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Insomnia disorder in adolescence is prevalent, persistent and associated with adverse outcomes, including reduced quality of life. Cognitive behavioural therapy for insomnia (CBT-i) has shown promise as an effective treatment for adolescents. Recent research has highlighted the role of emotion regulation in insomnia, suggesting that the inclusion of emotion regulation techniques may enhance CBT-i.
Aims:
To evaluate the feasibility and preliminary effectiveness of a CBT-i treatment program for insomnia in early adolescence, augmented with emotion regulation strategies, using a case-series design.
Method:
Three participants (mean 11.67 years) completed the program that consisted of seven, weekly individual therapy sessions and parental participation. Participants monitored their sleep daily during the intervention, and insomnia diagnostic status and severity, use of emotion regulation strategies and quality of life were assessed at baseline, post-intervention and at 6-week follow-up.
Results:
At post-treatment, none of the participants met criteria for insomnia and all reported statistically reliable reductions in symptoms. Improvements were maintained at follow-up for two participants. Sleep onset latency was reduced and improvements in quality of life were evident. There were no changes in the use of emotion regulation strategies following treatment. Adolescents and parents reported high program satisfaction.
Conclusions:
This preliminary evaluation provides support for the effectiveness of the CBT-i program tested. However, given that emotion regulation did not change and yet improvements in sleep were evident, the usefulness of augmenting the program with emotion regulation strategies requires further evaluation.
Bone is a complex tissue-organ system integrating multiple components in hierarchical layers of molecular cues, cellular communities, and networking highways. Bone moves through space and time in a dynamic manner modulated by homeostatic mechanisms nuanced through a coordinated intercalation of biological and biomechanical rhythms. The price we vertebrate species pay for maintaining this magnificently orchestrated tissue-organ is daunting.
Bone is the most metabolically expensive tissue in the human body. For every ounce of bone, a pound of soft tissue is required for maintenance [1]. Moreover, the human skeletal system must be rugged in order to handle years of cyclic loading at high forces on the order of kilonewtons, and highly sensitive to the calibrated kinetics of calcium and phosphate release in order to maintain meticulously modulated ion levels [2]. Consequently, the intrinsic design of bone and the dynamics that sustain it are an instructional core for regenerative bone therapeutics.
In this chapter we will introduce the profoundly compelling biodynamic structural marvel that gives shape to the amorphous mass in which it is wrapped and provides the fulcrums and pulleys that propel our anatomy along the avenues and boulevards of our towns. We will probe the blueprint of bone as a defining mold that guides and mentors attempts in the laboratory to design and develop compositions to repair and regenerate this structural tour de force.
There is good evidence for the benefits of short-term cognitive stimulation therapy for dementia but little is known about possible long-term effects.
Aims
To evaluate the effectiveness of maintenance cognitive stimulation therapy (CST) for people with dementia in a single-blind, pragmatic randomised controlled trial including a substudy with participants taking acetylcholinesterase inhibitors (AChEIs).
Method
The participants were 236 people with dementia from 9 care homes and 9 community services. Prior to randomisation all participants received the 7-week, 14-session CST programme. The intervention group received the weekly maintenance CST group programme for 24 weeks. The control group received usual care. Primary outcomes were cognition and quality of life (clinical trial registration: ISRCTN26286067).
Results
For the intervention group at the 6-month primary end-point there were significant benefits for self-rated quality of life (Quality of Life in Alzheimer's Disease (QoL-AD) P = 0.03). At 3 months there were improvements for proxy-rated quality of life (QoL-AD P = 0.01, Dementia Quality of Life scale (DEMQOL) P = 0.03) and activities of daily living (P = 0.04). The intervention subgroup taking AChEIs showed cognitive benefits (on the Mini-Mental State Examination) at 3 (P = 0.03) and 6 months (P = 0.03).
Conclusions
Continuing CST improves quality of life; and improves cognition for those taking AChEIs.
This paper describes the rationale for and development of an online cognitive-behavioural treatment for child and adolescent anxiety (BRAVE–ONLINE). It highlights the challenges involved in adapting a clinic-based intervention for delivery using the internet, with separate sessions for parents and their children (or adolescents). We outline strategies to ensure that young people remain engaged in online therapy, and describe techniques designed to optimize the alliance between clients and the online therapist. Two case studies are presented that illustrate the practical and technical aspects of implementing the intervention, and demonstrate the feasibility of achieving successful outcomes using online delivery of CBT for child and adolescent anxiety. However, firm conclusions regarding the efficacy of this approach cannot be drawn until the results of randomized controlled trials are available. The paper identifies directions for future research.
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