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Hoarding disorder (HD) is primarily characterised by difficulties with discarding possessions. Evidence-based psychological interventions such as CBT have been found to be of benefit to people with HD. However, people with HD may receive a psychosocial intervention provided by other professions such as social workers or a multi-disciplinary team before receiving psychological therapy, if at all.
Objectives:
The aim of this systematic review is to evaluate psychosocial interventions for HD.
Method:
Searches were conducted on three databases (PsycInfo; MEDLINE; Embase) and grey literature, and the search strategy was designed to capture psychosocial interventions for adults with HD.
Results:
Studies (n=5) were included where the outcome was related to a psychosocial factors, such as fire safety, tenancy preservation and QoL. These psychosocial interventions show improvements in those with HD, with effect sizes ranging from d=0.86 to d=1.41.
Conclusions:
Despite the limited research on psychosocial interventions for HD, this systematic review suggests it is a promising area for further research in this area.
Key learning aims
(1) To identify what psychosocial interventions are available for people experiencing hoarding difficulties.
(2) To identify how available psychosocial interventions for hoarding difficulties are delivered and by whom.
(3) To examine the effectiveness of psychosocial interventions for people experiencing hoarding difficulties.
The provincial coinage was transformed during the new regime of Augustus and the adoption of his portrait. Roman interventions, however, were rare and localised, except for Nero.
Our systematic review aims to synthesise the evidence on interventions targeting improvement in patient adherence to psychological treatments for common mental disorders. A search was conducted on six electronic databases using search terms under the following concepts: common mental disorders, adherence, psychological treatments and controlled trial study design. Due to the heterogeneity in intervention content and outcomes evaluated in the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Cochrane Risk of Bias Version 2 tool for randomised controlled trials and the Cochrane ROBINS-I tool for non-randomised controlled trials. The search yielded 23 distinct studies with a total sample size of 2,779 participants. All studies were conducted in high-income or upper-middle-income countries. Interventions to improve patient adherence to psychological treatments included reminders and between-session engagement (e.g., text messages), motivational interviewing, therapy orientation (e.g., expectation-setting) and overcoming structural barriers (e.g., case management). Interventions from 18 out of 23 studies were successful in improving at least one primary adherence outcome of interest (e.g., session attendance). Some studies also reported an improvement in secondary outcomes – six studies reported an improvement in at least one clinical outcome (e.g., depression), and three studies reported improvements in at least one measure of well-being or disability (e.g., days spent in in-patient treatment). By incorporating these interventions into psychological treatment services, therapists can better engage with and support their patients, potentially leading to improved mental health outcomes and overall well-being.
To identify and map spiritual care interventions to address spiritual needs and alleviate suffering of patients in the context of palliative care.
Methods
A scoping review using the PRISMA ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist was conducted according to the JBI (Joanna Briggs Institute) guidelines. The search was conducted from October 2022 to January 2023 using 9 electronic databases and gray literature. Studies on spiritual care interventions in palliative care were included. Disagreements between the 2 reviewers were resolved by discussion or a third reviewer.
Results
A total of 47 studies were included in this review. All selected articles were published between 2003 and 2022. In total, 8 types of spiritual care interventions were identified to assess spiritual needs and/or alleviate suffering: conversations between the patient and a team member, religious practice interventions, therapeutic presence, guided music therapy, multidisciplinary interventions, guided meditation, art therapy, and combined interventions with multiple components such as music, art, integrative therapy, and reflection.
Significance of results
Our study identified few spiritual care interventions in palliative care worldwide. Although this review noted a gradual increase in studies, there is a need to improve the reporting quality of spiritual care interventions, so they can be replicated in other contexts. The different interventions identified in this review can be a contribution to palliative care teams as they provide a basis for what is currently being done internationally to alleviate suffering in palliative care and what can be improved. No patient or public contribution was required to design or undertake this methodological research.
This chapter provides a research agenda for pediatric climate distress. It is structured into five domains. First, it reviews the importance of delineating among existing definitions of climate distress, including distinguishing between normal and pathological stress responses and integrating concepts from existing anxiety literature. Second, it discusses the importance of researching the epidemiology of climate distress, including developing and validating measurement tools, identifying young people most vulnerable and resilient, and considering the effects of parental mental health and social determinants of health on youths’ psychological responses. Third, it highlights the need to explore the psychological meaning and sequelae of climate change, including moral disengagement, dialectics of climate distress, and moral outrage. Fourth, it points to conventional and novel interventions to address climate distress that require further investigation. Fifth, it reviews the need to assess how climate change may impact young peoples’ psychological distress on a biological level. It concludes with recommendations for how to foster interdisciplinary collaborations and increase funding for this research.
Clinical work with climate-distressed youth using a developmental framework is described, from two theoretical perspectives: acceptance and commitment therapy (ACT) and psychodynamic psychotherapy. General principles of climate-informed therapy are delineated, and case examples illustrate the use of theory in practice. Interventions involving the family, psychoeducation, resilience-building skills, developing a conscious relationship to nature, engaging in environmentally beneficial actions, increasing the tolerance for uncertainty, and developing career goals around the needs of a changing environment and society are described. The authors discuss the need for the clinician to prepare themselves for the challenges of this work, which include one’s own reactions of emotional distress when youth bring this topic up. Ways the clinician can model responses to climate distress are discussed, including staying informed about the multiple unfolding, intersecting crises, and tolerating a multitude of emotional reactions attendant to this urgent situation. The clinician is encouraged to have and use play materials that can be adapted to environmental themes. The importance of providing a secure attachment relationship to use as a base in “weathering the storms” of the climate crisis is emphasized.
Edited by
Allan Young, Institute of Psychiatry, King's College London,Marsal Sanches, Baylor College of Medicine, Texas,Jair C. Soares, McGovern Medical School, The University of Texas,Mario Juruena, King's College London
There is no consensus for the concept of treatment-resistant depression (TRD). Although some authors argue considering TRD a depression subtype is not supported by evidence, its impact on the individual and society is clear. This chapter discusses the concept of TRD, presents evidence about its neurobiology, pharmacological interventions, and describes drugs currently under investigation. Among the pharmacological strategies to manage TRD, guidelines include increasing the antidepressant dose, switching to another new antidepressant, combining two or more antidepressants, and augmentation of the current medication. Several new components have been investigated for TRD targeting, for instance, the glutamatergic system, inflammatory system, the opioid system, the cholinergic system, dopaminergic system, and neurotrophin signaling. Finally, machine-learning techniques using clinical and neurobiological data provide promising information about treatment outcomes prediction that could change the current approach to a more personalized one.
Adolescence is an important life-stage during which shifts towards more healthy and sustainable diets can be promoted. Adolescents have increasing influence over their food choices informed by their developing personal knowledge and values, impacting long-term dietary behaviours into adulthood(1). We aimed to review the recent literature regarding adolescents’ perceptions of environmentally sustainable diets, and interventions to support adolescents to eat sustainably. We reviewed published literature that focussed on adolescent participants and their perceptions of, or interventions to support, sustainable dietary habits. Five electronic databases were searched to include studies published since 2012 that met the inclusion criteria. The JBI approach and PRISMA-Sc checklist(2) was used for source screening, data extraction and presentation of data. Data was extracted including study characteristics, methodology and results in relation to each research question. The extracted data was reported, synthesised and discussed in the context of the food system framework(3) and broader research. Twenty-eight articles were included in the review. Findings suggest that adolescents’ understanding of what constitutes sustainable eating is low. Most adolescents, when asked, were unsure of what constitutes sustainable eating, or a plant-based diet. The environmental impact of the production methods, transport and packaging of foods was most commonly reported when adolescents considered the environmental impact of their foods. The most commonly perceived barrier to consuming sustainable foods mentioned was cost, particularly by adolescents from lower socioeconomic backgrounds. Other barriers include unappealing taste, appearance or smell of ‘sustainable’ food items (particularly those that were vegetarian). Geographical limitations impacting the ability to grow or purchase local and organic products were also mentioned as barriers to consuming sustainable foods. Adolescents reported a lack of understanding of sustainable diets, and distrust of sustainability-related claims from fast-food outlets regarding the quality or source of ingredients, making it difficult to make informed food choices. Additionally, behaviours conflicting with personal and/or group norms were noted as barriers to adopting sustainable dietary habits. Adolescents that had previously received relevant education, valued nature and health, or were from a rural or indigenous community, were more likely to value environmentally sustainable food choices. Interventions which target adolescents’ cognitive understanding and aspiration to make sustainable food choices appear to improve their attitudes towards sustainable food, whereas interventions to increase the availability of sustainable foods improved the environmental sustainability of adolescents’ dietary intake. Multicomponent, tailored and community-based interventions were most effective however the long-term effect of these interventions remains unclear. More research is needed in diverse countries and settings, with consideration of adolescents’ level of autonomy in food choice and long term-effectiveness of interventions.
Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for “at-risk” students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students’ mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme’s underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.
This chapter reviews the evidence behind the anti-misinformation interventions that have been designed and tested since misinformation research exploded in popularity around 2016. It focuses on four types of intervention: boosting skills or competences (media/digital literacy, critical thinking, and prebunking); nudging people by making changes to social media platforms’ choice architecture; debunking misinformation through fact-checking; and (automated) content labelling. These interventions have one of three goals: to improve relevant skills such as spotting manipulation techniques, source criticism, or lateral reading (in the case of boosting interventions and some content labels); to change people’s behavior, most commonly improving the quality of their sharing decisions (for nudges and most content labels); or to reduce misperceptions and misbeliefs (in the case of debunking). While many such interventions have been shown to work well in lab studies, there continues to be an evidence gap with respect to their effectiveness over time, and how well they work in real-life settings (such as on social media).
Greater unpredictability in childhood from the level of the caregiver-child dyad to broader family, home, or environmental instability is consistently associated with disruptions in cognitive, socioemotional, behavioral, and biological development in humans. These findings are bolstered by experimental research in non-human animal models suggesting that early life unpredictability is an important environmental signal to the developing organism that shapes neurodevelopment and behavior. Research on childhood unpredictability has surged in the past several years, guided in part by theoretical grounding from the developmental psychopathology framework (shaped largely by Dr. Dante Cicchetti’s innovative work). The current review focuses on future directions for unpredictability research, including probing intergenerational effects, the role of predictability in resilience, cultural and contextual considerations, and novel developmental outcomes that should be tested in relation to childhood unpredictability. We urge the integration of multidisciplinary perspectives and collaborations into future research on unpredictability. We also provide ideas for translating this research to real-world practice and policy and encourage high-quality research testing whether incorporating predictability into interventions and policy improves developmental outcomes, which would support further dissemination of these findings.
Alcohol is the number one substance used by young people and people of college age. Binge drinking (BD) in this age group is considered one of the most important global health issues, as much harm accrues from it and even lives are lost. This study aimed to review the interventions to curb BD or encourage responsible drinking among college students and young adults. MEDLINE (PubMed), ERIC and APA PsycINFO were searched. The selected articles were published in English and had to evaluate a BD reduction program through a randomized control trial (RCT) among college students or young adults between the ages of 17–24 years. The exclusion criteria included research not published in English, systematic review articles, qualitative studies, designs other than RCTs and discussion articles on college students drinking with no findings. The three reviewers independently screened and extracted the data using the PRISMA guidelines. The overall quality of the studies was assessed. Then, 10 of the 12 interventions studied were found to be successful in reducing BD among college students, though the effect sizes were small to medium. A minority of the studies used behavior change theories. Effective interventions for reducing BD among college students and young adults should include robust behavior change theories, longer follow-up time and the operationalization of multiple outcomes. Process evaluation is needed to be conducted in these studies.
Postpartum depression affects around 12% of mothers in developed countries, with consequences for the whole family. Many women with depressive symptoms remain undetected and untreated. The aim of this study was to investigate to what extent women with depressive symptoms at 6 weeks postpartum are identified by the healthcare system, the interventions they received, and remission rates at 6 months postpartum.
Methods
Postpartum women scoring 12–30 on the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks after delivery (n = 697) were identified from the longitudinal cohort study “Biology, Affect, Stress, Imaging and Cognition” (BASIC) in Uppsala, Sweden. A total of 593 women were included. Background and remission information at 6 months was collected from the BASIC dataset. Medical records were examined to identify interventions received.
Results
Most women (n = 349, 58.7%) were not identified by the healthcare system as having depressive symptoms and 89% lacked any record of interventions. Remission rates at 6 months postpartum were 69% in this group. Among women identified by the healthcare system, 90% received interventions and about 50% were in remission at 6 months postpartum. The EPDS reduction during the study period was largest in the group identified by the child health services (CHS, −5.15) compared to the non-identified (−4.24, p < 0.001).
Conclusions
Despite screening guidelines, many women with depressive symptoms had no documentation of screening or interventions by the healthcare system. Furthermore, a significant proportion did not achieve remission despite interventions. Being identified by CHS was associated with the largest reduction of symptoms. Research is needed to understand gaps in the healthcare processes, to better identify peripartum depression.
This review aims to emphasise the impact of poor nutrition on children’s health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.
This chapter starts by considering the key differences that make public health practice focused on children unique to that focused on adults and older people and emphasizes the importance of early intervention as part of a life-course approach. The demography of the health of children is detailed, followed by a description of the major causes of ill health in children and young people, key public health challenges for this age group and their families and a summary of effective public health interventions to improve health and well-being and reduce inequalities. Three case studies are offered: the impact of the COVID-19 pandemic; childhood obesity; and children’s and adolescents’ mental health. These highlight the complexity of these major public health challenges, how the tools described in Part 1 can be used to understand them and the importance of strategic and system-wide approaches.
Chapter six deals with the period after the Cold War. Social theory describes this era in terms of uncertainty. Such accounts overlook the prevalence of ontologies of certainty in politics, the steady advancement of technologies of predictability and how the current security situation was produced by acts of omission and commission. After 1991, liberal teleologies dominated Western strategy. The seeming ‘end of history’ and triumph of liberalism appeared to close off the future and justify strategies that sidestepped international institutions of predictability. Russia reacted by further undermining institutions and norms that created predictability. This downward spiral has culminated in the current security climate. Russian political world views of the period emphasize eternal political laws, conspiracies and a hostile world. The chapter analyses the starting phases of the Russo-Ukrainian war of 2022. Paradoxically, Western societies are increasingly regular and predictable in numerous ways but reproduce discourses of uncertainty. These trends feed off each other – the more regular everyday life is, the more shocking and disturbing exceptions and surprises become.
Traditional wars with the aim to conquer territory have become rare after WWII. The Russian invasion of Ukraine departs from the trend but does not fundamentally alter it. This book examines the incentives, and restraints on the interstate use of force. Theories on the causes of war are discussed and a description of post-WWII conflicts and uses of force is offered. Discussion of restraints will focus on the role of military – including nuclear – deterrence, on the effects of conciliation, diplomacy, and disarmament and on the effects of restricting legal rules, notably the UN Charter.
Analysis is offered the UN Charter articles, notably Art. 2:4, that relate to the use of force. The Friendly Relations Declaration adopted by the General Assembly in 1970 is a useful tool of interpretation. The forcible seizure of territory is found to be a primary objective of the ban on the use of force. Post WWII, such seizures have been uncommon, but a few are cited. Interventions are of different kinds and many – that contain elements of force – fall under the prohibition in Art. 2:4. The term ‘force ‘does not cover ‘economic pressures’ but may cover various kinds of cyber-attacks. What the ban on ‘threat’ of force covers has not yet been authoritatively clarified. As only force ‘in international relations’ are covered, the article does not restrict governments’ use of force inside their own territories but it does prohibit foreign interventions supporting rebels. The case of the civil war in Syria and the interventions in it is discussed.
The international community has come a long way to develop a fabric of rules by means of treaties. While the effectiveness of this system generally is high, it is not easy to assess the impact of the handful of rules of the UN Charter that outlaw the interstate use of force. The absence of armed conflicts between great powers or other signs of restraints on the use of force may have been the result of other factors than the ban in the Charter, like fear of initiating nuclear war or fear of the economic cost of ruptures. The rule allowing force in self-defence only when an armed attack occurs has been under strain. Interventions have been undertaken, for instance to remove governments or to forestall nuclear proliferation. While unable to take enforcement actions, majorities in the UN General Assembly have been remarkably firm in an orthodox affirmation of the rules. Through interpretation there has also been some mitigation in terse rules. Thus, the prohibition of the interstate use of ‘force’ has not been taken to cover economic pressure and the right to self-defence ‘if an armed attack occurs’ may have regard to both past attacks and attacks deemed ‘imminent’ – but not to ‘anticipated’ self-defence.