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Structured, empirically supported psychological interventions are lacking for patients who require organ transplantation. This stage IA psychotherapy development project developed and tested the feasibility, acceptability, tolerability, and preliminary efficacy of an 8-week group cognitive behavioral stress management intervention adapted for patients with end-stage liver disease awaiting liver transplantation.
Twenty-nine English-speaking United Network for Organ Sharing–registered patients with end-stage liver disease from a single transplantation center enrolled in 8-week, group cognitive-behavioral liver stress management and relaxation training intervention adapted for patients with end-stage liver disease. Patients completed pre- and postintervention surveys that included the Beck Depression Inventory II and the Beck Anxiety Inventory. Feasibility, acceptability, tolerability, and preliminary efficacy were assessed.
Attendance rate was 69.40%. The intervention was rated as “good” to “excellent” by 100% of participants who completed the postintervention survey in teaching them new skills to relax and to cope with stress, and by 94.12% of participants in helping them feel supported while waiting for a liver transplant. No adverse events were recorded over the course of treatment. Attrition was 13.79%. Anxious and depressive symptoms were not statistically different after the intervention.
Significance of results
The liver stress management and relaxation training intervention is feasible, acceptable, and tolerable to end-stage liver disease patients within a transplant clinic setting. Anxious and depressive symptoms remained stable postintervention. Randomized controlled trials are needed to study the intervention's effectiveness in this population.
Acute crisis respite care involves the provision of mental health services in a short-term residential setting that functions as an alternative to acute voluntary psychiatric hospitalisation. For the past two decades, short-term residential alternatives to psychiatric hospitalisation have grown steadily in both the United States and the UK despite the lack of a coherent definition, purpose, or conceptualisation for their use. As employed here, the term ‘acute crisis’ respite care does not include the use of acute hospital stays to provide respite for family members of a severely mentally ill adult (Geiser et al., 1988) or the brief placement of such patients with carefully selected families in the community in order to provide respite to families or residential service providers (Britton & Mattson-Melcher, 1985). Although ‘crisis hostels’ (Brook, 1973) may have represented an early form of acute crisis respite care, crisis respite services are distinct from ‘hostel’ services because the latter usually functions as an alternative to hospital-based institutionalisation for long-stay patients (Gibbons, 1986; Hyde et al., 1987; Simpson et al., 1989).
There is considerable evidence in the literature of the need for acute crisis respite care. Studies of family members of de-institutionalised mental patients consistently indicate a need for respite care among family members (Zirul et al., 1989), including families with members living in board and care homes (Segal & Kotler, 1989). Evidence for this need is also provided by the requests from community providers of severely ill patients (Ghaziuddian, 1988).
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