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The first find of microdiamond in the Nordøyane ultra-high-pressure (UHP) domain of the Western Gneiss Region (WGR) of the Scandinavian Caledonides reshaped tectonic models for the region. Nevertheless, in spite of much progress regarding the meaning and significance of this find, the history of rock that the diamonds were found in is complex and still largely ambiguous. To investigate this, we report U–Pb zircon ages obtained from the exact crushed sample material in which metamorphic diamond was first found. The grains exhibit complicated internal zoning with distinct detrital cores overgrown by metamorphic rims. The cores yielded a range of ages from the Archaean to the late Neoproterozoic / early Cambrian. This detrital zircon age spectrum is broadly similar to detrital signatures recorded by metasedimentary rocks of the Lower and Middle allochthons elsewhere within the orogen. Thus, our dating results support the previously proposed affinity of the studied gneiss to the Seve–Blåhø Nappe of the Middle Allochthon. Metamorphic rims yielded a well-defined peak at 447 ± 2 Ma and a broad population that ranges between c. 437 and 423 Ma. The data reveal a prolonged metamorphic history of the Fjørtoft gneiss that is far more complex then would be expected for a UHP rock that has seen a single burial and exhumation cycle. The data are consistent with a model involving multiple such cycles, which would provide renewed support for the dunk tectonics model that has been postulated for the region.
Two types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.
To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.
In a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.
Significant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.
Although MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.
Declaration of interest
P.L. and D.L.B. have been involved in the training and dissemination of MBT.
Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects.
A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT.
We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term.
There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.
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