Monday, 13 August 2018

With Short, Intense Sessions, Some

With Short, Intense Sessions,
With Short, Intense Sessions, Some Patients Finish Therapy in only Weeks
Six middle- and high-school students sat around a table on a Monday afternoon, watching a psychologist write three letters on a whiteboard:


“What does O.C.D. stand for?” the psychologist, Avital Falk asked the group.
“Obsessive-compulsive disorder,” answered a timid A 12-year-old boy wearing a blue blazer and red tie.
“What makes it a disorder?” Dr. Falk asked.
“Because it’s messing up our lives,” said Sydney, a chatty 14-year-old with long red hair.
These children have O.C.D., an illness characterized by recurrent, intrusive thoughts and repetitive behaviors, or other problems with anxiety.
They are also participants during a novel treatment program at Weill Cornell Medicine in NY.
Typically patients with O.C.D. see a therapist once every week for an hour over several months, but this program consists of two-hour group meetings 3 times every week, plus up to four additional hours of individual therapy per week.
Some patients complete the treatment in only fortnight.
The program, which began in 2016, is a component of a replacement wave of concentrated, intensive therapy programs for psychiatric disorders.
The kid Mind Institute in NY launched a two-day “boot camp” for teens with social anxiety last year.
The Houston O.C.D. Program in Texas operated its first weeklong treatment program for adolescents during respite for local schools.
In Atlanta, Emory University is in its third year of a two-week therapy program for veterans with post-traumatic stress disorder, funded by the Wounded Warrior Project.
Similar offerings for veterans are now available at U.C.L.A. Health in California, Rush University center in Chicago and Massachusetts General Hospital in Boston.
The approach is gaining popularity partially due to new research showing that for both adults and youngsters, the concentrated the approach is usually even as effective, and in some ways simpler, as treatment that's opened up over several months.

A meta-analysis of randomized, controlled trials published last year within the journal Behaviour Research and Therapy found remission rates of 54 percent for youngsters in intensive, concentrated cognitive behavioral therapy (C.B.T.) for anxiety disorders and 57 percent for those in standard C.B.T., a difference that wasn't statistically significant.
Just 2.3 percent of patients who did the concentrated therapy dropped out during treatment, compared with 6.5 percent for normal C.B.T. At Emory, only 5 percent of veterans within the two-week PTSD program left before finishing, consistent with a paper published within the fall of 2017.
Another meta-analysis (this one among both randomized, controlled trials and studies without an impact group), published in 2015 within the Journal of Obsessive-Compulsive and Related Disorders, found that O.C.D. patients who were treated with intensive, concentrated therapy were more improved after treatment ended than those that received traditional weekly or twice weekly C.B.T.
At a follow-up point of about three months, both groups were equally improved.
The intensive treatments seem to figure best for anxiety-related disorders.
They typically contain C.B.T., during which patients repeatedly expose themselves to the very situations they fear.
Supporters of the approach said that while it's going to involve an identical number of total hours as weekly therapy, relief is quicker. Thomas H.

Ollendick, a psychology professor at Virginia Tech, who helped pioneer a one-day treatment for phobias and has studied a one-week treatment for O.C.D. said this will be crucial for people whose illnesses are preventing them from attending school or work.
And with concentrated treatment, Dr. Ollendick said, “you don’t have every week in between to unlearn what you learned within the session or have additional experiences which will lead you to think, ‘Oh, I better be afraid.’”
The concentrated format allows therapists to deliver evidence-based treatment to more people, since it’s easier for patients who sleep in places without access to high-quality therapy to travel for a one- of the two-week program, said Donna B.

Pincus, director of the kid and Adolescent Fear and Anxiety Treatment Program at Boston University, which runs five- to eight-day intensive treatment programs for anxiety disorder, separation mental disorder and phobias.
Even patients who live nearby may find it easier to require off every week of labor or plan treatment during a faculty break, instead of affect the logistics of weekly therapy.
“People are pulled out of their everyday lives for 2 weeks — they're not handling work and spouses and youngsters,” said Barbara O. Rothbaum, a professor of psychiatry and behavioral sciences at the Emory University School of drugs.
“It really may be quite a bubble for them to try to this work.”
The intensive, concentrated approach also has downsides.
The worth tag for the Houston respite program, for instance, was $2,500 for the week.
Many programs don’t accept insurance.

Sometimes insurance companies will reimburse for less than a little portion of treatment or would require patients to first prove that less intensive therapy has failed before coverage kicks in.
Patients also got to be motivated and prepared and willing to maneuver quickly into exposure work, noted Boston University’s, Dr. Pincus.
Some patients use concentrated therapies to kick-start treatment or as an adjunct to longer-term therapy.

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