No abstract

Although trauma-focused cognitive behavior therapy (TF-CBT) is the frontline treatment for post-traumatic stress disorder (PTSD), up to one-half of patients are treatment nonresponders. To understand treatment nonresponse, it is important to understand the neural mechanisms of TF-CBT. Here, we used whole-brain intrinsic functional connectivity analysis to identify neural connectomic signatures of treatment outcome. In total, 36 PTSD patients and 36 healthy individuals underwent functional MRI at pre-treatment baseline. Patients then underwent nine sessions of TF-CBT and completed clinical and follow-up MRIs. We used an established large-scale brain network atlas to parcellate the brain into 343 brain regions. Pairwise intrinsic task-free functional connectivity was calculated and used to identify pretreatment connectomic features that were correlated with reduction of PTSD severity from pretreatment to post treatment. We formed a composite metric of intrinsic connections associated with therapeutic outcome, and then interrogated this composite metric to determine if it distinguished PTSD treatment responders and nonresponders from healthy control status and changed post treatment. Lower pre-treatment connectivity for the cingulo-opercular, salience, default mode, dorsal attention, and frontoparietal executive control brain networks was associated with treatment improvement. Treatment responders had lower while nonresponders had significantly greater connectivity than controls at pretreatment. With therapy, connectivity significantly increased for responders and decreased for nonresponders, while controls remain unchanged over this time period. We provide evidence that the intrinsic functional architecture of the brain, specifically connectivity within and between brain networks associated with external vigilance, self-awareness, and cognitive control, may characterize a positive response to TF-CBT for PTSD.

Background Secondary schools are increasingly supporting adolescents’ mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators’ skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers’ knowledge and confidence in caring for students’ mental health. Objective This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers. Methods A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants’ perceptions of program effectiveness. Results A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness. Conclusions Findings indicated that a web-based training program may be beneficial for improving secondary school teachers’ abilities to care for students’ mental health; however, program modifications are required to increase training completions. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529

Anxiety is common in those with medical conditions and has significant impacts on mental well‐being as well as physical health outcomes. While several systematic reviews have examined the prevalence of anxiety in specific dermatological conditions, no reviews have examined the prevalence across the entire dermatology outpatient setting. This systematic review aims to provide an overview to dermatologists of the prevalence of, and trends in, anxiety in their outpatient clinics. As such, prevalence of anxiety in dermatology outpatient clinics was examined, and variations across type of anxiety and dermatological conditions were assessed. A search of PubMed, Embase, Cochrane and PsycINFO was conducted for studies that assessed anxiety prevalence in dermatology outpatients, with the last search conducted on 7 September 2022. Results underwent title/abstract and full‐text screening, followed by data extraction. Studies of patients 16 years and older and representative of dermatology clinics were included. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklist. Meta‐analysis was conducted using CMA software, and subgroup analysis was conducted on relevant variables. 5423 studies were identified, and 32 included, with a total n = 12,812 participants. Under the random effects model, prevalence was estimated at 26.7% (95%CI 22.4–31.4; 95%PI 9.7–55.4). Subgroup analysis revealed a higher prevalence among studies of psoriasis patients than general dermatology studies. Estimates of prevalence were higher when assessed via self‐report screening than diagnostic interview. Anxiety occurred frequently among dermatology outpatients, especially psoriasis outpatients, at a higher rate than common estimates of prevalence in the general population. Given the effect of anxiety on patient outcomes and well‐being, dermatologists are encouraged to consider how anxiety may impact patients in their clinic, and how they can best identify patients with anxiety and subsequently support them.