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L’efficacia dei trattamenti non farmacologici
Abstract
Health is a complex and multifactorial construct that coincides with a state of complete physical, mental and social well-being and does not merely consist of the absence of disease, impairment, or infirmity. For this reason, pharmacological treatments alone cannot achieve well-being in the person to whom they are being administered. A growing body of studies on the placebo effect and unconventional treatments are testing the effectiveness of tools, techniques, and alternative procedures in pharmacological treatment, with more and more encouraging results. As a consequence of these findings, a new concept of care is emerging, which is pushing the specific techniques of each approach, pharmacological or not, into the background by focusing on the factors which are common to all treatments. The element that can summarize the majority of these factors is, in all likelihood, a helping relationship, within which techniques, medications, and placebos acquire meaning and significance as useful tools to achieve personal well-being.
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Objective: honpharmacological treatments are available for attention deficit hyperactivity disorder (ADHD), although their efficacy remains uncertain. The authors undertook meta-analyses of the efficacy of dietary (restricted elimination diets, artificial food color exclusions, and free fatty acid supplementation) and psychological (cognitive training, neurofeedback, and behavioral interventions) ADHD treatments. Method: using a common systematic search and a rigorous coding and data extraction strategy across domains, the authors searched electronic databases to identify published randomized controlled trials that involved individuals who were diagnosed with ADHD (or who met a validated cutoff on a recognized rating scale) and that included an ADHD outcome. Results: fifty-four of the 2,904 nonduplicate screened records were included in the analyses. Two different analyses were performed. When the outcome measure was based on ADHD assessments by raters closest to the therapeutic setting, all dietary (standardized mean differences=0.21–0.48) and psychological (standardized mean differences=0.40–0.64) treatments produced statistically significant effects. However, when the best probably blinded assessment was employed, effects remained significant for free fatty acid supplementation (standardized mean difference=0.16) and artificial food color exclusion (standardized mean difference=0.42) but were substantially attenuated to nonsignificant levels for other treatments. Conclusions: free fatty acid supplementation produced small but significant reductions in ADHD symptoms even with probably blinded assessments, although the clinical significance of these effects remains to be determined. Artificial food color exclusion produced larger effects but often in individuals selected for food sensitivities. Better evidence for efficacy from blinded assessments is required for behavioral interventions, neurofeedback, cognitive training, and restricted elimination diets before they can be supported as treatments for core ADHD symptoms
Luborsky et al.'s findings of a non-significant effect size between the outcome of different therapies reinforces earlier meta-analyses demonstrating equivalence of bonafide treatments. Such results cast doubt on the power of the medical model of psychotherapy, which posits specific treatment effects for patients with specific diagnoses. Furthermore, studies of other features of this model—such as component (dismantling) approaches, adherence to a manual, or theoretically relevant interaction effects—have shown little support for it. The preponderance of evidence points to the widespread operation of common factors such as therapist-client alliance, therapist allegiance to a theoretical orientation, and other therapist effects in determining treatment outcome. This commentary draws out the implications of these findings for psychotherapy research, practice, and policy.
Il modello di disabilità proposto alla comunità internazionale dall’Organizzazione Mondiale della Sanità [OMS] e diffuso attraverso la Classificazione internazionale del funzionamento, della disabilità e della salute [ICF] (WHO, 2001), apre nuove prospettive sulla ridefinizione dell’intervento preventivo. Definito come modello di tipo biopsicosociale, in quanto integra le varie dimensioni del funzionamento umano proposte da due modelli dicotomici che per anni hanno caratterizzato opposte fazioni all’interno del dibattito internazionale sulla disabilità (il modello medico e il modello sociale), il modello biopsicosociale risulta dirompente per il concetto di “prevenzione terziaria che ha come scopo limitare le disabilità connesse al disturbo”, come ricorda Ammaniti nell’intervento che inaugura questo dibattito, ed apre una serie di problemi e di prospettive che vorremmo tentare qui di richiamare.
The authors present background on the development of principles for the identification of empirically supported interventions in counseling psychology by the American Psychological Association's Division 17 and include an overview of guiding considerations around which these principles were developed As a context for these principles, the authors present a brief history of the social-economic-professional context within which the sometimes contentious movement toward the recognition of empirically supported treatments has developed within Seven principles for the consideration of the empirical support of counseling psychology interventions are presented along with discussion of the rationale behind each principle.
This paper uses the fictional case of the ‘Babel fish’ to explore and illustrate the issues involved in the controversy about the use of cochlear implants in prelinguistically deaf children. Analysis of this controversy suggests that the development of genetic tests for deafness poses a serious threat to the continued flourishing of Deaf culture. I argue that the relationships between Deaf and hearing cultures that are revealed and constructed in debates about genetic testing are themselves deserving of ethical evaluation. Making good policy about genetic testing for deafness will require addressing questions in political philosophy and anthropology about the value of culture and also thinking hard about what sorts of experiences and achievements make a human life worthwhile.
This study reviews the most recent (from 2000 to 2011) Clinical Controlled Trials (CCT) and Randomized Controlled Trials (RCT) concerning the use of music and music-therapy (MT) in the context of dementia and related issues. Studies which explored the efficacy of music and MT on behavioral and psychological symptoms of dementia (BPSD) are prevalent, while those aiming at assessing a potential effect of these approaches on cognitive and physiological aspects are scant. Although with some limitations, the results of these studies are consistent with the efficacy of MT approach on BPSD. In this context, the ability of the music therapist to directly interact with the patients appears to be crucial for the success of the intervention. This review was endorsed by the Italian Psychogeriatric Association (AIP) and represents its view about the criteria to select appropriate music and MT approaches in the field of dementia. Accordingly, we have developed a list of recommendations to facilitate the current use of these techniques in the context of non-pharmacological treatments for patients with dementia.
Quality of life depends on various physical and social conditions, such as the epidemiological environment in which a person lives. The availability of health care and the nature of medical insurance—public as well as private—are among the important influences on life and death. So are other social services, including basic educa tion and the orderliness of urban living, and the access to modern medical knowledge in rural communities. The statistics on mortality draw our attention to all these policy issues. Mortality information can throw light also on the nature of social inequalities, including gender bias and racial disparities
Integrative oncology is the synthesis of mainstream cancer care and evidence-based complementary therapies. Complementary strategies include massage therapies, acupuncture, fitness, and mind-body techniques, which take advantage of the reciprocal relationship between the mind and body. Neuropathic pain--and pain more generally--is part of a complex process involving the whole physical and psychosocial being, therefore requiring an integrative management approach. Several studies have demonstrated, for example, that social context plays an important role in the perception of pain and that a patient's coping strategies can influence the persistence of pain. In this article, we briefly describe research illustrating the promise of integrative approaches for the treatment of cancer-related neuropathic pain.
Co-occurring pain, fatigue, and sleep disturbance comprise a common symptom cluster in patients with cancer. Treatment approaches that target the cluster of symptoms rather than just a single symptom need to be identified and tested.
To synthesize evidence regarding mind-body interventions that have shown efficacy in treating two or more symptoms in the pain-fatigue-sleep disturbance cancer symptom cluster.
A literature search was conducted using CINAHL, Medline, and PsychInfo databases through March 2009. Studies were categorized based on the type of mind-body intervention (relaxation, imagery/hypnosis, cognitive-behavioral therapy/coping skills training [CBT/CST], meditation, music, and virtual reality), and a preliminary review was conducted with respect to efficacy for pain, fatigue, and sleep disturbance. Mind-body interventions were selected for review if there was evidence of efficacy for at least two of the three symptoms. Forty-three studies addressing five types of mind-body interventions met criteria and are summarized in this review.
Imagery/hypnosis and CBT/CST interventions have produced improvement in all the three cancer-related symptoms individually: pain, fatigue, and sleep disturbance. Relaxation has resulted in improvements in pain and sleep disturbance. Meditation interventions have demonstrated beneficial effects on fatigue and sleep disturbance. Music interventions have demonstrated efficacy for pain and fatigue. No trials were found that tested the mind-body interventions specifically for the pain-fatigue-sleep disturbance symptom cluster.
Efficacy studies are needed to test the impact of relaxation, imagery/hypnosis, CBT/CST, meditation, and music interventions in persons with cancer experiencing concurrent pain, fatigue, and sleep disturbance. These mind-body interventions could help patients manage all the symptoms in the cluster with a single treatment strategy.