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Depression and anxiety disorders are common mental disorders worldwide. The MANAS trial aimed to test the effectiveness of an intervention led by lay health counsellors in primary care settings to improve outcomes of people with these disorders. In this cluster randomised trial, primary care facilities in Goa, India, were assigned (1:1) by computer-generated randomised sequence to intervention or control (enhanced usual care) groups. All adults who screened positive for common mental disorders were eligible. The collaborative stepped-care intervention offered case management and psychosocial interventions, provided by a trained lay health counsellor, supplemented by antidepressant drugs by the primary care physician and supervision by a mental health specialist. The research assessor was masked. The primary outcome was recovery from common mental disorders as defined by the International Statistical Classification of Diseases and Related Health Problems—10th revision (ICD-10) at 6 months. This study is registered with ClinicalTrials.gov, number NCT00446407. 24 study clusters, with an equal proportion of public and private facilities, were randomised equally between groups. 1160 of 1360 (85%) patients in the intervention group and 1269 of 1436 (88%) in the control group completed the outcome assessment. Patients with ICD-10-confirmed common mental disorders in the intervention group were more likely to have recovered at 6 months than were those in the control group (n=620 [65·0%] vs 553 [52·9%]; risk ratio 1·22, 95% CI 1·00–1·47; risk difference=12·1%, 95% CI 1·6%–22·5%). The intervention had strong evidence of an effect in public facility attenders (369 [65·9%] vs 267 [42·5%], risk ratio 1·55, 95% CI 1·02–2·35) but no evidence for an effect in private facility attenders (251 [64·1%] vs 286 [65·9%], risk ratio 0·95, 0·74–1·22). There were three deaths and four suicide attempts in the collaborative stepped-care group and six deaths and six suicide attempts in the enhanced usual care group. None of the deaths were from suicide. A trained lay counsellor-led collaborative care intervention can lead to an improvement in recovery from CMD among patients attending public primary care facilities. The Wellcome Trust.

Individuals with generalized anxiety disorder (GAD) often face challenges with self-regulation and limited access to traditional therapy. Although acceptance and commitment therapy (ACT) has demonstrated both efficacy and effectiveness in promoting psychological flexibility, scalable solutions are necessary to address these barriers. This study introduces Anzeilax, an ACT-based digital therapeutic (DTx) that incorporates self-talk as a novel mechanism of action (MoA) to enhance psychological flexibility in the treatment of GAD. This study aimed to evaluate the efficacy of Anzeilax in reducing anxiety symptoms in individuals with GAD. A 10-week, parallel-group, superiority randomized controlled trial (RCT) was conducted with 96 participants diagnosed with GAD (Generalized Anxiety Disorder 7-item scale [GAD-7] scores≥10, age≥19 years). The participants were randomly assigned (1:1) to receive either Anzeilax alongside treatment as usual (TAU, treatment group; n=48, 50%) or TAU alone (control group; n=48). Only the outcome evaluators were blinded to the group assignment. The primary outcome was the change in the GAD-7 score from baseline to week 10. The secondary outcomes included the Beck Anxiety Inventory (BAI) for anxiety symptoms, the Penn State Worry Questionnaire (PSWQ) for pathological worry, and the Hospital Anxiety and Depression Scale (HADS) for anxiety (HADS-A) and depression (HADS-D) symptoms. All self-report outcomes were assessed at baseline and at weeks 5 (midintervention), 10 (postintervention), and 15 (follow-up). During the trial, 34 (71%) and 31 (65%) participants in the treatment group maintained at least 80% of the prescribed usage frequency at weeks 5 and 10, respectively. Based on the full analysis set (FAS), participants using Anzeilax demonstrated significant improvement in anxiety symptoms compared to the control group. Analysis of the primary outcome at 10 weeks postintervention compared to baseline exhibited a significant reduction in GAD-7 scores (adjusted mean difference -2.26, 95% CI -3.78 to -0.74, P=.002). Secondary outcomes at the same time point indicated consistent improvements, with significant group-by-time interactions observed in the GAD-7 (Cohen d=0.60, P=.008), BAI (Cohen d=0.50, P=.008), PSWQ (Cohen d=0.62, P=.002), and HADS-A (Cohen d=0.50, P=.01) scores. These improvements were sustained at the follow-up assessment (week 15). Although the differences in depressive symptoms between the two groups did not present statistical significance, notable improvements were observed in the treatment group. Anzeilax demonstrated clinically meaningful efficacy in reducing anxiety symptoms when combined with TAU. The results showed consistent improvements across multiple anxiety measures, with effects sustained through follow-up. The incorporation of context-sensitive self-talk within an ACT-based DTx framework offers a promising and accessible solution for treating individuals with GAD. ClinicalTrials.gov NCT06010654; https://clinicaltrials.gov/study/NCT06010654.

This study examined the relationship between caregivers’ and youths’ treatment expectations and characteristics of exposure tasks (quantity, mastery, compliance) in cognitive-behavioral therapy (CBT) for childhood anxiety. Additionally, compliance with exposure tasks was tested as a mediator of the relationship between treatment expectations and symptom improvement. Data were from youth (N = 279; 7–17 years old) enrolled in the Child/Adolescent Anxiety Multimodal Study (CAMS) and randomized to cognitive-behavioral therapy (CBT) or the combination of CBT and sertraline for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. Caregivers and youth independently reported treatment expectations prior to randomization, anxiety was assessed pre- and post-treatment by independent evaluators blind to treatment condition, and exposure characteristics were recorded by the cognitive-behavioral therapists following each session. For both caregivers and youths, more positive expectations that anxiety would improve with treatment were associated with greater compliance with exposure tasks, and compliance mediated the relationship between treatment expectations and change in anxiety symptoms following treatment. Additionally, more positive parent treatment expectations were related to a greater number and percentage of sessions with exposure. More positive youth treatment expectations were associated with greater mastery during sessions focused on exposure. Findings underscore the importance of addressing parents’ and youths’ treatment expectations at the outset of therapy to facilitate engagement in exposure and maximize therapeutic gains.

\"Description Illustrating the power of play for helping children overcome a wide variety of worries, fears, and phobias, this book provides a toolkit of play therapy approaches and techniques. Coverage encompasses everyday fears and worries in 3- to 12-year-olds as well as anxiety disorders and posttraumatic problems. Leading practitioners describe their approaches step by step and share vivid illustrative case material. Each chapter also summarizes the research base for the interventions discussed. Key topics include adapting therapy to each child's developmental level, engaging reluctant or less communicative clients, and involving parents in treatment. Keywords children, childhood anxieties, anxiety disorders, play therapy, psychotherapy, therapeutic play, interventions, techniques, worries, fears, phobias, schools, posttraumatic stress disorder, PTSD, treatments, approaches, Theraplay, nightmares, nighttime fears, afraid of the dark, selective mutism, obsessive-compulsive disorder, OCD, separation anxiety, social anxiety disorder, generalized anxiety disorder, disasters, child sexual abuse, play-based treatments, play activities, counseling children, counselors, psychotherapists, parents, parenting strategies, school-age children, preschoolers, anxious children, fearful children, traumatized children, worrying, car accidents, stressful life events, books on play therapy, books on childhood anxiety\"-- Provided by publisher.

Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults. We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults. We examined findings for the overall sample, as well as within each diagnostic category (clinicaltrials.gov identifier: NCT00347269). The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults. These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.

\"_This widely used book is packed with indispensable tools for treating the most common clinical problems encountered in outpatient mental health practice. Chapters provide basic information on depression and the six major anxiety disorders; step-by-step instructions for evidence-based assessment and intervention; illustrative case examples; and practical guidance for writing reports and dealing with third-party payers. In a convenient large-size format, the book features 125 reproducible client handouts, homework sheets, and therapist forms for assessment and record keeping. The included CD-ROM enables clinicians to rapidly generate individualized treatment plans, print extra copies of the forms, and find information on frequently prescribed medications._New to This Edition*The latest research on each disorder and its treatment.*Innovative techniques that draw on cognitive, behavioral, mindfulness, and acceptance-based approaches.*Two chapters offering expanded descriptions of basic behavioral and cognitive techniques.*47 of the 125 reproducibles are entirely new. __\"--Provided by publisher.

Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance. Patients who had recently attempted suicide were randomly allocated to treatment as usual (n = 60) or treatment as usual plus ASSIP (n = 60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-month follow-up period. The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry. The primary outcome measure was repeat suicide attempts during the 24-month follow-up period. Secondary outcome measures were suicidal ideation, depression, and health-care utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated. During the 24-month follow-up period, five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n = 5) and 26.7% (n = 16). ASSIP was associated with an approximately 80% reduced risk of participants making at least one repeat suicide attempt (Wald χ21 = 13.1, 95% CI 12.4-13.7, p < 0.001). ASSIP participants spent 72% fewer days in the hospital during follow-up (ASSIP: 29 d; control group: 105 d; W = 94.5, p = 0.038). Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n = 20) had more previous suicide attempts and a higher number of reattempts. Key study limitations were missing data and dropout rates. Although both were generally low, they increased during follow-up. At 24 months, the group difference in dropout rate was significant: ASSIP, 7% (n = 4); control, 22% (n = 13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment. ASSIP, a manual-based brief therapy for patients who have recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy-to-administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings. ClinicalTrials.gov NCT02505373.