solution focused therapy literature review

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Practitioner Review: The effectiveness of solution focused brief therapy with children and families: a systematic and critical evaluation of the literature from 1990-2010

Affiliation.

1 School of Education, University of Manchester, Manchester, UK. [email protected]
PMID: 23452301
DOI: 10.1111/jcpp.12058

Background and scope: Solution focused brief therapy (SFBT) is a strengths-based therapeutic approach, emphasizing the resources that people possess and how these can be applied to a positive change process. The current study provides a systematic review of the SFBT evidence base and a critical evaluation of the use and application of SFBT in clinical practice with children and families.

Methods: Between 21 December 2010 and 12 May 2011 forty-four database searches (including, PsychInfo, ISI Web of Knowledge, ASSIA, British Education Index, Medline and Scopus), web searches and consultation with experts in the field were used to identify reports of SFBT studies published between 1990 and 2010. Studies were then screened according to trialled qualitative and quantitative assessment frameworks and reported according to the PRISMA guidelines.

Results: A total of 38 studies were included in the review. Of these, 9 applied SFBT to internalizing child behaviour problems, 3 applied SFBT to both internalizing and externalizing child behaviour problems, 15 applied the approach to externalizing child behaviour problems and 9 evaluated the application of SFBT in relation to a range of other issues.

Conclusions: Although much of the literature has methodological weaknesses, existing research does provide tentative support for the use of SFBT, particularly in relation to internalizing and externalizing child behaviour problems. SFBT appears particularly effective as an early intervention when presenting problems are not severe. Further well-controlled outcome studies are needed. Studies included in the review highlight promising avenues for further research.

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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Cover of Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Solution-focused brief therapy in schools: a review of the outcome literature.

JS Kim and C Franklin .

Review published: 2009 .

CRD summary

This review concluded that despite mixed results, solution-focused brief therapy showed promise in working with at-risk students in school settings, specifically for reducing intensity of students' negative feelings, managing conduct problems and externalising behavioural problems. Given a lack of details on study quality and other methodological concerns it is difficult to judge the reliability of these conclusions.

Authors' objectives

To assess the effectiveness of solution-focused brief therapy on behavioural problems of children and adolescents in schools.

PsycINFO, ERIC, Expanded Academic Search Premier and Social Services Abstract were searched for studies conducted in the United States (US) from 1988 to August 2007. Search terms were reported.

Study selection

Experimental studies that evaluated solution-focused brief therapy defined using recognised criteria in children and adolescents or in school settings were eligible for inclusion. Studies that did not contain at least one pre-specified core component of solution-focused brief therapy were excluded.

Outcomes reported in the review included changes in scores from: Hare Self-Esteem Scale; Conners' Teacher Rating Scale; Conner's Parent Rating Scale; Feelings, Attitudes and Behaviours Scale for Children; Substance Abuse Subtle Screening Inventory Adolescent-2; and Child Behaviour Checklist-Youth.

Included studies recruited children and adolescents from elementary school, middle school and high schools. One study recruited only female students. Included studies were published between 2000 and 2008.

The authors did not state how many reviewers assessed studies for inclusion.

Assessment of study quality

The authors did not state they assessed validity.

Data extraction

Means and standard deviations were extracted to enable the calculation of effect size. If there was no significant difference between experimental and control groups, the effect size was not calculated (this did not appear to be applied consistently).

The authors did not state how many reviewers performed data extraction.

Methods of synthesis

The studies were combined in a narrative synthesis supported by data tables.

Results of the review

Seven studies were included (n=364): five quasi-experimental design studies, one experimental design and one single case design. Sample size ranged from seven to 86. Duration of follow-up was not reported.

Results were mixed for both within-group and between-group comparisons. Five studies showed the benefit of solution-focused brief therapy for at least one outcome: reduced intensity of students' negative feelings; managed conduct problems; improved academic outcomes; and positively externalised behavioural problems and substance use. One study found that solution-focused therapy had a similar effect on students' behavioural change as cognitive behavioural therapy. Based on effect sizes calculated in individual studies, solution-focused brief therapy had small to large effect sizes.

Three studies reported that solution-focused brief therapy was not effective in increased grade scores or improved attendance rates of students. One study showed no effect of solution-focused brief therapy on students' behaviour change. Two studies reported no effect of solution-focused brief therapy on students' self-esteem.

Authors' conclusions

Despite mixed results, solution-focused brief therapy showed promise in working with at-risk students in school settings, specifically for reducing the intensity of students' negative feelings, managing conduct problems and externalising behavioural problems.

CRD commentary

The review addressed a clear question supported by appropriate inclusion criteria. Relevant sources were searched. There were no specific attempts to find unpublished studies, so risk of publication bias could not be ruled out. It was unclear whether steps were made to minimise errors and bias in the review process. Although the authors discussed some aspects on study quality, no formal validity assessment was carried out. A narrative synthesis was appropriate given the diversity of included studies. Exclusion of studies conducted outside USA was likely to have resulted in relevant studies being missed from the synthesis and limited the generalisability of the findings to settings outside USA. Given a lack of further details on study quality and other methodological concerns it is difficult to judge the reliability of the authors' conclusions.

Implications of the review for practice and research

Practice : The authors recommended that practitioners may further explore use of solution-focused brief therapy in their work with children and adolescents in schools.

Research : The authors stated that more studies were required to provide a strong evidence base for use of solution-focused brief therapy on behavioural problems of children and adolescents in schools. Future well-designed studies should examine more carefully on which school-based populations and problem areas solution-focused brief therapy was most effective.

Not stated.

Bibliographic details

Kim JS, Franklin C. Solution-focused brief therapy in schools: a review of the outcome literature. Children and Youth Services Review 2009; 31(4): 464-470.

Original Paper URL

http://dx.doi.org/10.1016/j.childyouth.2008.10.002

Indexing Status

Subject indexing assigned by CRD

Humans; Mental Disorders; Outcome Assessment (Health Care); Psychotherapy, Brief; Schools; Treatment Outcome

AccessionNumber

12009107106

Database entry date
Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

Cite this Page Kim JS, Franklin C. Solution-focused brief therapy in schools: a review of the outcome literature. 2009. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

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Carfilzomib-induced thrombotic microangiopathy (TMA) refractory to eculizumab: A case report and literature review

Case Report
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Published: 27 August 2024

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solution focused therapy literature review

Mina Meseha 1 ,
Jill Lykon 1 &
David Coffey 1

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This case report describes the clinical course of a patient with relapsed IgA kappa multiple myeloma with high-risk cytogenetics. Initially treated with daratumumab–bortezomib–lenalidomide–dexamethasone (Dara-VRD) then transitioned to lenalidomide maintenance. However, he experienced a relapse and was treated with carfilzomib-based therapy (CFZ) but developed drug-induced thrombotic microangiopathy (DI-TMA). Despite receiving eculizumab and supportive care, the patient's condition worsened, leading to encephalopathy and refractory gastrointestinal bleeding in the setting of persistent thrombocytopenia. Ultimately, the decision was made to transition to comfort-focused care. DI-TMA has been documented with various proteasome inhibitors such as ixazomib and bortezomib. Additionally, other medications such as cyclosporine, tacrolimus, clopidogrel, ticlopidine, and interferon have been associated with DI-TMA as well (Pisoni et al. (Drug Saf 24:491–501, 2001) [ 18 ]). Here we discuss a case of carfilzomib-induced TMA (CFZ-TMA) refractory to eculizumab as well as a review of the published literature.

Two cases of carfilzomib‐induced thrombotic microangiopathy successfully treated with Eculizumab in multiple myeloma

Microangiopathy in multiple myeloma: a case of carfilzomib-induced secondary thrombotic microangiopathy successfully treated with plasma exchange and complement inhibition

Renal thrombotic microangiopathy and podocytopathy associated with the use of carfilzomib in a patient with multiple myeloma

Avoid common mistakes on your manuscript.

Introduction

Multiple myeloma (MM) is a plasma cell neoplasm characterized by clonal proliferation of malignant plasma cells in the bone marrow with an abnormal increase of monoclonal protein leading to end-organ damage. Treatment approaches have evolved with the introduction of novel agents and immunotherapies, such as bispecific antibodies and CAR-T cell therapy. However, proteasome inhibitors (PI) are still the mainstay of treatment and come with the risk of adverse events, including TMA, particularly with CFZ, an irreversible PI.

TMA manifests across various clinical conditions including thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), atypical HUS (aHUS), DI-TMA, disseminated intravascular coagulopathy (DIC), malignancy, malignant hypertension, and transplant. Several factors contribute to the pathogenesis of DI-TMA, including (a) multiple myeloma as an independent risk factor, (b) germline mutations in the complement alternative pathway (c) reduced VEGF production by renal epithelial cells [ 1 , 2 ], and (d) immune-mediated or dose-dependent drug toxicity [ 3 ]. These mechanisms lead to the common clinical manifestations of TMA syndromes, which include endothelial injury resulting in the formation of microvascular thrombi, microangiopathic hemolysis, and thrombocytopenia [ 3 , 4 , 5 ]. Additionally, viral infections have been reported as triggers of acute disease, especially in late-onset CFZ-TMA [ 6 ]. This case highlights the challenges in managing CFZ-TMA and the need for other therapeutic options.

Case report

A 77-year-old male underwent an anemia workup and received a diagnosis of IgA kappa multiple myeloma, Revised International Staging System (R-ISS) stage III. His labs showed serum IgA 4,792 mg/dL with suppressed IgG and IgM, free kappa light chain (FKLC) 16.58 mg/dL, free lambda light chain (FLLC) 0.47 mg/dL, serum creatinine 1.46 mg/dL, serum calcium 9.9 mg/dL, hemoglobin 7.9 g/dL, albumin 3.3 g/dl, B2-microglobulin 12.86 mg/L. Bone marrow biopsy showed 80% plasma cells of overall marrow cellularity. Cytogenetic analysis revealed 1q gain, t(14;16), 13q deletion, trisomy/tetrasomy of chromosomes 1, 4, 11, 13, 14, 15, 16, and 17. Whole body MRI showed no suspicious osseous lesions. He started on daratumumab–bortezomib–lenalidomide–dexamethasone (Dara-VRD) and after eight cycles achieved a complete response (CR) with negative minimal residual disease (MRD) by flow cytometry (10 –5 sensitivity). Following this, the patient transitioned to lenalidomide maintenance, and autologous stem cell transplant (ASCT) was deferred.

Seven months later, he had a biochemical relapse evidenced by FKLC 15.98 mg/dl and kappa/lambda ratio 10.8. A subsequent bone marrow biopsy demonstrated 70% plasma cells of overall marrow cellularity. The patient’s treatment regimen was adjusted to carfilzomib–pomalidomide–dexamethasone (KPD), consisting of an initial dose of CFZ at 20 mg/m 2 followed by subsequent doses of 70 mg/m 2 on days 1, 8, and 15 of each cycle [ 7 ]. Pomalidomide was administered at a daily dose of 4 mg for 21 days followed by a 7-day rest period, and dexamethasone 20 mg twice a week. Additionally, he was prescribed apixaban 5 mg twice daily due to an elevated risk of DVT from a history of atrial fibrillation, and acyclovir 400 mg twice daily for viral prophylaxis.

After he had completed the 3rd cycle of KPD, he presented to our institution with 6 days of generalized weakness fatigue, shortness of breath as well as poor appetite, and decreased urinary output. On admission, he had tachypnea (respiratory rate 27–32 breaths/minute), elevated blood pressure (151/77 mmHg), normal heart rate and temperature.

His admission labs showed hemoglobin level decreased from 9.5 g/dL to 7.5 g/dL, platelet count dropped from 161,000/µL to 30,000/µL, creatinine level increased from 1.19 mg/dL to 8.19 mg/dL, with a corresponding decline in estimated glomerular filtration rate (eGFR) from 60 to 6 mL/min/1.73m 2 , and potassium level was 7.3 mmol/l. He was subsequently admitted to the medical ICU and started on intermittent hemodialysis due to persistent hyperkalemia and oliguric acute kidney injury (AKI). A transthoracic echo (TTE) revealed normal cardiac function.

Laboratory findings further indicated evidence of microangiopathic hemolytic anemia (MAHA), with elevated lactate dehydrogenase (LDH) levels at 989 U/L, total bilirubin at 1.7 mg/dL, and haptoglobin levels below 10 mg/dL. Examination of the peripheral blood smear (Fig. 1 ) revealed the presence of schistocytes, immature myeloid cells, as well as abundant plasmacytoid and lymphocytic elements. Considering the patient's renal failure, thrombocytopenia, and hemolytic anemia, it was suspected that he was experiencing CFZ-TMA. Alternative causes of TMA were investigated and ruled out. The normal coagulation studies and ADAMTS13 activity of 56% (greater than 10%) effectively rule out DIC and TTP. Furthermore, the absence of a history of diarrhea made it unlikely that the TMA was associated with Shiga toxin-producing Escherichia coli (STEC)-related HUS. Complement analysis (C3, C4, and CH50) were within normal ranges further ruling out aHUS. Notably, he was in relapse as indicated by a monoclonal protein of 1.20 g/dL, IgA 4,792 mg/dL, FKLC 64.33 mg/dl, and kappa/lambda ratio 201.03.

Peripheral smear showing schistocytes (red arrows) (Wright Giemsa stain, 100X oil immersion)

On hospital day 7, a single dose of 900 mg of eculizumab, an anti-complement C5 monoclonal antibody was administered concurrently with the haemophilus B polysaccharide, pneumococcal 23-valent (Pneumovax 23), and meningococcal vaccines. This approach was taken because the risks associated with delaying eculizumab therapy were deemed greater than the risk of developing a serious infection. Additionally, the patient was initiated on prophylactic antibiotic, penicillin 250 mg twice daily, for 2 weeks. Despite administering another dose of eculizumab on day 14, there was no improvement observed in the patient's hemoglobin level, platelet count, or serum creatinine/eGFR (Fig. 2 ). He continued to rely on supportive measures, including red blood cell and platelet transfusions, as well as hemodialysis. Furthermore, the upper extremities doppler ultrasound revealed acute obstructive DVT in the left axillary and brachial veins. Despite efforts, the patient developed encephalopathy and refractory gastrointestinal bleeding due to ongoing thrombocytopenia. Given these complications, the patient's family decided to transition to comfort-focused care.

Lab values pre and post-Eculizumab administration

CFZ-TMA is an uncommon adverse reaction not initially reported in the original clinical trial. However, A retrospective study documented only 16 cases between 2012 and 2019 [ 8 ]. Among 281 newly diagnosed multiple myeloma patients (NDMM) treated with carfilzomib-cyclophosphamide, and dexamethasone in the CARDAMON trial, eight (2.8%) experienced a TMA [ 9 , 10 ]. Studies have shown that TMA can occur at any stage throughout the treatment course [ 3 , 4 , 6 , 11 ]. Despite the wide range of doses at which CFZ is administered, from 20 mg/m 2 to 70 mg/m 2 , with 56 mg/m 2 typically considered the therapeutic dose, no specific dose cutoff associated with TMA has been identified [ 8 , 12 ]. Nevertheless, in a study by Moscvin et al., who observed within their cohort, 7 out of 10 patients with TMA received CFZ at a dose of 56 mg/m 2 twice weekly indicating dose-dependent drug toxicity [ 1 ].

This condition is characterized by MAHA, thrombocytopenia, and acute renal failure. While the precise mechanism remains incompletely understood, it is believed to stem from several factors. Firstly, the effects of multiple myeloma. Secondly, CFZ acts as a ubiquitin–proteasome pathway inhibitor, thereby inhibiting the transcription factor NFκB. This inhibition can disrupt vascular endothelial growth factor (VEGF) production, contributing to complement overproduction. Consequently, this cascade of events can result in endothelial and renal microvasculature damage, microthrombi formation, hemolysis, and platelet consumption. Lastly, CFZ-mediated genetic variations in complement genes such as deletions of complement factor H-related proteins (CFHR) region [ 1 , 2 , 8 , 13 ]. Our patient developed TMA following three cycles of 70 mg/m 2 CFZ once weekly [ 7 ]. It is suspected that drug toxicity from this high dose, combined with disease progression, contributed to the development of CFZ-induced TMA.

TMA is typically diagnosed through a process of exclusion of other potential differentials including TTP, HUS, and aHUS. The workup should include a comprehensive assessment. This includes a complete blood count (CBC) to evaluate for anemia and thrombocytopenia. Additionally, a complete metabolic panel (CMP) is essential for assessing AKI. Examination of a peripheral smear is crucial to identify schistocytes, which, when accompanied by elevated LDH levels and low haptoglobin, suggest the presence of MAHA. Nonetheless, renal biopsy to visualize thrombotic angiopathy remains the gold standard for diagnosing TMA. However, it is associated with a significant risk of bleeding, particularly in individuals with thrombocytopenia [ 2 ]. Meanwhile, obtaining ADAMTS13 levels is essential to exclude TTP, while complement testing and, if available complement gene analysis are used to rule out aHUS.

The management approach for CFZ-TMA typically includes discontinuing CFZ to prevent further kidney damage. Additionally, early administering of a weekly 900 mg dose of eculizumab, a terminal complement inhibitor, has shown benefit in many case reports [ 5 , 14 ]. Although the duration may vary depending on the individual case, 4 weeks is recommended. Nevertheless, in a recent large case series study of CFZ-TMA, the patients presented with severe AKI and were treated with eculizumab, yet they showed no apparent improvement in pathophysiology or prognosis [ 15 ]. The lack of response to eculizumab could also imply that the pathogenesis may not solely involve the complement pathway.

Some cases have also reported the use of supportive therapies such as plasmapheresis, high-dose glucocorticoid, and hemodialysis [ 9 , 11 , 14 ]. The therapeutic plasma exchange (TPE) is a reasonable intervention in cases of suspected TTP; however, it can be halted if ADAMTS13 activity is found to be normal, thus ruling out TTP [ 16 ]. In a study by Fotiou et al., involving 114 CFZ-treated patients, all six patients who developed TMA received plasmapheresis and steroids; rituximab was additionally administered in one patient; but none were treated with eculizumab. Renal function and platelets recovered fully in five patients, whereas one died of sepsis. Notably, none of the patients had progressive myeloma at the time of the event and ADAMTS-13 was evaluated in two patients and was within normal limits [ 17 ].

Finally, our case emphasizes the significance of patients’ close monitoring for early signs of TMA during CFZ therapy. It is crucial to consider stopping the medication or early dose adjustments to the treatment as necessary to manage this complication effectively.

Despite advances in multiple myeloma treatment, managing treatment-related complications remains challenging, particularly in high-risk patients with refractory disease. Therapy-induced TMA, as seen in this case, presents a diagnostic challenge and can lead to serious, potentially life-threatening complications. While eculizumab is a standard treatment for TMA, it was ineffective in halting its progression in this instance. This case highlights the importance of a thorough diagnostic approach for CFZ-TMA and underscores the need for increased vigilance. Healthcare providers should closely monitor patients for early signs of TMA during CFZ therapy, and consider early modifications and dose adjustments to the treatment as necessary.

Funding declaration

The authors did not receive any specific grant from public, commercial, or not-for-profit funding agencies.

Data availability

No datasets were generated or analysed during the current study.

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Mina Meseha, Dan Qu, Jill Lykon & David Coffey

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Meseha, M., Qu, D., Lykon, J. et al. Carfilzomib-induced thrombotic microangiopathy (TMA) refractory to eculizumab: A case report and literature review. Ann Hematol (2024). https://doi.org/10.1007/s00277-024-05965-9

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Home > Medicine > JOURNALSFP > Vol. 3 (2020) > Iss. 1

Solution Focused Therapy for Trauma Survivors: A Review of the Outcome Literature

Ray Eads Follow Mo Yee Lee Follow

Directly confronting and processing past trauma can be distressing for clients and may contribute to the high dropout rates among leading trauma treatments. Solution-focused therapy (SFT) primarily focuses on the present and future and has been proposed as a strengths-based alternative for treating trauma survivors. This review systematically evaluated the existing outcome literature for the effectiveness of SFT for trauma survivors. Multiple databases were searched using search terms to identify results for solution-focused therapy as a treatment for trauma survivors. Eligible studies included experimental, quasi-experimental, or pre-post designs that reported outcome measures following SFT-based treatment. A total of five studies met inclusion criteria and were evaluated and summarized. Four out of the five studies included data on within-subjects changes in the SFT treatment group, reporting statistically significant improvements on trauma symptoms, recovery, self-esteem, and parenting, with moderate to large effect sizes. Three studies compared SFT with treatment-as- usual (TAU) or no treatment and found mixed results. Compared to control groups, SFT showed statistically significant improvements with large effect sizes on post-traumatic growth and sleep issues, but effect sizes for trauma symptoms were small and not statistically significant or varied greatly between different reporters. The existing literature provides initial evidence of overall improvement for trauma survivors who received SFT, but the effectiveness of SFT at addressing trauma symptoms requires further investigation. More high quality, controlled studies are needed to evaluate SFT as a trauma treatment.

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Eads, Ray and Lee, Mo Yee (2019) "Solution Focused Therapy for Trauma Survivors: A Review of the Outcome Literature," Journal of Solution Focused Practices : Vol. 3: Iss. 1, Article 9. Available at: https://digitalscholarship.unlv.edu/journalsfp/vol3/iss1/9

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Solution-focused brief therapy in schools: A review of the outcome literature

2009, Children and Youth Services Review

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This thesis will be made up of three parts, namely the Literature Review, the Empirical Paper and the Critical Appraisal. Part 1 will aim to critically explore the research pertaining to Solution Focused Brief Therapy (SFBT) and its application within educational psychology (EP) practice, with reference to use with children and young people, and will go on to introduce the research questions in relation to this piece of research. Part 2, the Empirical Paper, will provide a detailed account of the process that was followed in order to explore the research questions relating to SFBT. The methodology and results will be presented and discussed in terms of relevance to the literature as well as relevance to EP practice. Part 3, the Critical Appraisal, will aim to provide a reflective and reflexive account of the research process. The first part will focus on the contribution to knowledge gained from the research project. The second part will include a critical account of the research pr...

Robert Brooks

Solution Focused Brief Therapy (SFBT) is routinely practiced in schools throughout the UK by Educational Psychologists (EPs) and school based counsellors with children and adolescents. Reasons for this include: (1) brief commitment requirements necessary to affect change; (2) an emerging evidence base endorsing its effectiveness, and (3) congruence between SFBT and social constructionist approaches that challenge limiting beliefs about the agency and potential of young people with Behavioural, Emotional and Social Difficulties (BESD). This case study reflects on the effectiveness of a three session SFBT episode with a young person with BESD in one secondary school using the Child Outcome Rating Scale (CORS) and Goal Progress Chart (GPC). Small gains were found in CORS measures and sustained improvements in measures of GPC were recorded from baseline to endpoint three months later. Although these results do not provide unequivocally support for SFBT, the benefits may have been offset by the young person’s experience of a bereavement during the therapeutic period. The study endorses the utility of SFBT when working with adolescents with BESD in schools, but also highlight limitations in the use of the CORS instrument to evaluate progress. Suggestions are made as to how these limitations may be overcome.

The Beacon Georgia School Counselor Association Official Magazine

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