any number of additional interventions utilized at the same time as a main intervention to supercharge treatment efficacy. For instance, drugs might be utilized at the same time as CBT (cognitive behavior therapy), with the CBT being the main type of intervention- psychotherapy as part of a group might be utilized in addition to psychodynamic therapy on a personal level, having every intervention present it’s individual views and techniques to press upon the patient’s cognitive consciousness and renewal. Adjunctive treatment is usually executed by a doctor who is not the physician being used to execute the main intervention.
ADJUNCTIVE THERAPY : “Adjunctive therapy is a common approach for severe alcoholism in which CBT might be used in conjunction with the prescribing of Anabuse.”
Cite this page: N., Sam M.S., “ADJUNCTIVE THERAPY,” in PsychologyDictionary.org, April 7, 2013, https://psychologydictionary.org/adjunctive-therapy/ (accessed January 16, 2023).
Caption: Options for posturgical
adjunctive
treatment of keloids include corticosteroid injections, injectable interferon, and pressure dressings, according to Dr.
Adjunctive
Nutraceuticals for Depression: A Systematic Review and Meta-Analyses.
(14) Patients in the
adjunctive
therapy study were randomized to flexibly dosed LATUDA 20-120 mg/day plus lithium or valproate (N=183) or placebo plus lithium or valproate (N=165).
In addition to demographic data, we compiled information on disease severity, the type of
adjunctive
treatment administered to each patient, the frequency of debridements, the length of observation, and remission rates.
3.3 Meta-analysis results for changes in weight and BMI after
adjunctive
treatment with metformin
This strict adherence to one mood stabilizer, combined with
adjunctive
personalized treatments such as antidepressants or benzodiazepines, prescribed at the discretion of the treating clinician, ensured that the study tested the strategy of using either lithium or quetiapine as the base of treatment, Dr.
Adjunctive
naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year.
Here are some additional examples of
adjunctive
dental care that TRICARE may cover:
OBJECTIVE: This meta-analysis aimed to assess the effectiveness and safety of Chinese herbal medicine (CHM) as an
adjunctive
method to standard therapy for patients with diabetic foot ulcers (DFU).
In a unanimous vote, a federal advisory panel agreed that the antiepileptic drug ezogabine had been shown to be effective as
adjunctive
therapy for partial onset seizures, but recommended that treated patients be closely monitored for the development of urinary retention.
The panellists reached a high level of consensus regarding a definition of yoga and agreed upon its’ general therapeutic benefits. All experts agreed that yoga is a form of exercise focused on strength, flexibility and balance that involves movement through postures and involves a focus on breath. Most acknowledged that yoga aims to integrate body and mind, is an embodied, mindful practice encouraging an individual to bring attention to their own experience in their body, including bodily sensations, breaths and thoughts that can enhance physical mental and emotional wellbeing. These descriptions of yoga are consistent with popular conceptualisations of the practice within Western culture [25, 26] that tend to place less emphasis on philosophical components of traditional practice. As such, it was unsurprising that, although some experts acknowledged the spiritual, ethical components of living a non-destructive life promoted by yoga philosophy [24, 44], the panel did not reach consensus on these items.
Although the panel reached criteria for consensus that ‘yoga is a nice adjunct therapy for various problems, physically and emotionally’, when presented with items generated pertaining to yoga’s usefulness in specific disorders, the opinions of experts were mixed. For example, panellists agreed on the usefulness of yoga as an adjunct therapy for mood disorders at a rate nearing consensus (82.35%), consistent with research in the field [45, 46]. Notably, none of the experts made comments or direct reference to bipolar disorder in the present study, possibly reflecting a dearth of research in this area [47]. Lack of research may also explain why comments made by experts around yoga for anxiety reduction were also not met with panel consensus, despite recent meta-analytical evidence demonstrating small short-term effects of yoga on anxiety compared to no treatment [48]. Additionally, whilst yoga was highlighted by some panellists as a useful adjunct therapy for trauma, when asked to rate and rerate collective opinion, the majority of experts selected ‘neither agree nor disagree’ as their response. As reflected by comments made by panellists, it is possible that some experts were not familiar with research conducted in the area and as such were tentative in providing an opinion [46, 48, 49].
Given the lack of consensus found regarding use of yoga in depression, anxiety and trauma, it was foreseeable that consensus would similarly not be achieved around the use of yoga to treat these symptoms when occurring concurrently in people with AN. Indeed, very few studies have examined the use of yoga specifically in patients diagnosed with AN [30, 31]. In a clinical RCT [30], Carei et al. found that a group of AN/BN patients with a comorbid DSM-IV diagnosis of psychotic disorder, conversion disorder, substance related disorder or/and an Axis II disorder demonstrated greater decreases in eating disorder symptoms (assessed with the Eating Disorder Examination) while Body Mass Index (BMI) was maintained compared to the control group (standard care only) when receiving the yoga intervention with standard care. However, both control and intervention groups demonstrated lower scores on anxiety and depression over time (using Beck Depression Inventory & State-Trait Anxiety Inventory) and thus reduced symptomology could be explained by the standard care each group received rather than the yoga intervention. Effect sizes were also small with low statistical power due to limited sample size, with no differentiation made between AN and Bulimia Nervosa (BN) patients. This suggests that, despite the availability of preliminary evidence regarding the effectiveness of yoga in alleviating anxiety and depressive symptoms, these findings are not yet supported in clinical samples with comorbid AN.
In contrast, it is noteworthy that the majority of items that reached consensus pertaining to the use of yoga as an adjunct therapy in AN populations consisted of cautionary statements about its use in clinical settings and thus should be carefully considered. Items included recommendations that yoga should only be used when the patient with AN is medically stable and that positive responses regarding the use of yoga are not valid across the board for all people with AN, notably those in a very compromised physical condition. Experts also expressed concern at a level reaching consensus that there is a risk of yoga being harmful because it could be used to increase calorie expenditure, that individual with AN may tend to be obsessional and perfectionistic in their practice and gravitate towards strenuous forms of yoga (e.g. hot yoga, power yoga) which are detrimental. Although some promising research has emerged on the use of yoga in eating disorder populations, none of these studies to date have assessed for potential risks of use of yoga outside of BMI. In Cramer et al.’s meta-analysis and systematic review of the safety of Yoga [50], they concluded that yoga appeared to be safe compared to treatment as usual except for in psychological/educational interventions where more yoga intervention-related adverse events and more non-serious adverse events occurred in the yoga group. Given the complexity of AN populations and their relationship with exercise, it is important that future research includes measures assessing potential risks for use of yoga amongst these patients. This was recommended at high levels of consensus in the present study, with experts expressing that there should be outcome measures that help the clinician know whether yoga is beneficial for the individual (e.g. body checking doesn’t increase, injury doesn’t occur, weight doesn’t go down).
It is also important to consider that unhealthy exercise has been found to be a major barrier to recovery from AN due to its association with a negative clinical profile and poor treatment outcomes [36, 51]. However, many authors have suggested that recovery from unhealthy exercise should move away from cessation and abstinence towards assisting the patient to establish a healthy, functional level of exercise, with accumulating evidence available in support of participation in structured exercise programs during treatment to assist in attenuating treatment-related symptoms, difficulties and distress [36, 52,53,54]. Although the panellists expressed caution regarding potential pitfalls for the use of yoga, they also endorsed at a level of consensus that yoga offers a gentle reintroduction to physical activity for patients with AN. Nevertheless, the importance of making carefully considered clinical judgements when recommending yoga was highlighted, that yoga is useful in some and not all patients, and that any intervention, including yoga, depends on the client and should be tailored to their individual needs and preferences. These comments are consistent with findings [36] where experts in the field of AN also advocated for the importance of clinical judgement in the reintroduction and promotion of healthy exercise.
Despite failing to reach consensus on the therapeutic benefits of yoga in people with AN, the panel strongly indicated that it’s worth exploring in further research. The panel delineated a number of potential benefits of yoga, with items around increased mindfulness, focus on breath, increased experiential awareness of the body and offering a break from the usual treatment routine nearing consensus. While some experts on the panel were familiar with research in the field and made comments about their personal experiences implementing yoga interventions with clients deemed to be suitable (e.g. “I have a direct experience of clients finding yoga to be a powerful intervention in supporting them to shift their relationship with AN through cultivating a more comprehension connection between their mind and body, in the practice of mindfulness to defuse from difficult thoughts and beliefs and also very importantly cultivation of self-compassion and kindness”), others commented that they were not familiar with the research data. Although it is reasonable for experts to be conservative around recommendations when there is limited research available, such comments suggest that clinicians in the field may not be aware of the current research on the use of yoga in clinical populations unless they have a personal or professional interest in its use.
Strengths
To the authors’ knowledge, this is the first study to synthesise expert opinion on the use of yoga as an adjunct therapy in the management of anxiety, depression and overexercise in individuals with AN. A diverse panel of experts were recruited internationally for the study, and although panellist attrition is a common problem in Delphi studies [39], this study had strong retention rates across the three iterations (94.4% at round 1, 100% round 2 and 3).
Limitations
The study limitations need to be acknowledged. Although this study had a strong retention rate across the three iterations (94.4%) the sample size was small. Additionally, the low response rate from individuals invited to participate may have resulted in sample bias. As such, those who participated in the study may have been more interested or held strong opinions of the research topic topic and/or were interested to participate for collegial reasons. Given that the findings are influenced by the composition of the expert panel, the results cannot necessarily be generalised to all clinicians involved in the treatment of AN. Further, as potentially more than half of the sample may not have had extensive knowledge or experience about yoga it is a limitation that those potentially in a position to integrate yoga into their practice appear not to be well-versed in the literature. Despite this, all individuals who participated in the study were considered experts in the field of AN. Given there is little research in the use of Yoga in people with AN, it is possible that those who did not respond to the study invitation preferred to withhold an opinion without a solid understanding of yoga or it’s therapeutic use. Experts contacted may also have refrained from response due to time constraints given the multiple contributions necessary across time points to generate reliable findings in a Delphi study. It is also acknowledged that findings may have differed with an approach to analysis such as that of Tierney and Fox [55] where responses are aggregated independent of those scored outside a range of consensus agreement and are thus less susceptible to a skew in the distribution of responses. Further, as the focus population for the current study was AN, these findings cannot be generalised to other eating disorder diagnoses. Additionally, the sex of the individual with AN was not specified for panellists and therefore conclusions cannot be made according to patient’s sex and as such future research may benefit from studying such variables. Future research may also benefit from examining whether treatment decisions differ depending on the clinical setting whilst also taking into consideration the opinions of other staff members such as nurses, GP’s, nutritionists and the patients themselves. It is also worth noting that experts unanimously agreed that yoga does not constitute a standalone therapy. As the study clearly focused on the use of yoga as an adjunctive therapy rather than a body-based activity that can be incorporated alongside treatment as usual, some participants commented that ‘yoga is not therapy’ and chose to ‘neither agree nor disagree’ with statements that described yoga as a therapeutic adjunct. This may have affected the findings, and as such, future research would benefit around the development of guidelines around whether yoga should be described as therapy or rather an activity that may hold therapeutic benefit for the patient.
