinence among frequent drinkers and four targeted smoking cessation (in homeless veterans and those with post-traumatic stress disorder). One targeted medication adherence. MEASURES:The efficacy of CM to increase alcohol and nicotine abstinence was compared with control using several outcomes; percentage of negative samples (PNS), quit rate (QR) and longest duration abstinent (LDA) at the end of the intervention. FINDINGS:The random-effects meta-analyses produced pooled effect sizes of; PNS [d = 0.94, 95% confidence interval (CI) = 0.63-1.25], LDA (d = 1.08, 95% CI = 0.69-1.46) and QR (d = 0.46, 95% CI = 0.27-0.66), demonstrating better outcomes across the CM conditions. Most of the studies were rated as of moderate quality. 'Fail-safe N' computations for PNS indicated that 50 studies would be needed to produce a non-significant overall effect size. None could be calculated for QR and LDA due to insufficient number of studies. CONCLUSION:Mobile telephone-delivered contingency management performs significantly better than control conditions in reducing tobacco and alcohol use among adults not in treatment for substance use disorders.

Project description:BACKGROUND:Over 75% of individuals are exposed to a traumatic event, and a substantial minority goes on to experience mental health problems that can be chronic and pernicious in their lifetime. Early interventions show promise for preventing trauma following psychopathology; however, a face-to-face intervention can be costly, and there are many barriers to accessing this format of care. OBJECTIVE:The aim of this study was to systematically review studies of internet-delivered early interventions for trauma-exposed individuals. METHODS:A literature search was conducted in PsycINFO and PubMed for papers published between 1991 and 2017. Papers were included if the following criteria were met: (1) an internet-based intervention was described and applied to individuals exposed to a traumatic event; (2) the authors stated that the intervention was intended to be applied early following trauma exposure or as a preventive intervention; and (3) data on mental health symptoms at pre-and postintervention were described (regardless of whether these were primary outcomes). Methodological quality of included studies was assessed using the Downs and Black checklist. RESULTS:The interventions in the 7 studies identified were categorized as selected (ie, delivered to an entire sample after trauma regardless of psychopathology symptoms) or indicated (ie, delivered to those endorsing some level of posttraumatic distress). Selected interventions did not produce significant symptom improvement compared with treatment-as-usual or no intervention control groups. However, indicated interventions yielded significant improvements over other active control conditions on mental health outcomes. CONCLUSIONS:Consistent with the notion that many experience natural recovery following trauma, results imply that indicated early internet-delivered interventions hold the most promise in future prevention efforts. More studies that use rigorous methods and clearly defined outcomes are needed to evaluate the efficacy of early internet-delivered interventions. Moreover, basic research on risk and resilience factors following trauma exposure is necessary to inform indicated internet-delivered interventions.

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Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach.

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Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach.

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