Behaviour research and therapy
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Review Meta Analysis
Moderators of the effect of psychological interventions on depression and anxiety in cardiac surgery patients: A systematic review and meta-analysis.
Cardiac surgery patients may be provided with psychological interventions to counteract depression and anxiety associated with surgical procedures. This systematic review and meta-analysis investigated whether intervention efficacy was impacted by type of cardiac procedure/cardiac event; control condition content; intervention duration; intervention timing; facilitator type; and risk of bias. MEDLINE, EMBASE, and PsycINFO were searched for randomized controlled trials comparing anxiety and depression outcomes, pre and post psychological and cardiac interventions. ⋯ Depression (but not anxiety) was reduced more when the experimental intervention was compared to an 'alternative' intervention, and when the intervention was delivered to coronary artery bypass graft patients. Anxiety (but not depression) was decreased more when interventions were delivered to implantable cardioverter defibrillator patients, and were of 'high' or 'unclear' risk of bias. In addition to estimating efficacy, future work in this domain needs to take into account the moderating effects of intervention, sample, and study characteristics.
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Review Meta Analysis
Moderators of the effect of psychological interventions on depression and anxiety in cardiac surgery patients: A systematic review and meta-analysis.
Cardiac surgery patients may be provided with psychological interventions to counteract depression and anxiety associated with surgical procedures. This systematic review and meta-analysis investigated whether intervention efficacy was impacted by type of cardiac procedure/cardiac event; control condition content; intervention duration; intervention timing; facilitator type; and risk of bias. MEDLINE, EMBASE, and PsycINFO were searched for randomized controlled trials comparing anxiety and depression outcomes, pre and post psychological and cardiac interventions. ⋯ Depression (but not anxiety) was reduced more when the experimental intervention was compared to an 'alternative' intervention, and when the intervention was delivered to coronary artery bypass graft patients. Anxiety (but not depression) was decreased more when interventions were delivered to implantable cardioverter defibrillator patients, and were of 'high' or 'unclear' risk of bias. In addition to estimating efficacy, future work in this domain needs to take into account the moderating effects of intervention, sample, and study characteristics.
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The last few decades has seen psychological theories of chronic pain dominated by behavioural concepts and particularly, by the operant model as described by Fordyce et al. (1968: Fordyce, W., Fowler, R., & DeLateur, B. (1968) An application of behavior modification technique to a problem of chronic pain. Behaviour Research and Therapy, 6, 105-107, 1976: Fordyce, W. E. (1976) Behavioral methods for chronic pain and illness. ⋯ Instead, consistent with research from other areas (particularly the anxiety disorders), chronic pain and the problems associated with it may be better explained by a reformulated cognitive-behavioural theory which although not ignoring the observable behaviours of pain patients and their associations with social reinforcers, interprets these phenomena from a cognitive perspective. Thus, a modified CBT is proffered, focusing more directly on patients' thoughts about, and appraisals of, their pain. Evidence in support of such a theory is provided, as are suggestions for further research and the implications such a theory has for treatment.
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Rachman's (1980) analysis [Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy, 18, 51-60] of emotional processing is extended and applied to the prevention of relapse and recurrence in depression. ⋯ Only the last of these facilitates emotional processing; the second may prevent effective emotional processing and perpetuate depression by ruminative, conceptually dominated processing. This analysis suggests a further strategy to prevent relapse, in addition to modifying depressogenic schematic models, by teaching recovered depressed patients skills to switch processing modes by intentional redeployment of attention. Results of a recent trial of mindfulness-based cognitive therapy support the effectiveness of this novel alternative strategy.
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Although there is anecdotal evidence for the psychoanalgesic properties of distraction, research evidence is equivocal. Drawing on the clinical and experimental studies of attention-based coping strategies for pain control, and the theoretically driven 'cognitive' models of the human attention system, two experiments are reported. ⋯ Experiment Two tests the hypothesis that the low intensity pain patients in Experiment One are coping with the dual demand of processing the pain and processing the task by switching quickly between these attentional demands. The results of both experiments are discussed in terms of the evidence for the analgesic properties attention based coping strategies with clinical pain populations and re-addresses the literature on coping with pain in terms of cognitive theories of attention.