Hetrick, Sarah E; Cox, Georgina R; Witt, Katrina G; Bir, Julliet J; Merry, Sally N
Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011. To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents. We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field. We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression. Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE. We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was
Mak, Vivian W M; Chan, Calais K Y
Despite rapid growth in the female prison population, there is little research on effectiveness of psychological interventions for them. To test the hypotheses that (1) each of two psychological interventions administered separately - cognitive behavioural therapy (CBT) or positive psychology intervention (PPI) - would be more effective than 'treatment-as-usual' alone in reducing psychological distress and enhancing psychological well-being; (2) outcomes would differ according to intervention; and (3) combining the interventions would be more effective than delivering either alone. We recruited 40 women in a special Hong Kong prison unit for female offenders with psychological distress. Half of them received eight sessions of CBT followed by eight sessions of PPI; the other half received the same interventions in the reverse order. We recruited another 35 women who received only 'treatment as usual' (TAU) in the same unit. We used various clinical scales to assess the women's psychological distress or well-being before and after the interventions or at similar time points for the comparison women. All intervention group women showed a significant reduction in psychological distress and enhancement in psychological well-being after each intervention alone compared to the TAU women. There were no significant differences between CBT and PPI in this respect. Receiving both treatments, however, did yield significantly more improvement than either intervention alone in reducing depressive thoughts and enhancing global judgement of life satisfaction, self-perceived strengths and hopeful thinking style. Our findings provide preliminary empirical support for the effectiveness of psychological interventions with psychologically distressed women in prison. It would be important now to conduct a full, randomised trial to determine optimal length and combinations of treatment. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Full Text Available ABSTRACT Cervical cancer is the most frequent cause of death related gynecology malignancy in Indonesia. Recent management of advanced-stage cervical cancer has still not been able to improve the prognosis. Chemotherapy and radiation intervention, as well as therapy may resulting pain and cause psychological stress for some patient, furthermore it could effect on the quality of life. Cortisol is a hormone of adrenal cortex, it secretes due to increased production of ACTH by anterior pituitary which is associated with stressful condition. To analyze the effect of Cognitive Behavior Therapy (CBT intervention on serum cortisol levels and pain score of patients with advanced-stage cervical cancer. This experimental study was a double blind non-randomized clinical trial post-test group design. It was using two groups in this study, each group consisting of 15 subjects, the treatment group were given CBT and standard therapy, while the control group were only given a standard therapy. The study was conducted in the gynecology oncology ward and the gynecology oncology clinic of Dr. Moewardi Hospital Surakarta and Prodia Laboratory, from January - March 2015. Cortisol level of the treatment group was 1.03 ± 0.71 mg / dL, and the control group was 11.41 ± 7.34 mg / dL. Pain score in the treatment group was 4.46 ± 0.83, and the control group was 7.34 ± 0.74. There are significant differences in serum cortisol level decrease (p = 0.00 and pain score (p = 0.00 between the CBT intervention with standard therapy group compared and the standard therapy only group
Scott, Jennifer L; Dawkins, Sarah; Quinn, Michael G; Sanderson, Kristy; Elliott, Kate-Ellen J; Stirling, Christine; Schüz, Ben; Robinson, Andrew
Face-to-face delivery of CBT is not always optimal or practical for informal dementia carers (DCs). Technology-based formats of CBT delivery (TB-CBT) have been developed with the aim to improve client engagement and accessibility, and lower delivery costs, and offers potential benefits for DCs. However, research of TB-CBT for DCs has maintained heavy reliance on therapist involvement. The efficacy of pure TB-CBT interventions for DCs is not currently established Methods: A systematic review of trials of pure TB-CBT intervention for DCs from 1995 was conducted. PsycINFO, Cochrane Reviews, Scopus and MedLine databases were searched using key terms related to CBT, carers and dementia. Four hundred and forty two articles were identified, and inclusion/exclusion criteria were applied; studies were only retained if quantitative data was available, and there was no active therapist contact. Four articles were retained; two randomized and two waitlist control trials. Methodological and reporting quality was assessed. Meta-analyses were conducted for the outcome measures of caregiver depression. Meta-analysis revealed small significant post-intervention effects of pure TB-CBT interventions for depression; equivalent to face-to-face interventions. However, there is no evidence regarding long-term efficacy of pure TB-CBT for DCs. The systematic review further identified critical methodological and reporting shortcomings pertaining to these trials Conclusions: Pure TB-CBT interventions may offer a convenient, economical method for delivering psychological interventions to DCs. Future research needs to investigate their long-term efficacy, and consider potential moderating and mediating factors underpinning the mechanisms of effect of these programs. This will help to provide more targeted interventions to this underserviced population.
Full Text Available The objective of the present study is to further elucitate the specifics cognitive behavioural therapy (CBT based on the treatment of 2 patients. The theoretical background of the therapy is based on the idea that the learning processes determine behaviour (behavioural therapy, acquisition and consolidation of beliefs and view of the world (cognitive therapy. The CBT is short-term (usually 12–20 weekly sessions. It assumes close links between the patient’s thoughts (about self, the world and the future and his/her emotions, behaviour and physiology. The patient’s work in between sessions consists in observation of their own thoughts, behaviours, and emotions, and introduction of changes within the scope of their thoughts and behaviours. The goal of cognitive behavioural therapy is autonomy and independence of a patient, attainment of the patient’s objectives, and remedying the most important problems of the patient. The therapist should be active, warm and empathic. Cognitive behavioural therapy is structured and active. Between sessions, the patient receives homework assignments to complete. During therapy, information is collected by experiments and verification of hypotheses. It should be emphasized that for changes to occur in the process of psychotherapy it is necessary to establish a strong therapeutic alliance.
MENOS4 trial: a multicentre randomised controlled trial (RCT) of a breast care nurse delivered cognitive behavioural therapy (CBT) intervention to reduce the impact of hot flushes in women with breast cancer: Study Protocol.
Fenlon, Deborah; Nuttall, Jacqueline; May, Carl; Raftery, James; Fields, Jo; Kirkpatrick, Emma; Abab, Julia; Ellis, Mary; Rose, Taylor; Khambhaita, Priya; Galanopoulou, Angeliki; Maishman, Tom; Haviland, Jo; Griffiths, Gareth; Turner, Lesley; Hunter, Myra
Women who have been treated for breast cancer may identify vasomotor symptoms, such as hot flushes and night sweats (HFNS), as a serious problem. HFNS are unpleasant to experience and can have a significant impact on daily life, potentially leading to reduced adherence to life saving adjuvant hormonal therapy. It is known that Cognitive Behavioural Therapy (CBT) is effective for the alleviation of hot flushes in both well women and women who have had breast cancer. Most women with breast cancer will see a breast care nurse and there is evidence that nurses can be trained to deliver psychological treatments to a satisfactory level, whilst also maintaining treatment fidelity. The research team will assess whether breast care nurses can effectively deliver a CBT intervention to alleviate hot flushes in women with breast cancer. This study is a multi-centre phase III individually randomised controlled trial of group CBT versus usual care to reduce the impact of hot flushes in women with breast cancer. 120-160 women with primary breast cancer experiencing seven or more problematic HFNS a week will be randomised to receive either treatment as usual (TAU) or participation in the group CBT intervention plus TAU (CBT Group). A process evaluation using May's Normalisation Process Theory will be conducted, as well as practical and organisational issues relating to the implementation of the intervention. Fidelity of implementation of the intervention will be conducted by expert assessment. The cost effectiveness of the intervention will also be assessed. There is a need for studies that enable effective interventions to be implemented in practice. There is good evidence that CBT is helpful for women with breast cancer who experience HFNS, yet it is not widely available. It is not yet known whether the intervention can be effectively delivered by breast care nurses or implemented in practice. This study will provide information on both whether the intervention can effectively
Hare, Jennifer S J
This case report presents a Cognitive Behavioural Therapy (CBT) intervention provided for a 63-year-old male, who had experienced dental phobia for over 50-years. This gentleman initially received intravenous sedation (IVS) for 5-years within a Specialist Sedation and Special Care dental department, before being referred for the long-term management of his dental phobia, within the embedded specialist Dental Health Psychology Service in a London Dental Hospital. This brief report will consider aspects of the CBT intervention delivered in relation to assessment, case conceptualisation, course of treatment and outcomes; reflecting on the complementary aspects of sedation and CBT. Learning points will be identified for the role of CBT or CBT-based techniques within dental anxiety management settings.
Carroll, Kathleen M; Ball, Samuel A; Martino, Steve; Nich, Charla; Babuscio, Theresa A; Nuro, Kathryn F; Gordon, Melissa A; Portnoy, Galina A; Rounsaville, Bruce J
This study evaluated the efficacy of a computer-based version of cognitive-behavioral therapy (CBT) for substance dependence. This was a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomly assigned to standard treatment or standard treatment with biweekly access to computer-based training in CBT (CBT4CBT) skills. Treatment retention and data availability were comparable across the treatment conditions. Participants assigned to the CBT4CBT condition submitted significantly more urine specimens that were negative for any type of drugs and tended to have longer continuous periods of abstinence during treatment. The CBT4CBT program was positively evaluated by participants. In the CBT4CBT condition, outcome was more strongly associated with treatment engagement than in treatment as usual; furthermore, completion of homework assignments in CBT4CBT was significantly correlated with outcome and a significant predictor of treatment involvement. These data suggest that CBT4CBT is an effective adjunct to standard outpatient treatment for substance dependence and may provide an important means of making CBT, an empirically validated treatment, more broadly available.
Khalsa, Manjit K; Greiner-Ferris, Julie M; Hofmann, Stefan G; Khalsa, Sat Bir S
Cognitive behavioural therapy (CBT) is an effective treatment for generalized anxiety disorder, but there is still room for improvement. The aim of the present study was to examine the potential benefit of enriching CBT with kundalini yoga (Y-CBT). Participants consisted of treatment resistant clients at a community mental health clinic. A total of 32 participants enrolled in the study and 22 completed the programme. After the Y-CBT intervention, pre-post comparisons showed statistically significant improvements in state and trait anxiety, depression, panic, sleep and quality of life. Results from this preliminary study suggest that Y-CBT may have potential as a promising treatment for those suffering from generalized anxiety disorder. Yoga-enhanced cognitive behavioural therapy (Y-CBT) may be a promising new treatment for those suffering from generalized anxiety disorder. Y-CBT may also reduce depression in those suffering from generalized anxiety. Y-CBT may reduce depression and anxiety in a clinic population where clients suffer from multiple diagnoses including generalized anxiety disorder. Copyright © 2014 John Wiley & Sons, Ltd.
Kew, Kayleigh M; Nashed, Marina; Dulay, Valdeep; Yorke, Janelle
People with asthma have a higher prevalence of anxiety and depression than the general population. This is associated with poorer asthma control, medication adherence, and health outcomes. Cognitive behavioural therapy (CBT) may be a way to improve the quality of life of people with asthma by addressing associated psychological issues, which may lead to a lower risk of exacerbations and better asthma control. To assess the efficacy of CBT for asthma compared with usual care. We searched the Cochrane Airways Group Specialised Register, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also searched reference lists of all primary studies and review articles and contacted authors for unpublished data. The most recent searches were conducted in August 2016. We included parallel randomised controlled trials (RCTs) comparing any cognitive behavioural intervention to usual care or no intervention. We included studies of adults or adolescents with asthma, with or without comorbid anxiety or depression. We included studies reported as full text, those published as abstract only, and unpublished data. Two or more review authors independently screened the search results, extracted data, and assessed included studies for risk of bias. We analysed dichotomous data as odds ratios (ORs) and continuous data as mean differences (MDs) or standardised mean differences (SMD) where scales varied across studies, all using a random-effects model. The primary outcomes were asthma-related quality of life and exacerbations requiring at least a course of oral steroids. We rated all outcomes using GRADE and presented our confidence in the results in a 'Summary of findings' table. We included nine RCTs involving 407 adults with asthma in this review; no studies included adolescents under 18. Study size ranged from 10 to 94 (median 40), and mean age ranged from 39 to 53. Study populations generally had persistent asthma, but
Khalsa, Manjit K.; Greiner-Ferris, Julie M.; Hofmann, Stefan G.; Khalsa, Sat Bir S.
Cognitive behavioral therapy is an effective treatment for generalized anxiety disorder (GAD), but there is still room for improvement. The aim of the present study was to examine the potential benefit of enriching cognitive behavioral therapy (CBT) with Kundalini Yoga (Y-CBT). Participants consisted of treatment resistant clients at a community mental health clinic. A total of 32 participants enrolled in the study and 22 completed the program. After the Y-CBT intervention, pre-post comparisons showed statistically significant improvements in state and trait anxiety, depression, panic, sleep, and quality of life. Results from this preliminary study suggest that Y-CBT may have potential as a promising treatment for those suffering from GAD. PMID:24804619
Currently, there are different treatment options like computer-assisted cognitive behavioral therapy, computer-based cognitive behavioral therapy and also, internet-based CBT. However, preliminary evidence suggests that computerised cognitive behaviour therapies (cCBT, are acceptable and effective interventions for children and adolescents. In this study is to review not only the effectiveness of cognitive behaviour treatments of depression and anxiety in children and adolescents but also the tecniques which have been used and their effects on the course and the treatments. [JCBPR 2014; 3(2.000: 99-108
Liedl, Alexandra; Müller, Julia; Morina, Naser; Karl, Anke; Denke, Claudia; Knaevelsrud, Christine
Many traumatized refugees experience both posttraumatic stress disorder and chronic pain. Based on Mutual Maintenance Theory and the Perpetual Avoidance Model, this study examined the additional effect of physical activity within a biofeedback-based cognitive behavioral therapy (CBT-BF) for traumatized refugees. In a controlled design, 36 patients were randomized into one of three conditions (CBT-BF, CBT-BF with physical activity [CBT-BF+active], and a waiting list control group [WL]). Thirty patients (n=10 in each group) completed the treatment and a follow-up assessment 3 months later. Participants' coping strategies, pain and mental health status, and physiological reactivity were assessed before and after the intervention and at 3-month follow-up. Treatment effects were analyzed using analyses of variance with baseline scores as covariates (ANCOVAs) and the Reliable Change Index. The CBT-BF and CBT-BF+active groups showed improvements in all outcome measures relative to the WL group. The effect sizes for the main outcome measures were higher in the CBT-BF+active group than in the CBT-BF group. Repeated measures analyses of covariance showed significant group effects for coping strategies--in particular, for the "cognitive restructuring" and "counter-activities" subscales as well as a marginally significant group effect for "perceived self-competence"--with the CBT-BF+active group showing more favorable outcomes than the CBT-BF group. Moreover, 60% of participants in the CBT-BF+active group showed clinically reliable intraindividual change in at least one subscale of the pain coping strategies questionnaire, compared with just 30% of participants in the CBT-BF group. Findings of improved coping strategies, larger effect sizes, and higher rates of clinical improvement in the CBT-BF+active group suggest that physical activity adds value to pain management interventions for traumatized refugees. Given the small sample size, however, these preliminary results need
Mariano, Timothy Y; Urman, Richard D; Hutchison, Catherine A; Jamison, Robert N; Edwards, Robert R
Chronic low back pain (CLBP) is a major source of physical and psychiatric morbidity and mortality, and the current overreliance on opioid analgesics has contributed to a burgeoning epidemic in the USA. Cognitive behavioral therapy (CBT) is an empirically supported treatment for CLBP, but little information exists regarding its potential efficacy for CLBP's precursor condition, subacute low back pain (sALBP), defined here as having a 7-12-week duration. Earlier intervention with CBT at the sALBP stage could produce larger clinical benefits. This systematic review was undertaken to characterize and highlight this knowledge gap. Of 240 unique articles identified by comprehensive database searches, only six prospective, sALBP-focused, randomized controlled trials (RCTs) published within the past 20 years met criteria for inclusion in this review. These studies varied widely in their sample sizes, precise definition of sALBP, nature of CBT intervention, and outcome measures. Five of the six showed significant improvements associated with CBT, but the heterogeneity of the studies prevented quantitative comparisons. CBT has not been adequately studied as a potential early intervention treatment for sALBP patients. None of the six identified papers studied US civilians or leveraged innovations such as teletherapy-able to reach patients in remote or underserved areas-underscoring critical gaps in current back pain treatment. Given the severity of the US opioid epidemic, non-pharmacologic options such as CBT should be rigorously explored in the sALBP population.
Taylor, Hannah Lund; Rybarczyk, Bruce D; Nay, William; Leszczyszyn, David
To test cognitive-behavioral therapy for insomnia (CBT-I) in patients who not only receive psychiatric treatment in a outpatient psychiatry clinic but also continue to experience chronic insomnia despite receiving pharmacological treatment for sleep. CBT-I included an optional module for discontinuing hypnotic medications. Patients were randomized to 5 sessions of individual CBT-I (n = 13) or treatment as usual (n = 10). Sleep parameters were assessed using sleep diaries at pre- and posttreatment. Questionnaires measuring depression, anxiety, and health-related quality of life were also administered. CBT-I was associated with significant improvement in sleep, with 46% obtaining normal global sleep ratings after treatment. However, no changes in secondary outcomes (depression, anxiety, quality of life) were obtained and no patients elected to discontinue their hypnotic medications. Patients with complex, chronic psychiatric conditions can obtain sleep improvements with CBT-I beyond those obtained with pharmacotherapy alone; however, sleep interventions alone may not have the same effect on mental health outcomes in samples with more severe and chronic psychiatric symptoms and dependency on hypnotic medications. © 2015 Wiley Periodicals, Inc.
Cavallo, Dana A.; Cooney, Judith L.; Duhig, Amy M.; Smith, Anne E.; Liss, Thomas B.; McFetridge, Amanda K.; Babuscio, Theresa; Nich, Charla; Carroll, Kathleen M.; Rounsaville, Bruce J.; Krishnan-Sarin, Suchitra
This pilot study evaluated the optimal format of cognitive behavioral therapy (CBT) to combine with contingency management (CM) in a four-week, high school-based smoking cessation program. Thirty-four adolescent smokers received a standard weekly version of CBT or a frequent brief behavioral intervention. Results indicate a trend toward a higher seven-day point prevalence end-of-treatment abstinence rate and percent days abstinent during treatment in the CBT condition. In addition, significantly more participants in the CBT group completed treatment. These preliminary results suggest that when combined with CM, the standard weekly format of CBT is more acceptable to adolescent smokers. PMID:18058412
Full Text Available Abstract Background Depression in adolescents is a significant problem that impairs everyday functioning and increases the risk of severe mental health disorders in adulthood. Relatively few adolescents with depression are identified and referred for treatment indicating the need to investigate alternative preventive approaches. Study Design A pragmatic cluster randomised controlled trial evaluating the effectiveness of a school based prevention programme on symptoms of depression in "high risk" adolescents (aged 12-16. The unit of allocation is year groups (n = 28 which are assigned to one of three conditions: an active intervention based upon cognitive behaviour therapy, attention control or treatment as usual. Assessments will be undertaken at screening, baseline, 6 months and 12 months. The primary outcome measure is change on the Short Mood and Feeling Questionnaire at 12 months. Secondary outcome measures will assess changes in negative thoughts, self esteem, anxiety, school connectedness, peer attachment, alcohol and substance misuse, bullying and self harm. Discussion As of August 2010, all 28 year groups (n = 5023 had been recruited and the assigned interventions delivered. Final 12 month assessments are scheduled to be completed by March 2011. Trial Registration ISRCTN19083628
Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial.
Ussher, Jane M; Perz, Janette
A randomised control trial (RCT) was conducted to examine the efficacy of couple-based cognitive behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait-list control. Triangulation of quantitative and qualitative outcome measures evaluated changes pre-post intervention. Eighty three women were randomly allocated across three conditions, with 63 completing post-intervention measures, a retention rate of 76%. Repeated measures analysis of variance found a significant time by group interaction identifying that women in the two CBT conditions reported lower total premenstrual symptoms, emotional reactivity/mood, and premenstrual distress, in comparison to the wait list control. Significantly higher active behavioural coping post-intervention was found in the couple condition than in the one-to-one and wait list control groups. Qualitative analysis provided insight into the subjective experience of PMDs and participation in the intervention study. Across groups, women reported increased awareness and understanding of premenstrual change post-intervention. A larger proportion of women in the CBT conditions reported reduction in intensity and frequency of negative premenstrual emotional reactivity, increased communication and help-seeking, increased understanding and acceptance of embodied change, and the development of coping skills, post-intervention. Increased partner understanding and improved relationship post-intervention was reported by a greater proportion of participants in the CBT conditions, most markedly in the couple condition. These findings suggest that one-to-one and couple CBT interventions can significantly reduce women's premenstrual symptomatology and distress, and improve premenstrual coping. Couple based CBT interventions may have a greater positive impact upon behavioural coping and perceptions of relationship context and support. This suggests that CBT should be available for women reporting moderate
Picariello, Federica; Moss-Morris, Rona; Macdougall, Iain C.; Norton, Sam; Da Silva-Gane, Maria; Farrington, Ken; Clayton, Hope; Chilcot, Joseph
Introduction Fatigue is one of the most common and disabling symptoms in end-stage kidney disease, particularly among in-centre haemodialysis patients. This two-arm parallel group feasibility randomised controlled trial will determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of a cognitive-behavioural therapy (CBT)-based intervention for fatigue among in-centre haemodialysis patients.Methods We aim t...
Hoogsteder, L.M; Stams, G.J.J.M.; Figge, M.A.; Changoe, K.; van Horn, J.; Hendriks, J.; Wissink, I.B.
This meta-analysis, including six studies (13 effect sizes) and 164 adolescents, examined the effectiveness of individually oriented treatment (which means that the intervention contained at least an individual component, possibly in combination with group and/or family therapy) with CBT-elements
Sivec, Harry J; Montesano, Vicki L; Skubby, David; Knepp, Kristen A; Munetz, Mark R
This exploratory case comparison examines the influence of case management activities on engagement and progress in psychotherapy for clients with schizophrenia. Six clients were recruited to participate in ten sessions of Cognitive Behavioral Therapy for psychosis (CBT-p). Three clients who had received Cognitive Behavioral techniques for psychosis (CBt-p, a low-intensity case management intervention) prior to receiving therapy were selected from referrals. A comparison group of three clients who had received standard case management services was selected from referrals. Cases within and across groups were compared on outcome measures and observations from case review were offered to inform future research. Delivering CBT-p services on a continuum from low- to high-intensity is discussed.
Losada, Andrés; Márquez-González, María; Romero-Moreno, Rosa; Mausbach, Brent T; López, Javier; Fernández-Fernández, Virginia; Nogales-González, Celia
The differential efficacy of acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) for dementia family caregivers' is analyzed through a randomized controlled trial. Participants were 135 caregivers with high depressive symptomatology who were randomly allocated to the intervention conditions or a control group (CG). Pre-, postintervention, and follow-up measurements assessed depressive symptomatology, anxiety, leisure, dysfunctional thoughts, and experiential avoidance. Depression: Significant effects of interventions compared with CG were found for CBT (p dementia caregivers. (c) 2015 APA, all rights reserved).
Koffel, Erin; Bramoweth, Adam D; Ulmer, Christi S
The American College of Physicians (ACP) recently identified cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for insomnia. Although CBT-I improves sleep outcomes and reduces the risks associated with reliance on hypnotics, patients are rarely referred to this treatment, especially in primary care where most insomnia treatment is provided. We reviewed the evidence about barriers to CBT-I referrals and efforts to increase the use of CBT-I services. PubMed, PsycINFO, and Embase were searched on January 11, 2018; additional titles were added based on a review of bibliographies and expert opinion and 51 articles were included in the results of this narrative review. Implementation research testing specific interventions to increase routine and sustained use of CBT-I was lacking. Most research focused on pre-implementation work that revealed the complexity of delivering CBT-I in routine healthcare settings due to three distinct categories of barriers. First, system barriers result in limited access to CBT-I and behavioral sleep medicine (BSM) providers. Second, primary care providers are not adequately screening for sleep issues and referring appropriately due to a lack of knowledge, treatment beliefs, and a lack of motivation to assess and treat insomnia. Finally, patient barriers, including a lack of knowledge, treatment beliefs, and limited access, prevent patients from engaging in CBT-I. These findings are organized using a conceptual model to represent the many challenges inherent in providing guideline-concordant insomnia care. We conclude with an agenda for future implementation research to systematically address these challenges.
Stikkelbroek, Yvonne; Bodden, Denise Hm; Deković, Maja; van Baar, Anneloes L
Depressive disorders occur in 2 to 5% of the adolescents and are associated with a high burden of disease, a high risk of recurrence and a heightened risk for development of other problems, like suicide attempts. The effectiveness of cognitive behaviour therapy (CBT), cost-effectiveness of this treatment and the costs of illness of clinical depression in adolescents are still unclear. Although several Randomized Controlled Trials (RCT) have been conducted to establish the efficacy of CBT, the effectiveness has not been established yet. Aim of this study is to conduct a RCT to test the effectiveness of CBT and to establish the cost-effectiveness of CBT under rigorous conditions within routine care provided by professionals already working in mental health institutions. CBT is investigated with a multi-site, RCT using block randomisation. The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old. Adolescents are randomly assigned to the experimental (N = 70, CBT) or control condition (N = 70, TAU). Four assessments (pre, post, follow up at 6 and 12 months) and two mediator assessments during treatment are conducted. Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL. Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts. Costs and treatment characteristics will also be assessed. Furthermore, moderator and mediator analyses will be conducted. This trial will be the first to compare CBT with TAU under rigorous conditions within routine care and with a complex sample. Furthermore, cost-effectiveness of treatment and cost-of-illness of clinical depression are established which will provide new insights on depression as a disorder and its treatment. Dutch Trial register number
Stanley, Barbara; Brown, Gregory; Brent, David A.; Wells, Karen; Poling, Kim; Curry, John; Kennard, Betsy D.; Wagner, Ann; Cwik, Mary F.; Klomek, Anat Brunstein; Goldstein, Tina; Vitiello, Benedetto; Barnett, Shannon; Daniel, Stephanie; Hughes, Jennifer
Objective: To describe the elements of a manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide. Method: The CBT-SP was developed using a risk reduction and relapse prevention approach and…
Carroll, Kathleen M.; Ball, Samuel A.; Martino, Steve; Nich, Charla; Babuscio, Theresa A.; Rounsaville, Bruce J.
Objectives To evaluate the durability of effects of a computer assisted version of cognitive behavioral therapy (CBT) as treatment for substance dependence through a 6 month follow-up. Methods Following a randomized clinical trial in which 73 individuals seeking outpatient treatment for substance dependence in an outpatient community setting were randomized to either standard treatment-as-usual (TAU) or TAU with 8 weeks of biweekly access to computer-based training for CBT (CBT4CBT), participants were interviewed one, three, and six months after the termination of study treatments. Results Sixty of the 73 participants were reached for follow-up (82%); follow up rates and availability of data were comparable across treatment conditions. Random regression analyses of use across time indicated significant differences between groups, such that those assigned to TAU increased their drug use across time while those assigned to CBT4CBT tended to improve slightly. The durability of the CBT4CBT effect remained even after controlling for treatment retention, treatment substance use outcomes, and exposure to other treatment during the follow-up period. Conclusions Computerized CBT4CBT appears to have both short-term and enduring effects on drug use. PMID:19041197
Amin, Nima; Chadha, Mehak; Jain, Minal; Karia, Kishan; Kothari, Varun; Patel, Tejus; Suseeharan, Melanie; Ahmed, Maroof; Sherwani, Yusuf; Siddiqui, Sarim; Lin, Yuting
Background Mobile health (mHealth) apps can offer users numerous benefits, representing a feasible and acceptable means of administering health interventions such as cognitive behavioral therapy (CBT). CBT is commonly used in the treatment of mental health conditions, where it has a strong evidence base, suggesting that it represents an effective method to elicit health behavior change. More importantly, CBT has proved to be effective in smoking cessation, in the context of smoking-related costs to the National Health Service (NHS) having been estimated to be as high as £2.6bn in 2015. Although the evidence base for computerized CBT in mental health is strong, there is limited literature on its use in smoking cessation. This, combined with the cost-effectiveness of mHealth interventions, advocates a need for research into the effectiveness of CBT-based smoking cessation apps. Objective The objective of this study was, first, to explore participants’ perceptions of 2 mHealth apps, a CBT-based app, Quit Genius, and a non-CBT-based app, NHS Smokefree, over a variety of themes. Second, the study aimed to investigate the perceptions and health behavior of users of each app with respect to smoking cessation. Methods A qualitative short-term longitudinal study was conducted, using a sample of 29 smokers allocated to one of the 2 apps, Quit Genius or Smokefree. Each user underwent 2 one-to-one semistructured interviews, 1 week apart. Thematic analysis was carried out, and important themes were identified. Descriptive statistics regarding participants’ perceptions and health behavior in relation to smoking cessation are also provided. Results The thematic analysis resulted in five higher themes and several subthemes. Participants were generally more positive about Quit Genius’s features, as well as about its design and information engagement and quality. Quit Genius users reported increased motivation to quit smoking, as well as greater willingness to continue using
Tudor-Sfetea, Carina; Rabee, Riham; Najim, Muhammad; Amin, Nima; Chadha, Mehak; Jain, Minal; Karia, Kishan; Kothari, Varun; Patel, Tejus; Suseeharan, Melanie; Ahmed, Maroof; Sherwani, Yusuf; Siddiqui, Sarim; Lin, Yuting; Eisingerich, Andreas B
Mobile health (mHealth) apps can offer users numerous benefits, representing a feasible and acceptable means of administering health interventions such as cognitive behavioral therapy (CBT). CBT is commonly used in the treatment of mental health conditions, where it has a strong evidence base, suggesting that it represents an effective method to elicit health behavior change. More importantly, CBT has proved to be effective in smoking cessation, in the context of smoking-related costs to the National Health Service (NHS) having been estimated to be as high as £2.6bn in 2015. Although the evidence base for computerized CBT in mental health is strong, there is limited literature on its use in smoking cessation. This, combined with the cost-effectiveness of mHealth interventions, advocates a need for research into the effectiveness of CBT-based smoking cessation apps. The objective of this study was, first, to explore participants' perceptions of 2 mHealth apps, a CBT-based app, Quit Genius, and a non-CBT-based app, NHS Smokefree, over a variety of themes. Second, the study aimed to investigate the perceptions and health behavior of users of each app with respect to smoking cessation. A qualitative short-term longitudinal study was conducted, using a sample of 29 smokers allocated to one of the 2 apps, Quit Genius or Smokefree. Each user underwent 2 one-to-one semistructured interviews, 1 week apart. Thematic analysis was carried out, and important themes were identified. Descriptive statistics regarding participants' perceptions and health behavior in relation to smoking cessation are also provided. The thematic analysis resulted in five higher themes and several subthemes. Participants were generally more positive about Quit Genius's features, as well as about its design and information engagement and quality. Quit Genius users reported increased motivation to quit smoking, as well as greater willingness to continue using their allocated app after 1 week. Moreover
In this study, it is aimed to review efficacy of Cognitive Behavioral Therapy (CBT) and Cognitive Behavioral Group Therapy (CBGT) on childhood and adolescence in mood and anxiety disorders. Many researches have shown that cognitive behaviour therapy (CBT) can be effective in the treatment of depression and anxiety in children and adolescents. Child and adolescent depression and anxiety are frequent disorders which may have a recurring and chronic course. PsycINFO, Medline and the Turkish P...
Arch, Joanna J.; Eifert, Georg H.; Davies, Carolyn; Vilardaga, Jennifer C. Plumb; Rose, Raphael D.; Craske, Michelle G.
Objective: Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. Method: One hundred twenty-eight individuals (52% female, mean age = 38, 33%…
Naeem, Farooq; Phiri, Peter; Munshi, Tariq; Rathod, Shanaya; Ayub, Muhhhamad; Gobbi, Mary; Kingdon, David
It has been suggested that cognitive behaviour therapy (CBT) needs adaptation for it to be effective for patients from collectivistic cultures, as currently CBT is underpinned by individualistic values. In prior studies we have demonstrated that CBT could be adapted for Pakistani patients in Southampton, UK, and for local populations in Pakistan. Findings from these studies suggest that CBT can be adapted for patients from collectivistic cultures using a series of steps. In this paper we focus on these steps, and the process of adapting CBT for specific groups. The adaptation process should focus on three major areas of therapy, rather than simple translation of therapy manuals. These include (1) awareness of relevant cultural issues and preparation for therapy, (2) assessment and engagement, and (3) adjustments in therapy. We also discuss the best practice guidelines that evolved from this work to help therapists working with this population. We reiterate that CBT can be adapted effectively for patients from traditional cultures. This is, however, an emerging area in psychotherapy, and further work is required to refine the methodology and to test adapted CBT.
O'Callaghan, Paul; Cunningham, Enda
This pilot study examined the impact of a 10 session, group-based, early-intervention cognitive behavioural therapy (CBT) programme (Cool Connections) on anxiety, depression and self-concept in nine 8-11 year old pupils in Northern Ireland. The intervention was facilitated by a teacher, education welfare officer and two classroom assistants, with…
Cunningham, Jasmyn E A; Shapiro, Colin M
Major depressive disorder is one of the most commonly diagnosed psychiatric illnesses, and it has a profound negative impact on an individual's ability to function. Up to 90% of individuals suffering from depression also report sleep and circadian disruptions. If these disruptions are not effectively resolved over the course of treatment, the likelihood of relapse into depression is greatly increased. Cognitive Behavioural Therapy for Insomnia (CBT-I) has shown promise in treating these sleep and circadian disturbances associated with depression, and may be effective as a stand-alone treatment for depression. This may be particularly relevant in cases where antidepressant medications are not ideal (e.g. due to contraindications, cost, or treatment resistance). A systematic literature review was conducted of trials investigating the use of CBT-I to treat depression in adults. Therapy included in-person CBT-I, as well as telehealth and group CBT-I. CBT-I presents a promising treatment for depression comorbid with insomnia. In-person therapy has the most supporting evidence for its efficacy, though treatment effects may not be additive with those of antidepressant medications. Insomnia improvement due to CBT-I may mediate the improvement in depressive symptoms. There is less evidence for the use of telehealth, though a stepped-care approach is indicated based on baseline depressive severity. More research on group therapy and telehealth modalities of delivering CBT-I are required before making recommendations. Copyright © 2018 Elsevier Inc. All rights reserved.
Williams, A.D.; O'Moore, Kathleen; Mason, Elizabeth; Andrews, Gavin
Social anxiety disorder (SAD) is a common, chronic and disabling mental disorder. Cognitive Behaviour Therapy (CBT) is a highly effective treatment of SAD and internet CBT (iCBT) offers a cost-effective and convenient alternative to face to face approaches, with high fidelity and demonstrated
Williams, A.D.; O'Moore, Kathleen; Mason, Elizabeth; Andrews, Gavin
Social anxiety disorder (SAD) is a common, chronic and disabling mental disorder. Cognitive Behaviour Therapy (CBT) is a highly effective treatment of SAD and internet CBT (iCBT) offers a cost-effective and convenient alternative to face to face approaches, with high fidelity and demonstrated efficacy. The aim of the current paper was to evaluate the effectiveness of an iCBT programme for SAD (The This Way Up Clinic Shyness Programme) when delivered in routine practice through two different p...
Williams, Alishia D.; O'Moore, Kathleen; Mason, Elizabeth; Andrews, Gavin
Social anxiety disorder (SAD) is a common, chronic and disabling mental disorder. Cognitive Behaviour Therapy (CBT) is a highly effective treatment of SAD and internet CBT (iCBT) offers a cost-effective and convenient alternative to face to face approaches, with high fidelity and demonstrated efficacy. The aim of the current paper was to evaluate the effectiveness of an iCBT programme for SAD (The This Way Up Clinic Shyness Programme) when delivered in routine practice through two different p...
Jones, Steven; McGrath, Elly; Hampshire, Kay; Owen, Rebecca; Riste, Lisa; Roberts, Chris; Davies, Linda; Mayes, Debbie
Anxiety comorbidity is common in bipolar disorder and is associated with worse treatment outcomes, greater risk of self harm, suicide and substance misuse. To date however there have been no psychological interventions specifically designed to address this problem. The primary objective of this trial is to establish the acceptability and feasibility of a new integrated intervention for anxiety in bipolar disorder designed in collaboration with individuals with personal experience of both problems. Single blind randomised controlled trials to assess the feasibility and acceptability of a time limited CBT informed psychological intervention for anxiety in bipolar disorder (AIBD) compared with treatment as usual. Participants will be recruited from across the North West of England from specialist mental health services and through primary care and self referral. The primary outcome of the study is the feasibility and acceptability of AIBD assessed by recruitment to target and retention to follow-up, as well as absence of untoward incidents associated with AIBD. We will also estimate the effect size of the impact of the intervention on anxiety and mood outcomes, as well as calculate preliminary estimates of cost-effectiveness and investigate potential mechanisms for this (stigma, self appraisal and stability of social rhythms). This is the first trial of an integrated intervention for anxiety in bipolar disorder. It is of interest to researchers involved in the development of new therapies for bipolar disorder as well as indicating the wider potential for evaluating approaches to the treatment of comorbidity in severe mental illness.
Gade, Hege; Friborg, Oddgeir; Rosenvinge, Jan H; Småstuen, Milada Cvancarova; Hjelmesæth, Jøran
To examine whether a preoperative cognitive behavioural therapy (CBT) intervention exceeds usual care in the improvements of dysfunctional eating behaviours, mood, affective symptoms and body weight 1 year after bariatric surgery. This is a 1-year follow-up of a single centre parallel-group randomised controlled trial ( http://clinicaltrials.gov/ct2/show/NCT01403558). A total of 80 (55 females) patients mean (SD) age 44 (10) years were included. The intervention group received 10 weeks of CBT prior to bariatric surgery, and the control group received nutritional support and education. Both groups were assessed at baseline (T0), post CBT intervention/preoperatively (T1), and 1 year postoperatively (T2). Using a mixed modelling statistical approach, we examined if the CBT group improved more across time than the control group. Our hypothesis was not supported as both groups had comparable improvements in all outcomes except for anxiety symptoms. Body weight declined by 30.2 % (37.3 kg) in the CBT group and by 31.2 % (40.0 kg) in the control group from baseline to follow-up, p = 0.82. There were statistically significant reductions in anxiety and depression symptoms in the CBT group between T0 and T1 and between T1 and T2 for depression only. However, in the control group, the anxiety score did not change significantly. The CBT group showed an earlier onset of improvements in all eating behaviours and affective symptoms than the control group. The 10-week CBT intervention showed beneficial effects preoperatively, but the non-significant group differences postoperatively indicate a genuine effect of surgery.
MacDonald, Danielle E; McFarlane, Traci L; Dionne, Michelle M; David, Lauren; Olmsted, Marion P
Rapid response to cognitive behavior therapy (CBT) for eating disorders (i.e., rapid and substantial change to key eating disorder behaviors in the initial weeks of treatment) robustly predicts good outcome at end-of-treatment and in follow up. The objective of this study was to determine whether rapid response to day hospital (DH) eating disorder treatment could be facilitated using a brief adjunctive CBT intervention focused on early change. 44 women (average age 27.3 [8.4]; 75% White, 6.3% Black, 6.9% Asian) were randomly assigned to 1 of 2 4-session adjunctive interventions: CBT focused on early change, or motivational interviewing (MI). DH was administered as usual. Outcomes included binge/purge frequency, Eating Disorder Examination-Questionnaire and Difficulties in Emotion Regulation Scale. Intent-to-treat analyses were used. The CBT group had a higher rate of rapid response (95.7%) compared to MI (71.4%; p = .04, V = .33). Those who received CBT also had fewer binge/purge episodes (p = .02) in the first 4 weeks of DH. By end-of-DH, CBT participants made greater improvements on overvaluation of weight and shape (p = .008), and emotion regulation (ps .05). The results of this study demonstrate that rapid response can be clinically facilitated using a CBT intervention that explicitly encourages early change. This provides the foundation for future research investigating whether enhancing rates of rapid response using such an intervention results in improved longer term outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Imamura, Kotaro; Kawakami, Norito; Furukawa, Toshi A; Matsuyama, Yutaka; Shimazu, Akihito; Umanodan, Rino; Kawakami, Sonoko; Kasai, Kiyoto
The purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy (iCBT) program in Manga format, the Japanese cartoon, for workers and to examine the effects of the iCBT program on improving subthreshold depression using a randomized controlled trial (RCT) design among workers employed in private companies in Japan. All workers in a company (n = 290) and all workers in three departments (n = 1,500) at the headquarters of another large company were recruited by an invitation e-mail. Participants who fulfilled the inclusion criteria were randomly allocated to intervention or control groups (N = 381 for each group). A six-week, six-lesson iCBT program using Manga (Japanese comic) story was developed. The program included several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem solving, and relaxation. The intervention group studied the iCBT program at a frequency of one lesson per week. Depression (Beck Depression Inventory II; BDI-II) was assessed as a primary outcome at baseline, and three- and six-month follow-ups for both intervention and control groups were performed. The iCBT program showed a significant intervention effect on BDI-II (t = -1.99, p<0.05) with small effect sizes (Cohen's d: -0.16, 95% Confidence Interval: -0.32 to 0.00, at six-month follow-up). The present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population. It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program. UMIN Clinical Trials Registry UMIN000006210.
Full Text Available The purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy (iCBT program in Manga format, the Japanese cartoon, for workers and to examine the effects of the iCBT program on improving subthreshold depression using a randomized controlled trial (RCT design among workers employed in private companies in Japan.All workers in a company (n = 290 and all workers in three departments (n = 1,500 at the headquarters of another large company were recruited by an invitation e-mail. Participants who fulfilled the inclusion criteria were randomly allocated to intervention or control groups (N = 381 for each group. A six-week, six-lesson iCBT program using Manga (Japanese comic story was developed. The program included several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem solving, and relaxation. The intervention group studied the iCBT program at a frequency of one lesson per week. Depression (Beck Depression Inventory II; BDI-II was assessed as a primary outcome at baseline, and three- and six-month follow-ups for both intervention and control groups were performed.The iCBT program showed a significant intervention effect on BDI-II (t = -1.99, p<0.05 with small effect sizes (Cohen's d: -0.16, 95% Confidence Interval: -0.32 to 0.00, at six-month follow-up.The present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population. It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program.UMIN Clinical Trials Registry UMIN000006210.
Kuhn, Eric; Weiss, Brandon J; Taylor, Katherine L; Hoffman, Julia E; Ramsey, Kelly M; Manber, Rachel; Gehrman, Philip; Crowley, Jill J; Ruzek, Josef I; Trockel, Mickey
This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176). VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released. Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p CBT-I practices (β = 0.286, p CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes. Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value. © 2016 American Academy of Sleep Medicine.
Kroese, Biza Stenfert; Jahoda, Andrew; Pert, Carol; Trower, Peter; Dagnan, Dave; Selkirk, Mhairi
Background: The role of support workers and other professionals in the psychotherapeutic process has been commented upon but not as yet been systematically investigated. Method: To explore their views and expectations of cognitive behaviour therapy (CBT) for adults with intellectual disabilities, eleven paid support workers and professionals were…
Khan, Muhammad; Akhter, Saeed; Soomro, Rabail Rani; Ali, Syed Shahzad
To evaluate the effectiveness of Cognitive Behavioural Therapy (CBT) along with General exercises and General exercises alone in chronic low back pain. Total 54 patients with chronic low back pain who fulfilled inclusion criteria were recruited from Physiotherapy, Department of Alain Poly Clinic Karachi and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences Karachi. Selected patients were equally divided and randomly assigned into two groups with simple randomisation method. The Cognitive Behavioural Therapy (CBT) and General exercises group received Operant model of CBT and General Exercises whereas General exercises group received General exercises only. Both groups received a home exercise program as well. Patients in both groups received 3 treatment sessions per week for 12 consecutive weeks. Clinical assessment was performed using Visual Analogue Scale (VAS) and Ronald Morris Disability Questionnaire at baseline and after 12 weeks. Both study groups showed statistically significant improvements in both outcomes measures p=0.000. However, mean improvements in post intervention VAS score and Ronald Morris score was better in CBT and exercises group as compared to General exercise group. In conclusion, both interventions are effective in treating chronic low back pain however; CBT & General exercises are clinically more effective than General exercises alone.
Williams, Alishia D; Andrews, Gavin
BACKGROUND: Depression is a common, recurrent, and debilitating problem and Internet delivered cognitive behaviour therapy (iCBT) could offer one solution. There are at least 25 controlled trials that demonstrate the efficacy of iCBT. The aim of the current paper was to evaluate the effectiveness of an iCBT Program in primary care that had been demonstrated to be efficacious in two randomized controlled trials (RCTs). METHOD: Quality assurance data from 359 patients prescribed the Sadness Pro...
Karyotaki, Eirini; Kemmeren, Lise; Riper, Heleen; Twisk, Jos; Hoogendoorn, Adriaan; Kleiboer, Annet; Mira, Adriana; Mackinnon, Andrew; Meyer, Björn; Botella, Cristina; Littlewood, Elizabeth; Andersson, Gerhard; Christensen, Helen; Klein, Jan P; Schröder, Johanna; Bretón-López, Juana; Scheider, Justine; Griffiths, Kathy; Farrer, Louise; Huibers, Marcus J H; Phillips, Rachel; Gilbody, Simon; Moritz, Steffen; Berger, Thomas; Pop, Victor; Spek, Viola; Cuijpers, Pim
Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
Davidson, Judith R; Dawson, Samantha; Krsmanovic, Adrijana
Primary care is where many patients with insomnia first ask for professional help. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia. Although CBT-I's efficacy is well established, its effectiveness in real-life primary care has seldom been investigated. We examined the effectiveness of CBT-I as routinely delivered in a Canadian primary care setting. The patients were 70 women and 11 men (mean age = 57.0 years, SD = 12.3); 83% had medical comorbidity. For the first 81 patients who took the six-session group program we compared initial and postprogram sleep diaries, sleep medication use, Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS), and visits to the family physician. Sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and ISI scores improved significantly (p 7). Wait-list data from 42 patients showed minimal sleep and mood improvements with the passage of time. Number of visits to the family physician six months postprogram decreased, although not significantly (p = .108). The CBT-I program was associated with improvement on all sleep and mood measures. Effect sizes were similar to, or larger than, those found in randomized controlled trials, demonstrating the real-world effectiveness of CBT-I in an interdisciplinary primary care setting.
Payne, Laura A; White, Kamila S; Gallagher, Matthew W; Woods, Scott W; Shear, M Katherine; Gorman, Jack M; Farchione, Todd J; Barlow, David H
Cognitive behavioral therapy (CBT) and pharmacotherapy are efficacious for the short-term treatment of panic disorder. Less is known about the efficacy of these therapies for individuals who do not respond fully to short-term CBT. The current trial is a second-step stratified randomized design comparing two treatment conditions-selective serotonin reuptake inhibitor (SSRI; paroxetine or citalopram; n = 34) and continued CBT (n = 24)-in a sample of individuals classified as treatment nonresponders to an initial course of CBT for panic disorder. Participants were randomized to 3 months of treatment and then followed for an additional 9 months. Only treatment responders after 3 months were maintained on the treatment until 12-month follow-up. Data analysis focused on panic disorder symptoms and achievement of response status across the first 3 months of treatment. Final follow-up data are presented descriptively. Participants in the SSRI condition showed significantly lower panic disorder symptoms as compared to continued CBT at 3 months. Results were similar when excluding individuals with comorbid major depression or analyzing the entire intent-to-treat sample. Group differences disappeared during 9-month naturalistic follow-up, although there was significant attrition and use of nonstudy therapies in both arms. These data suggest greater improvement in panic disorder symptoms when switching to SSRI after failure to fully respond to an initial course of CBT. Future studies should further investigate relapse following treatment discontinuation for nonresponders who became responders. Clinicaltrials.gov Identifier: NCT00000368; https://clinicaltrials.gov/show/NCT00000368. © 2015 Wiley Periodicals, Inc.
Moss-Morris, Rona; Dennison, Laura; Landau, Sabine; Yardley, Lucy; Silber, Eli; Chalder, Trudie
Objective: The aims were (a) to test the effectiveness of a nurse-led cognitive behavioral therapy (CBT) program to assist adjustment in the early stages of multiple sclerosis (MS) and (b) to determine moderators of treatment including baseline distress, social support (SS), and treatment preference. Method: Ninety-four ambulatory people with MS…
Adult attachment as a moderator of treatment outcome for generalized anxiety disorder: Comparison between cognitive-behavioral therapy (CBT) plus supportive listening and CBT plus interpersonal and emotional processing therapy.
Newman, Michelle G; Castonguay, Louis G; Jacobson, Nicholas C; Moore, Ginger A
To determine whether baseline dimensions of adult insecure attachment (avoidant and anxious) moderated outcome in a secondary analysis of a randomized controlled trial comparing cognitive-behavioral therapy (CBT) plus supportive listening (CBT + SL) versus CBT plus interpersonal and emotional processing therapy (CBT + I/EP). Eighty-three participants diagnosed with generalized anxiety disorder (GAD) were recruited from the community and assigned randomly to CBT + SL (n = 40) or to CBT + I/EP (n = 43) within a study using an additive design. PhD-level psychologists treated participants. Blind assessors evaluated participants at pretreatment, posttreatment, 6-month, 12-month, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (Penn State Worry Questionnaire, Hamilton Anxiety Rating Scale, Clinician's Severity Rating). Avoidant and anxious attachment were assessed using self-reported dismissing and angry states of mind, respectively, on the Perceptions of Adult Attachment Questionnaire. Consistent with our prediction, at all assessments higher levels of dismissing styles in those who received CBT + I/EP predicted greater change in GAD symptoms compared with those who received CBT + SL for whom dismissiveness was unrelated to the change. At postassessment, higher angry attachment was associated with less change in GAD symptoms for those receiving CBT + I/EP, compared with CBT + SL, for whom anger was unrelated to change in GAD symptoms. Pretreatment attachment-related anger failed to moderate outcome at other time points and therefore, these moderation effects were more short-lived than the ones for dismissing attachment. When compared with CBT + SL, CBT + I/EP may be better for individuals with GAD who have relatively higher dismissing styles of attachment. (c) 2015 APA, all rights reserved).
Adult Attachment as a Moderator of Treatment Outcome for Generalized Anxiety Disorder: Comparison Between Cognitive–Behavioral Therapy (CBT) Plus Supportive Listening and CBT Plus Interpersonal and Emotional Processing Therapy
Newman, Michelle G.; Castonguay, Louis G.; Jacobson, Nicholas C.; Moore, Ginger A.
Objective To determine whether baseline dimensions of adult insecure attachment (avoidant and anxious) moderated outcome in a secondary analysis of a randomized controlled trial comparing cognitive–behavioral therapy (CBT) plus supportive listening (CBT + SL) versus CBT plus interpersonal and emotional processing therapy (CBT + I/EP). Method Eighty-three participants diagnosed with generalized anxiety disorder (GAD) were recruited from the community and assigned randomly to CBT + SL (n = 40) or to CBT + I/EP (n = 43) within a study using an additive design. PhD-level psychologists treated participants. Blind assessors evaluated participants at pretreatment, posttreatment, 6-month, 12-month, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (Penn State Worry Questionnaire, Hamilton Anxiety Rating Scale, Clinician’s Severity Rating). Avoidant and anxious attachment were assessed using self-reported dismissing and angry states of mind, respectively, on the Perceptions of Adult Attachment Questionnaire. Results Consistent with our prediction, at all assessments higher levels of dismissing styles in those who received CBT + I/EP predicted greater change in GAD symptoms compared with those who received CBT + SL for whom dismissiveness was unrelated to the change. At postassessment, higher angry attachment was associated with less change in GAD symptoms for those receiving CBT + I/EP, compared with CBT + SL, for whom anger was unrelated to change in GAD symptoms. Pretreatment attachment-related anger failed to moderate outcome at other time points and therefore, these moderation effects were more short-lived than the ones for dismissing attachment. Conclusions When compared with CBT + SL, CBT + I/EP may be better for individuals with GAD who have relatively higher dismissing styles of attachment. PMID:26052875
de Jong, Martie; Korrelboom, Kees; van der Meer, Iris; Deen, Mathijs; Hoek, Hans W; Spinhoven, Philip
While eating disorder not otherwise specified (EDNOS) is the most common eating disorder (ED) diagnosis in routine clinical practice, no specific treatment methods for this diagnosis have yet been developed and studied. Enhanced cognitive behavioral therapy (CBT-E) has been described and put to the test as a transdiagnostic treatment protocol for all EDs, including EDNOS. Initial research in the UK suggests that CBT-E is more effective for EDs, especially bulimia nervosa (BN) and EDNOS, than the earlier version of CBT. These positive results of CBT-E have to be replicated in more detail, preferably by independent researchers in different countries. Being the first Dutch study into CBT-E, the results from this national multicenter study - on three sites specialized in EDs - will deliver important information about the effectiveness of CBT-E in several domains of ED pathology, while providing input for the upcoming update of the Dutch Multidisciplinary Guideline for the Treatment of Eating Disorders. A multicenter randomized controlled trial will be conducted. One hundred and thirty-two adult outpatients (aged 18 years and older) with an ED diagnosis and a Body Mass index (BMI) of between 17.5 and 40 will be randomly allocated to the control or the intervention group. Subjects in the control group will receive Treatment as Usual (standard outpatient treatment provided at the participating sites). Subjects in the intervention group will receive 20 sessions of CBT-E in 20 weeks. The design is a 2 (group) × 5 (time) repeated measures factorial design in which neither therapists nor patients will be blinded for treatment allocation. The primary outcome measure is recovery from the ED. Secondary outcome measures include ED psychopathology, common mental disorders, anxiety and depressive symptoms, health-related quality of life, health care use and productivity loss. Self-esteem, perfectionism and interpersonal problems will be examined as putative predictors and
Johnson, Sverre Urnes; Hoffart, Asle; Nordahl, Hans M; Wampold, Bruce E
Few studies have compared the effects of Metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) for comorbid anxiety disorders. In the current study we compared CBT and MCT for heterogeneous anxiety disorders in a residential setting. Ninety patients with a primary diagnosis of Post Traumatic Stress Disorder, Social Phobia or Panic disorder, with and without Agoraphobia, were randomized to either CBT or MCT. Patients were assessed at pre-treatment, post-treatment and one-year follow-up. Primary outcome measures were Beck Anxiety Inventory and ADIS IV and secondary outcome measures were SCID II, Beck Depression Inventory, Penn State Worry Questionnaire, The Symptom Checklist-90 and the Inventory of Interpersonal Problems-64. Treatment fidelity was satisfactory and therapist credibility was equal in both treatments. There was a significant difference in the level of anxiety favouring MCT at post-treatment (d=0.7), but there were no differences at one-year follow-up, mainly due to a further improvement in the CBT group during the follow-up period. Both treatments were efficacious. No differences in effect on comorbid diagnoses and symptoms were found, but MCT produced larger change in personality problems. MCT seems to have a more rapid effect on anxiety symptoms, but there were no significant differences in the long term for patients with comorbid anxiety disorders. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Lazaridou, Asimina; Kim, Jieun; Cahalan, Christine M; Loggia, Marco L; Franceschelli, Olivia; Berna, Chantal; Schur, Peter; Napadow, Vitaly; Edwards, Robert R
Fibromyalgia (FM) is a chronic, common pain disorder characterized by hyperalgesia. A key mechanism by which cognitive-behavioral therapy (CBT) fosters improvement in pain outcomes is via reductions in hyperalgesia and pain-related catastrophizing, a dysfunctional set of cognitive-emotional processes. However, the neural underpinnings of these CBT effects are unclear. Our aim was to assess CBT's effects on the brain circuitry underlying hyperalgesia in FM patients, and to explore the role of treatment-associated reduction in catastrophizing as a contributor to normalization of pain-relevant brain circuitry and clinical improvement. In total, 16 high-catastrophizing FM patients were enrolled in the study and randomized to 4 weeks of individual treatment with either CBT or a Fibromyalgia Education (control) condition. Resting state functional magnetic resonance imaging scans evaluated functional connectivity between key pain-processing brain regions at baseline and posttreatment. Clinical outcomes were assessed at baseline, posttreatment, and 6-month follow-up. Catastrophizing correlated with increased resting state functional connectivity between S1 and anterior insula. The CBT group showed larger reductions (compared with the education group) in catastrophizing at posttreatment (PCBT produced significant reductions in both pain and catastrophizing at the 6-month follow-up (PCBT group also showed reduced resting state connectivity between S1 and anterior/medial insula at posttreatment; these reductions in resting state connectivity were associated with concurrent treatment-related reductions in catastrophizing. The results add to the growing support for the clinically important associations between S1-insula connectivity, clinical pain, and catastrophizing, and suggest that CBT may, in part via reductions in catastrophizing, help to normalize pain-related brain responses in FM.
Fairburn, Christopher G; Bailey-Straebler, Suzanne; Basden, Shawnee; Doll, Helen A; Jones, Rebecca; Murphy, Rebecca; O'Connor, Marianne E; Cooper, Zafra
Eating disorders may be viewed from a transdiagnostic perspective and there is evidence supporting a transdiagnostic form of cognitive behaviour therapy (CBT-E). The aim of the present study was to compare CBT-E with interpersonal psychotherapy (IPT), a leading alternative treatment for adults with an eating disorder. One hundred and thirty patients with any form of eating disorder (body mass index >17.5 to CBT-E or IPT. Both treatments involved 20 sessions over 20 weeks followed by a 60-week closed follow-up period. Outcome was measured by independent blinded assessors. Twenty-nine participants (22.3%) did not complete treatment or were withdrawn. At post-treatment 65.5% of the CBT-E participants met criteria for remission compared with 33.3% of the IPT participants (p CBT-E remission rate remained higher (CBT-E 69.4%, IPT 49.0%; p = 0.028). The response to CBT-E was very similar to that observed in an earlier study. The findings indicate that CBT-E is potent treatment for the majority of outpatients with an eating disorder. IPT remains an alternative to CBT-E, but the response is less pronounced and slower to be expressed. ISRCTN 15562271. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Drmic, Irene E.; Aljunied, Mariam; Reaven, Judy
Adolescents with autism spectrum disorder (ASD) are at high risk for anxiety difficulties and disorders. Clinic-based cognitive behavioral therapy (CBT) is effective; however, few published school-based CBT programs for youth with ASD exist. In this study, the Facing Your Fears CBT protocol was adapted for delivery and piloted within a school…
Johnson, Jillian A; Rash, Joshua A; Campbell, Tavis S; Savard, Josée; Gehrman, Philip R; Perlis, Michael; Carlson, Linda E; Garland, Sheila N
This review examined the efficacy of cognitive behavior therapy for insomnia (CBT-I) in people diagnosed with cancer. Studies were identified through November 2014 using multiple databases, clinical trial records, and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I conducted in individuals with a cancer diagnosis who had clinically relevant insomnia. The primary outcome variable was sleep efficiency (SE) as measured by sleep diary. Eight studies including data from 752 cancer survivors met inclusion criteria. CBT-I resulted in a 15.5% improvement in SE relative to control conditions (6.1%) from pre- to post-intervention, with a medium effect size (ES: d = 0.53). Overall, sleep latency was reduced by 22 min with an ES of d = 0.43, compared to a reduction of 8 min in the control conditions. Wake after sleep onset was reduced by 30 min with an ES of d = 0.41, compared to 13 min in the control conditions. Large effect sizes were observed for self-reported insomnia severity (d = 0.77) for those patients who received CBT-I, representing a clinically relevant eight point reduction. Effects were durable up to 6 mo. The quality of the evidence supports a strong recommendation for the use of CBT-I among cancer survivors. Copyright © 2015 Elsevier Ltd. All rights reserved.
Iakimova, G; Dimitrova, S; Burté, T
Computer-delivered Cognitive Behavioral Therapies (C-CBT) are emerging as therapeutic techniques which contribute to overcome the barriers of health care access in adult populations with depression. The C-CBTs provide CBT techniques in a highly structured format comprising a number of educational lessons, homework, multimedia illustrations and supplementary materials via interactive computer interfaces. Programs are often administrated with a minimal or regular support provided by a clinician or a technician via email, telephone, online forums, or during face-to-face consultations. However, a lot of C-CBT is provided without any therapeutic support. Several reports showed that C-CBTs, both guided or unguided by a therapist, may be reliable and effective for patients with depression, and their use was recommended as part of the first step of the clinical care. The aim of the present qualitative review is to describe the operational format and functioning of five of the most cited unguided C-CBT programs for depression, to analyze their characteristics according to the CBT's principles, and to discuss the results of the randomized clinical trials (RCT) conducted to evaluate its effectiveness, adherence and user's experience. We analyzed five C-CBTs: Beating The Blues (BTB), MoodGYM, Sadness, Deprexis and Overcoming Depression on the Internet (ODIN) and 22 randomized controlled studies according to 5 dimensions: General characteristics; Methodology, structure and organization; Specific modules, themes and techniques: Clinical indications, recruitment mode, type of users with depression, type and mode of therapist's support, overall therapeutic effects, adherence and user's experience. The C-CBT have a secured free or pay-to-use access in different languages (English, German, Dutch, and Chinese) but not in French. The programs may be accessed at a medical center or at home via a CD-ROM or via an Internet connection. Some C-CBTs are very close to textual self
Kolko, David J.; Iselin, Anne-Marie R.; Gully, Kevin J.
This paper examines the sustainability and outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as delivered by practitioners in a community-based child protection program who had received training in the model several years earlier. Formerly described as Abuse-Focused CBT, AF-CBT is an evidence-based treatment (EBT) for…
Blashill, Aaron J; Safren, Steven A; Wilhelm, Sabine; Jampel, Jonathan; Taylor, S Wade; O'Cleirigh, Conall; Mayer, Kenneth H
Body image disturbance is a distressing and interfering problem among many sexual minority men living with HIV, and is associated with elevated depressive symptoms and poor HIV self-care (e.g., antiretroviral therapy [ART] nonadherence). The current study tested the preliminary efficacy of a newly created intervention: cognitive-behavioral therapy for body image and self-care (CBT-BISC) for this population. The current study entailed a 2-arm randomized controlled trial (N = 44) comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition. Analyses were conducted at 3 and 6 months after baseline. The primary outcome was body image disturbance (BDD-YBOCS), and secondary outcomes were ART adherence (electronically monitored via Wisepill), depressive symptoms (MADRS), and global functioning (GAF). At 3 months, the CBT-BISC condition showed substantial improvement in BDD-YBOCS (b = -13.6, SE = 2.7, 95% CI [-19.0, -8.3], p adherence (b = 8.8, SE = 3.3, 95% CI [2.0, 15.6], p = .01; dppc2 = .94); and GAF (b = 12.3, SE = 3.2, 95% CI [6.1, 18.6], p adherence findings were mixed depending on the calculation method. CBT-BISC shows preliminary efficacy in the integrated treatment of body image disturbance and HIV self-care behaviors among sexual minority men living with HIV. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Lecomte, T; Corbière, M; Lysaker, P H
Supported employment programs are highly effective in helping people with severe mental illness obtain competitive jobs quickly. However, job tenure is often a problem for many. Of the various obstacles to job tenure documented, dysfunctional beliefs regarding the workplace and one's own abilities has been proposed as a therapeutic target. The purpose of this article is threefold: (1) to describe the development and the content of a novel group cognitive behavioral intervention designed to increase job tenure for people receiving supported employment services; (2) to present the feasibility and acceptability of the intervention; and (3) to investigate some preliminary data regarding employment outcomes. A group CBT intervention offered during 8 sessions over the course of one month, in order to respect the rapid job search principle of IPS (individual placement and support), was developed. The content was tailored to facilitate the learning of skills specific to the workplace, such as recognizing and managing one's stressors at work, determining and modifying dysfunctional thoughts (e.g. not jumping to conclusions, finding alternatives, seeking facts), overcoming obstacles (e.g. problem solving), improving one's self-esteem as a worker (recognizing strengths and qualities), dealing with criticism, using positive assertiveness, finding coping strategies (for symptoms and stress) to use at work, negotiating work accommodations and overcoming stigma. A trial is currently underway, with half the participants receiving supported employment as well as CBT-SE and the other half receiving only supported employment. A subsample of the first 24 participants having completed the 12-month follow-up were used for the analyses, including 12 having received at least 3 sessions out of the 8 group sessions and 12 receiving only supported employment. Feasibility and acceptability were determined by the group therapists' feedback, the participants' feedback as well as attendance to
Sofronoff, Kate; Attwood, Tony; Hinton, Sharon
The aim of the study was to evaluate the effectiveness of a brief CBT intervention for anxiety with children diagnosed with Asperger syndrome (AS). A second interest was to evaluate whether more intensive parent involvement would increase the child's ability to manage anxiety outside of the clinic setting. Seventy-one children aged ten to twelve years were recruited to participate in the anxiety programme. All children were diagnosed with AS and the presence of anxiety symptoms was accepted on parent report via brief interview. Children were randomly assigned to one of three conditions: intervention for child only, intervention for child and parent, wait-list control. The two intervention groups demonstrated significant decreases in parent-reported anxiety symptoms at follow-up and a significant increase in the child's ability to generate positive strategies in an anxiety-provoking situation. There were a number of significant differences between the two interventions to suggest parent involvement as beneficial. The sample of children with AS in this study presented with a profile of anxiety similar to a sample of clinically diagnosed anxious children. The intervention was endorsed by parents as a useful programme for children diagnosed with Asperger syndrome and exhibiting anxiety symptoms, and active parent involvement enhanced the usefulness of the programme. Limitations of the study and future research are discussed.
Fairburn, Christopher G.; Bailey-Straebler, Suzanne; Basden, Shawnee; Doll, Helen A.; Jones, Rebecca; Murphy, Rebecca; O'Connor, Marianne E.; Cooper, Zafra
Eating disorders may be viewed from a transdiagnostic perspective and there is evidence supporting a transdiagnostic form of cognitive behaviour therapy (CBT-E). The aim of the present study was to compare CBT-E with interpersonal psychotherapy (IPT), a leading alternative treatment for adults with an eating disorder. One hundred and thirty patients with any form of eating disorder (body mass index >17.5 to <40.0) were randomized to either CBT-E or IPT. Both treatments involved 20 sessions over 20 weeks followed by a 60-week closed follow-up period. Outcome was measured by independent blinded assessors. Twenty-nine participants (22.3%) did not complete treatment or were withdrawn. At post-treatment 65.5% of the CBT-E participants met criteria for remission compared with 33.3% of the IPT participants (p < 0.001). Over follow-up the proportion of participants meeting criteria for remission increased, particularly in the IPT condition, but the CBT-E remission rate remained higher (CBT-E 69.4%, IPT 49.0%; p = 0.028). The response to CBT-E was very similar to that observed in an earlier study. The findings indicate that CBT-E is potent treatment for the majority of outpatients with an eating disorder. IPT remains an alternative to CBT-E, but the response is less pronounced and slower to be expressed. Current controlled trials ISRCTN 15562271. PMID:26000757
Wong, Mei Yin; Ree, Melissa J; Lee, Christopher W
Although cognitive behavioural therapy (CBT) for insomnia has resulted in significant reductions in symptoms, most patients are not classified as good sleepers after treatment. The present study investigated whether additional sessions of cognitive therapy (CT) or mindfulness-based therapy (MBT) could enhance CBT in 64 participants with primary insomnia. All participants were given four sessions of standard CBT as previous research had identified this number of sessions as an optimal balance between therapist guidance and patient independence. Participants were then allocated to further active treatment (four sessions of CT or MBT) or a no further treatment control. The additional treatments resulted in significant improvements beyond CBT on self-report and objective measures of sleep and were well tolerated as evidenced by no dropouts from either treatment. The effect sizes for each of these additional treatments were large and clinically significant. The mean scores on the primary outcome measure, the Insomnia Severity Index, were 5.74 for CT and 6.69 for MBT, which are within the good-sleeper range. Treatment effects were maintained at follow-up. There were no significant differences between CT and MBT on any outcome measure. These results provide encouraging data on how to enhance CBT for treatment of insomnia. Copyright © 2015 John Wiley & Sons, Ltd. CBT treatments for insomnia can be enhanced using recent developments in cognitive therapy. CBT treatments for insomnia can be enhanced using mindfulness-based treatments. Both cognitive therapy and mindfulness produce additional clinically significant change. Copyright © 2015 John Wiley & Sons, Ltd.
This presentation will describe how the model developed in Esben Hougaard's Adult CBT Therapy Program at Aarhus University - which integrates research, theory-building, training, and practice - has beenadapted to work with children and adolescents with anxiety disorders and their parents. The res......This presentation will describe how the model developed in Esben Hougaard's Adult CBT Therapy Program at Aarhus University - which integrates research, theory-building, training, and practice - has beenadapted to work with children and adolescents with anxiety disorders and their parents....... The resulting Youth CBT Therapy Program at Aarhus is organized around a short-term, 10-session, evidence-based, manualized, family-based, cognitive behavioral therapy (CBT) group program, called "Cool Kids" for children and "Chilled Adolescents" for adolescents, and derived from Ronald Rapee's work in Australia....... A distinctive aspect of the work of the Youth CBT Therapy Program is their incorporation of a case-study perspective into a series of group designs, including:(a) a randomized treatment vs. waitlist-control efficacy study (n=120); (b) an open, naturalistic effectiveness study of the program in two mental health...
Dèttore, Davide; Pozza, Andrea; Andersson, Gerhard
Cognitive behavioural therapy (CBT) is a well-established treatment for obsessive-compulsive disorder (OCD). However, few patients receive CBT, due to factors such as geographic limitations, perceived stigmatization, and lack of CBT services. Technology-delivered cognitive behavioural therapy (T-CBT) could be an effective strategy to improve patients' access to CBT. To date, a meta-analysis on the effectiveness of T-CBT for OCD has not been conducted. This study used meta-analytic techniques to summarize evidence on the efficacy of T-CBT for OCD versus control conditions and therapist-administered CBT. A meta-analysis according to Prisma guidelines was conducted on randomized controlled trials (RCTs) of T-CBT for OCD. Treatment was classified as T-CBT if evidence-based CBT active ingredients for OCD were included (psychoeducation, ERP, and cognitive restructuring), delivered through health technologies (e.g. self-help books, leaflets, and other forms of bibliotherapy) or remote communication technologies (e.g. the Internet, web-cameras, telephones, telephone-interactive voice response systems, and CD-ROMS). Studies using validated outcomes for OCD or depression were included. Eight trials were included (N = 420). Two trials were classified as at high risk of bias. T-CBT seemed to be superior to control conditions on OCD symptom outcomes at post-treatment (d = 0.82, 99% CI = 0.55-1.08, p = 0.001), but not on comorbid depression (d = 0.33, 99% CI = - 0.01-0.67, p = 0.020). Difference in the efficacy on OCD symptoms between T-CBT and therapist-administered CBT was not significant, despite a trend favouring therapist-administered CBT emerged (d = 0.45, 95% CI = 0.03-0.87, p = 0.033). Directions for research are discussed. Further RCTs are warranted to examine the efficacy of T-CBT for OCD.
Hauksson, Pétur; Ingibergsdóttir, Sylvía; Gunnarsdóttir, Thórunn; Jónsdóttir, Inga Hrefna
Cognitive behaviour therapy (CBT) has been shown to be effective, yet there is a paucity of research on the differential effectiveness of individual and group CBT for adults with treatment-resistant depression with psychiatric comorbidity. To investigate the effectiveness of individual and group CBT for inpatients, in an interdisciplinary rehabilitation setting; the extent of psychiatric comorbidity; and who benefits the most from group CBT. All patients (n = 181) received 6 weeks of rehabilitation (treatment as usual, TAU). In addition, they were randomly allocated to group CBT (n = 86) or individual CBT (n = 59) combined with TAU, or TAU only (n = 36). All CBT therapists were part of an interdisciplinary team, had at least 1-year CBT training, and attended weekly supervision. The same CBT manual was used for individual and group therapy, providing 12 sessions, two per week. Groups had 12-15 participants and two therapists in each session. Individual CBT was superior in efficacy to group CBT and TAU, with a large within-subject effect size (ES = 2.10). Group CBT was not superior to TAU. The benefits of treatment decreased over time, but remained large at 18-month follow-up for individual CBT (ES = 1.02), and medium for group CBT (ES = 0.46) and TAU (ES = 0.60). Individual CBT was an effective addition to TAU and showed significant improvements in symptom severity post-treatment and at 18-month follow-up. Disorder severity and comorbidity may have decreased effectiveness of group therapy primarily aimed at depression.
van Apeldoorn, F J; Stant, A D; van Hout, W J P J; Mersch, P P A; den Boer, J A
The objective of this study was to assess the cost-effectiveness of three empirically supported treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both (CBT+SSRI). Cost-effectiveness was examined based on the data from a multicenter randomized controlled trial. The Hamilton Anxiety Rating Scale was selected as a primary health outcome measure. Data on costs from a societal perspective (i.e., direct medical, direct non-medical, and indirect non-medical costs) were collected in the study sample (N=150) throughout a 24-month period in which patients received active treatment during the first twelve months and were seen twice for follow-up in the next twelve months. Total costs were largely influenced by costs of the interventions and productivity losses. The mean total societal costs were lower for CBT as compared to SSRI and CBT+SSRI. Costs of medication use were substantial for both SSRI and CBT+SSRI. When examining the balance between costs and health outcomes, both CBT and CBT+SSRI led to more positive outcomes than SSRI. Cognitive behavioral therapy is associated with the lowest societal costs. Cognitive behavioral therapy and CBT+SSRI are more cost-effective treatments for panic disorder with or without agoraphobia as compared to SSRI only. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Imamura, K; Kawakami, N; Furukawa, T A; Matsuyama, Y; Shimazu, A; Umanodan, R; Kawakami, S; Kasai, K
In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers. Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section. The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank χ2 = 7.04, p MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.
Mathewson, Karen J; Schmidt, Louis A; Miskovic, Vladimir; Santesso, Diane L; Duku, Eric; McCabe, Randi E; Antony, Martin M; Moscovitch, David A
Modifying dysfunctional emotion regulation is an important goal in psychological treatments for social anxiety disorder (SAD). Antecedent-focused strategies learned in cognitive behavioral therapy (CBT), such as cognitive reappraisal, have proven more effective in reducing social anxiety than response-focused strategies, such as expressive suppression. Still, not all patients with SAD respond well to CBT. Medications and physiological factors may also influence the clinical response. The purpose of the present study was to examine the role that these factors play in determining treatment response following CBT for SAD. Using multilevel modeling, we examined associations across four separate laboratory visits between change in self-reported anxiety and indices of reappraisal, suppression, medication status, and resting respiratory sinus arrhythmia (RSA), a proxy measure of self-regulatory capacity, in 23 socially anxious adults during a 12-week program of CBT. Most participants were ultimately classified as responders to CBT (n=15), but in some, anxiety levels remained unchanged (n=8). Medication use explained substantial variance related to individual differences in anxiety among participants. When modeled separately, reappraisal, suppression, and RSA each accounted for significant variance related to anxiety. However, the best-fitting model included reappraisal and RSA. Moreover, RSA reactivity (change in RSA levels over time) was more important for predicting anxiety reduction than were baseline levels of RSA. These findings suggest that reappraisal and parasympathetic responsiveness may be important in reducing anxiety in adults with SAD who respond well to CBT. Copyright © 2013 Elsevier B.V. All rights reserved.
iCanADAPT Early protocol: randomised controlled trial (RCT) of clinician supervised transdiagnostic internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety in early stage cancer survivors -vs- treatment as usual
Murphy, M. J.; Newby, J. M.; Butow, P.; Kirsten, L.; Allison, K.; Loughnan, S.; Price, M. A.; Shaw, J.; Shepherd, H.; Smith, J.; Andrews, G.
Background This RCT with two parallel arms will evaluate the efficacy of an internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for the treatment of clinical depression and/or anxiety in early stage cancer survivors. Methods/design Early stage cancer survivors will be recruited via the research arm of a not-for-profit clinical research unit and randomised to an intervention (iCBT) group or a ?treatment as usual? (TAU) control group. The minimum sample size for...
Bjaastad, Jon Fauskanger; Haugland, Bente Storm Mowatt; Fjermestad, Krister W; Torsheim, Torbjørn; Havik, Odd E; Heiervang, Einar R; Öst, Lars-Göran
The aim of the present study was to evaluate the psychometric properties of the Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT). The CAS-CBT is an 11-item scale developed to measure adherence and competence in cognitive-behavioral therapy (CBT) for anxiety disorders in youth. A total of 181 videotapes from the treatment sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014) comprising youth (N = 182, M age = 11.5 years, SD = 2.1, range 8-15 years, 53% girls, 90.7% Caucasian) with mixed anxiety disorders were assessed with the CAS-CBT to investigate interitem correlations, internal consistency, and factor structure. Internal consistency was good (Cronbach's alpha = .87). Factor analysis suggested a 2-factor solution with Factor 1 representing CBT structure and session goals (explaining 46.9% of the variance) and Factor 2 representing process and relational skills (explaining 19.7% of the variance). The sum-score for adherence and competence was strongly intercorrelated, r = .79, p .40, n = 10 videotapes) and also good to excellent interrater reliability when compared to expert raters (ICC = .83 for adherence and .64 for competence, n = 26 videotapes). High rater stability was also found (n = 15 videotapes). The findings suggest that the CAS-CBT is a reliable measure of adherence and competence in manualized CBT for anxiety disorders in youth. Further research is needed to investigate the validity of the scale and psychometric properties when used with other treatment programs, disorders and treatment formats. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
PsychotherapyPlus: augmentation of cognitive behavioral therapy (CBT) with prefrontal transcranial direct current stimulation (tDCS) in major depressive disorder-study design and methodology of a multicenter double-blind randomized placebo-controlled trial.
Bajbouj, Malek; Aust, Sabine; Spies, Jan; Herrera-Melendez, Ana-Lucia; Mayer, Sarah V; Peters, Maike; Plewnia, Christian; Fallgatter, Andreas J; Frase, Lukas; Normann, Claus; Behler, Nora; Wulf, Linda; Brakemeier, Eva-Lotta; Padberg, Frank
Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. About 20-30% of patients do not respond to the standard psychopharmacological and/or psychotherapeutic interventions. Mounting evidence from neuroimaging studies in MDD patients reveal altered activation patterns in lateral prefrontal brain areas. Successful cognitive behavioral therapy (CBT) is associated with a recovery of these neural alterations. Moreover, it has been demonstrated that transcranial direct current stimulation (tDCS) is capable of influencing prefrontal cortex activity and cognitive functions such as working memory and emotion regulation. Thus, a clinical trial investigating the effects of an antidepressant intervention combining CBT with tDCS seems promising. The present study investigates the antidepressant efficacy of a combined CBT-tDCS intervention as compared to CBT with sham-tDCS or CBT alone. A total of 192 patients (age range 20-65 years) with MDD (Hamilton Depression Rating Scale Score ≥ 15, 21-item version) will be recruited at four study sites across Germany (Berlin, Munich, Tuebingen, and Freiburg) and randomly assigned to one of the following three treatment arms: (1) CBT + active tDCS; (2) CBT + sham-tDCS; and (3) CBT alone. All participants will attend a 6-week psychotherapeutic intervention comprising 12 sessions of CBT each lasting 100 min in a closed group setting. tDCS will be applied simultaneously with CBT. Active tDCS includes stimulation with an intensity of 2 mA for 30 min with the anode placed over F3 and the cathode over F4 according to the EEG 10-20 system, if assigned. The primary outcome measure is the change in Montgomery-Åsberg Depression Rating Scale scores from baseline to 6, 18, and 30 weeks after the first session. Participants also undergo pre- and post-treatment neuropsychological testing and functional magnetic resonance imaging (fMRI) to assess changes in prefrontal functioning and connectivity
de Jong, M.; Korrelboom, C.W.; van der Meer, I.; Deen, M.; Hoek, H.W.; Spinhoven, P.
Background While eating disorder not otherwise specified (EDNOS) is the most common eating disorder (ED) diagnosis in routine clinical practice, no specific treatment methods for this diagnosis have yet been developed and studied. Enhanced cognitive behavioral therapy (CBT-E) has been described and
de Jong, Martie; Korrelboom, Kees; van der Meer, Iris; Deen, Mathijs; Hoek, Hans W.; Spinhoven, Philip
Background: While eating disorder not otherwise specified (EDNOS) is the most common eating disorder (ED) diagnosis in routine clinical practice, no specific treatment methods for this diagnosis have yet been developed and studied. Enhanced cognitive behavioral therapy (CBT-E) has been described and
Safren, Steven A; Gonzalez, Jeffrey S; Wexler, Deborah J; Psaros, Christina; Delahanty, Linda M; Blashill, Aaron J; Margolina, Aleksandra I; Cagliero, Enrico
To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. Immediately after acute treatment (4 months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI -31.14 to -10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI -42.95 to -17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29-1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI -38.2 to -10.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI -33.3 to -0.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.
DiNapoli, Elizabeth A; Pierpaoli, Christina M; Shah, Avani; Yang, Xin; Scogin, Forrest
We examined the effects of home-delivered cognitive-behavioral therapy (CBT) for depression on anxiety symptoms in an ethnically diverse, low resource, and medically frail sample of rural, older adults. This was a secondary analysis of a randomized clincial trial with 134 rural-dwelling adults 65 years and older with decreased quality of life and elevated psychological symptomatology. Anxiety symptoms were assessed with the anxiety and phobic anxiety subscales of the Symptom Checklist-90-Revised (SCL-90-R). Compared to a minimal support control condition, CBT for depression resulted in significantly greater improvements in symptoms of anxiety and phobic anxiety from pre-treatment to post-treatment. Home-delivered CBT for depression can be an effective treatment for anxiety in a hard-to-reach older populations. Additional research should explore integrated anxiety and depression protocols and other treatment modalities, including bibliotherapy or telehealth models of CBT, to reduce costs associated with its in home delivery. Flexibility in administration and adaptations to the CBT protocol may be necessary for use with vulnerable, rural older adults.
Rapley, Hannah A; Loades, Maria E
Whilst the evidence base for cognitive behavioural therapy (CBT) with children and young people is growing, the mechanisms through which these beneficial effects occur are still unclear. This systematic review seeks to appraise the relationship between therapeutic outcomes in CBT and therapist adherence and competence, within the child and adolescent literature. A systematic review was carried out, with five studies identified as meeting the inclusion criteria. The literature is currently small and inconclusive. Amongst the studies reviewed, there were inconsistent findings, with minimal-to-no effect sizes found between adherence, competence, and outcomes. The current paucity of research in this area means that conclusions are currently limited. The role and impact of adherence and competence on therapeutic outcomes remains unclear within individual CBT in a child population. This is comparable with the current adult literature, where findings also remain inconclusive. Further research avenues are discussed.
Hawley, Lance L; Padesky, Christine A; Hollon, Steven D; Mancuso, Enza; Laposa, Judith M; Brozina, Karen; Segal, Zindel V
Cognitive-behavioral therapy (CBT) for depression is highly effective. An essential element of this therapy involves acquiring and utilizing CBT skills; however, it is unclear whether the type of CBT skill used is associated with differential symptom alleviation. Outpatients (N = 356) diagnosed with a primary mood disorder received 14 two-hour group sessions of CBT for depression, using the Mind Over Mood protocol. In each session, patients completed the Beck Depression Inventory and throughout the week they reported on their use of CBT skills: behavioral activation (BA), cognitive restructuring (CR), and core belief (CB) strategies. Bivariate latent difference score (LDS) longitudinal analyses were used to examine patterns of differential skill use and subsequent symptom change, and multigroup LDS analyses were used to determine whether longitudinal associations differed as a function of initial depression severity. Higher levels of BA use were associated with a greater subsequent decrease in depressive symptoms for patients with mild to moderate initial depression symptoms relative to those with severe symptoms. Higher levels of CR use were associated with a greater subsequent decrease in depressive symptoms, whereas higher levels of CB use were followed by a subsequent increase in depressive symptoms, regardless of initial severity. Results indicated that the type of CBT skill used is associated with differential patterns of subsequent symptom change. BA use was associated with differential subsequent change as a function of initial severity (patients with less severe depression symptoms demonstrated greater symptom improvement), whereas CR use was associated with symptom alleviation and CB use with an increase in subsequent symptoms as related to initial severity. Copyright © 2016. Published by Elsevier Ltd.
van Apeldoorn, F.J.; van Hout, W.J.P.J.; Huisman, P.P.A.M.; Slaap, B.R.; Hale, W.W.; Visser, S.; van Dyck, R.; den Boer, J.A.
Objective: To establish whether the combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRI) was more effective in treating panic disorder (PD) than either CBT or SSRI alone, and to evaluate any differential effects between the mono-treatments. Method: Patients with PD (n = 150)
van Apeldoorn, F. J.; van Hout, W. J. P. J.; Huisman, J.M.E.; Slaap, B. R.; Hale, W. W.; Visser, S.; van Dyck, R.; den Boer, J. A.; Mersch, P.P.A.
Objective: To establish whether the combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRI) was more effective in treating panic disorder (PD) than either CBT or SSRI alone, and to evaluate any differential effects between the mono-treatments. Method: Patients with PD (n = 150)
van Apeldoorn, F.J.; Hout, W.J.P.J.; Mersch, P.P.A.; Huisman, M.; Slaap, B.R.; Hale, W.W., III; Visser, S.; van Dyck, R.; den Boer, J.A.
Objective: To establish whether the combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRI) was more effective in treating panic disorder (PD) than either CBT or SSRI alone, and to evaluate any differential effects between the monotreatments. Method: Patients with PD (n = 150)
Newby, Jill M; Williams, Alishia D; Andrews, Gavin
We explored whether transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) for mixed anxiety and depression effectively reduces repetitive negative thinking (RNT), and whether reductions in RNT and positive metacognitive beliefs mediate symptom improvement during iCBT. Participants
Alishia D. Williams
Full Text Available Social anxiety disorder (SAD is a common, chronic and disabling mental disorder. Cognitive Behaviour Therapy (CBT is a highly effective treatment of SAD and internet CBT (iCBT offers a cost-effective and convenient alternative to face to face approaches, with high fidelity and demonstrated efficacy. The aim of the current paper was to evaluate the effectiveness of an iCBT programme for SAD (The This Way Up Clinic Shyness Programme when delivered in routine practice through two different pathways. Patients in the prescription pathway (Study 1, N = 368, 50% female, mean age = 34 were ‘prescribed’ the Shyness Programme by a registered practitioner of the This Way Up Clinic who supervised their progress throughout the programme. Patients in the referral pathway (Study 2, N = 192, 50% female, mean age = 36 were referred to the This Way Up Clinic and supervised by a specialist CBT clinician at the clinic. Intention-to-treat marginal model analyses demonstrated significant reductions in primary outcomes of social anxiety symptoms (Mini-SPIN and psychological distress (K10, corresponding to large effect sizes (Cohen's d = .82–1.09, 95% CIs .59–1.31 and secondary outcomes of impairment (WHODAS-II and depressive symptoms (PHQ9, corresponding to small effect sizes (Cohen's d = .36–.46, 95% CIs .19–.68 for patients in both pathways. Results provide evidence of the effectiveness of iCBT for social anxiety disorder when delivered in routine practice.
Taylor, Jared C.
Cognitive Behavioral Therapy (CBT) is a treatment method consisting of different interventions that have a long history of use with individuals with anxiety and depression. Despite CBT possessing a breadth of research support of which many interventions are considered evidenced based, the level of use in schools is not well known. Using the…
Rational-emotive and cognitive-behavior therapy (REBT/CBT) versus pharmacotherapy versus REBT/CBT plus pharmacotherapy in the treatment of major depressive disorder in youth; a randomized clinical trial.
Iftene, Felicia; Predescu, Elena; Stefan, Simona; David, Daniel
Major depressive disorder is a highly prevalent and debilitating condition in youth, so developing efficient treatments is a priority for mental health professionals. Psychotherapy (i.e., cognitive behavioral therapy/CBT), pharmacotherapy (i.e., SSRI medication), and their combination have been shown to be effective in treating youth depression; however, the results are still mixed and there are few studies engaging multi-level analyses (i.e., subjective, cognitive, and biological). Therefore, the aims of this randomized control study (RCT) were both theoretical - integrating psychological and biological markers of depression in a multi-level outcome analysis - and practical - testing the generalizability of previous results on depressed Romanian youth population. Eighty-eight (N=88) depressed Romanian youths were randomly allocated to one of the three treatment arms: group Rational Emotive Behavior Therapy (REBT)/CBT (i.e., a form of CBT), pharmacotherapy (i.e., sertraline), and group REBT/CBT plus pharmacotherapy. The results showed that all outcomes (i.e., subjective, cognitive, and biological) significantly change from pre to post-treatment under all treatment conditions at a similar rate and there were no significant differences among conditions at post-test. In case of categorical analysis of the clinical response rate, we found a non-significant trend favoring group REBT/CBT therapy. Results of analyses concerning outcome interrelations are discussed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Does an online psychological intervention improve self-efficacy and disability in people also receiving Multimodal Manual Therapy for chronic low back pain compared to Multimodal Manual Therapy alone? Design of a randomized controlled trial
Petrozzi, M.J.; Leaver, A.; Jones, M.K.; Ferreira, P.H.; Rubinstein, S.M.; Mackey, M.G.
Background: Various interventions are available for the treatment of chronic low back pain (LBP), including Manual Therapy and Cognitive Behavioural Therapy (CBT). The purpose of this study is to evaluate whether the addition of an internet-based CBT program leads to better outcomes in patients who
Allen, Laura B.; White, Kamila S.; Barlow, David H.; Shear, M. Katherine; Gorman, Jack M.; Woods, Scott W.
Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disor...
Batista, Maja; Mestrović, Antonela; Vekić, Ana Marija; Malenical, Masa; Kukuruzović, Monika; Begovac, Ivan
A pilot study was conducted to examine the efficiency and satisfaction of cognitive behavioral therapy (CBT) intervention in youth with epilepsy regarding coping strategies. The CBT intervention was based on the main principles and empirically supported cognitive-behavioral techniques. The intervention consists of epilepsy education, stress education, and coping skill strategies. Seventeen children and adolescents aged 9-17 diagnosed with epilepsy for at least one year, with at least average intelligence and no history of serious mental illness completed the CBT intervention during summer camp, providing data on the efficiency of and satisfaction with CBT intervention. Upon completion of the CBT intervention, study subjects achieved significantly higher scores on the following Scale of Coping with Stress subscales: Problem solving; Seeking for social support from friends; Seeking for social support from family; and Cognitive restructuring, for both measures of usage frequency and effectiveness of each subscale. The participants reported a high level of satisfaction with the CBT intervention. This study provided explanation of research limitations and recommendations for future clinical trials.
Glass, Nancy; Hanson, Ginger C; Anger, W Kent; Laharnar, Naima; Campbell, Jacquelyn C; Weinstein, Marc; Perrin, Nancy
The study examines the effectiveness of a workplace violence and harassment prevention and response program with female homecare workers in a consumer driven model of care. Homecare workers were randomized to either; computer based training (CBT only) or computer-based training with homecare worker peer facilitation (CBT + peer). Participants completed measures on confidence, incidents of violence, and harassment, health and work outcomes at baseline, 3, 6 months post-baseline. Homecare workers reported improved confidence to prevent and respond to workplace violence and harassment and a reduction in incidents of workplace violence and harassment in both groups at 6-month follow-up. A decrease in negative health and work outcomes associated with violence and harassment were not reported in the groups. CBT alone or with trained peer facilitation with homecare workers can increase confidence and reduce incidents of workplace violence and harassment in a consumer-driven model of care. © 2017 Wiley Periodicals, Inc.
Unwin, Gemma; Tsimopoulou, Ioanna; Kroese, Biza Stenfert; Azmi, Sabiha
Relatively little is known about the application of cognitive behavioural therapy (CBT) to people with intellectual disabilities (ID). This review sought to synthesise available evidence on the effectiveness of CBT for anxiety or depression to assess the current level of evidence and make recommendations for future research. A comprehensive systematic literature search was conducted to identify qualitative and quantitative studies. Robust criteria were applied to select papers that were relevant to the review. Included papers were subject to quality appraisal. Eleven out of the 223 studies considered met our inclusion criteria and were included in the review in which CBT was used with participants with ID and anxiety (n=3), depression (n=4) or a mixed clinical presentation (n=4). There remains a paucity of evidence of effectiveness, however, the studies indicate that CBT is feasible and well-tolerated and may be effective in reducing symptoms of depression among adults with mild ID. Qualitative data reflect a positive perception of CBT amongst clients and carers. Further research is required to investigate the components of CBT, suitability for CBT, and requisite skills for CBT, which uses valid, sensitive and more holistic outcome measures. Copyright © 2015 Elsevier Ltd. All rights reserved.
Tobin, Karin; Davey-Rothwell, Melissa A; Nonyane, Bareng A S; Knowlton, Amy; Wissow, Lawrence; Latkin, Carl A
Depression and depressive symptoms mediate the association between drug use and HIV risk. Yet, there are few interventions that target depressive symptoms and HIV risk for people who use drugs (PWUD). This study was a randomized controlled trial of an integrated cognitive behavioral therapy and HIV prevention intervention to reduce depressive symptoms, injection risk behaviors and increase condom use in a sample of urban people who used heroin or cocaine in the prior 6 months. A total of 315 individuals aged 18-55, who self-reported at least one HIV drug and sex risk behavior and scored ≥16 and symptoms, but weak impact on HIV risk. This trial is registered with ClinicalTrials.gov under the title "Neighborhoods, Networks, Depression, and HIV Risk" number NCT01380613.
Waller, Glenn; Tatham, Madeleine; Turner, Hannah; Mountford, Victoria A; Bennetts, Alison; Bramwell, Kate; Dodd, Julie; Ingram, Lauren
Existing forms of evidence-based cognitive behavior therapy for eating disorders (CBT-ED) are relatively effective for nonunderweight cases. However, they are also expensive compared to CBT for other disorders. This study reports the first outcomes for a shorter, 10-session form of CBT-ED (CBT-T) for such cases, designed to be less demanding of resources. A case series of 106 nonunderweight eating disordered cases were considered for this effectiveness study. A protocolized 10-session version of CBT-ED was delivered by clinical assistants, under supervision. Measures assessed eating attitudes and behaviors, anxiety, depression, personality pathology, and the working alliance. Intention-to-treat analyses were used. Suitability, acceptability, working alliance ratings, and retention were all positive. Outcomes by the end of therapy and at three-month follow-up were positive for all symptoms, with levels of change, abstinence and remission that were comparable to those from effectiveness studies of longer forms of CBT. Higher levels of pretreatment anxiety predicted retention in treatment, but no factors predicted poorer response. Early change in eating attitudes and the working alliance were the strongest predictors of a positive response. This 10-session form of CBT-ED for nonunderweight eating disorders performed at a level that is comparable to versions of CBT-ED that are twice as long, despite being delivered by nonspecialist therapists. Replication and longer-term follow-ups are needed to ensure retained effects. However, CBT-T has promise as a therapy for use in a range of healthcare settings, to enhance access to treatment for such eating disorders. © 2018 Wiley Periodicals, Inc.
Dear, B F; Fogliati, V J; Fogliati, R; Gandy, M; McDonald, S; Talley, N; Holtmann, G; Titov, N; Jones, M
Many people with functional gastrointestinal disorders (FGIDs) face significant barriers in accessing psychological treatments that are known to reduce symptoms and their psychological sequelae. This study examined the feasibility and initial outcomes of a transdiagnostic and internet-delivered cognitive behaviour therapy (iCBT) intervention, the Chronic Conditions Course, for adults with functional gastrointestinal disorders (FGIDs). A single-group feasibility open trial design was employed and administered to twenty seven participants. The course ran for 8 weeks and was provided with weekly contact from a Clinical Psychologist. Seventy percent of participants completed the course within the 8 weeks and 81.5% provided data at post-treatment. High levels of satisfaction were observed and relatively little clinician time (M = 42.70 min per participant; SD = 46.25 min) was required. Evidence of clinical improvements in FGID symptoms (ds ≥ 0.46; avg. improvement ≥21%), anxiety symptoms (ds ≥ 0.99; avg. improvement ≥42%), and depression symptoms (ds ≥ 0.75; avg. improvement ≥35%) were observed, which either maintained or continued to improve to 3-month follow-up. Evidence of improvement was also observed in pain catastrophising and mental-health related quality of life, but not physical-health related quality of life. These findings highlight the potential value of transdiagnostic internet-delivered programs for adults with FGIDs and support for the conduct of larger-scale controlled studies. Copyright © 2018 Elsevier Inc. All rights reserved.
Alishia D Williams
Full Text Available BACKGROUND: Depression is a common, recurrent, and debilitating problem and Internet delivered cognitive behaviour therapy (iCBT could offer one solution. There are at least 25 controlled trials that demonstrate the efficacy of iCBT. The aim of the current paper was to evaluate the effectiveness of an iCBT Program in primary care that had been demonstrated to be efficacious in two randomized controlled trials (RCTs. METHOD: Quality assurance data from 359 patients prescribed the Sadness Program in Australia from October 2010 to November 2011 were included. RESULTS: Intent-to-treat marginal model analyses demonstrated significant reductions in depressive symptoms (PHQ9, distress (K10, and impairment (WHODAS-II with medium-large effect sizes (Cohen's d = .51-1.13., even in severe and/or suicidal patients (Cohen's d = .50-1.49. Secondary analyses on patients who completed all 6 lessons showed levels of clinically significant change as indexed by established criteria for remission, recovery, and reliable change. CONCLUSIONS: The Sadness Program is effective when prescribed by primary care practitioners and is consistent with a cost-effective stepped-care framework.
Comparison of the Effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and Sertraline on Depression and Anxiety in Patients after Coronary Artery Bypass Graft Surgery: Study Protocol for a Randomized Controlled Trial.
Hosseini, Seyed Hamzeh; Rafiei, Alireza; Gaemian, Ali; Tirgari, Abdolhakim; Zakavi, Aliasghar; Yazdani, Jamshid; Bolhari, Jafar; Golzari, Mahmood; Esmaeili Douki, Zahra; Vaezzadeh, Nazanin
Objective: The present study aimed at comparing the effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and sertraline on depression, anxiety, biomarker levels, and quality of life in patients after coronary artery bypass graft (CABG) surgery. Method: This was a randomized controlled trial with parallel groups. A total of 160 patients after CABG surgery will be screened for anxiety and depression according to clinical interviews based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and Hospital Anxiety Depression Scale (HADS) scores (≥ 8). To assess religious attitude, Golriz and Baraheni's Religious Attitude questionnaire will be used. Participants will be randomly allocated to 4 groups of 40 including 3 intervention groups (RCBT, CBT, and sertraline) and 1 control group (usual care). RCBT and CBT programs will consist of 12 one-hour weekly sessions. The participants in the pharmacological intervention group will receive 25-200 mg/d of sertraline for 3 months. The Short Form-36 Health Survey (SF-36) will be administered to assess the patients' quality of life. Blood samples will be taken and biomarker levels will be determined using the enzyme-linked immunosorbent assay (ELISA). The primary outcome will be reduction in anxiety and depression scores after the interventions. The secondary outcomes will be increase in quality of life scores and normalized biomarker levels after the interventions. Discussion: If RCBT is found to be more effective than the other methods; it can be used to improve patients' health status after CABG surgery. Irct ID: IRCT201404122898N5.
Smith, Patrick; Scott, Rebecca; Eshkevari, Ertimiss; Jatta, Fatoumata; Leigh, Eleanor; Harris, Victoria; Robinson, Alex; Abeles, Paul; Proudfoot, Judy; Verduyn, Chrissie; Yule, William
Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents. Copyright © 2015 Elsevier Ltd. All rights reserved.
Nowak, Izabela; Sabariego, Carla; Świtaj, Piotr; Anczewska, Marta
Schizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and "third wave" cognitive - behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO's International Classification of Functioning, Disability and Health (ICF) as a frame of reference. It also explores if current CBT interventions focus on recovery and what is their impact on disability domains. Medline and PsycINFO databases were searched for studies published in English between January 2009 and December 2015. Abstracts and full papers were screened against pre-defined selection criteria by two reviewers. Methodological quality of included studies was assessed by two independent raters using the Effective Public Health Practice Project Quality assessment tool for quantitative studies (EPHPP) guidelines. A total of 50 studies were included, 35 studies evaluating traditional CBT interventions and 15 evaluating "third wave" approaches. Overall, traditional CBT interventions addressed more disability domains than "third wave" approaches and mostly focused on mental functions reflecting schizophrenia psychopathology. Seven studies met the inclusion criteria of recovery-oriented interventions. The majority of studies evaluating these interventions had however a high risk of bias, therefore evidence on their effectiveness is inconclusive. Traditional CBT interventions address more disability domains than "third wave" therapies, however both approaches focus mostly on mental functions that reflect schizophrenia psychopathology. There are also few interventions that focus on recovery. These results indicate that CBT interventions going beyond symptom reduction are still needed. Recovery-focused CBT interventions
Yasinski, Carly; Hayes, Adele; Ready, C. Beth; Cummings, Jorden A.; Berman, Ilana S.; McCauley, Thomas; Webb, Charles; Deblinger, Esther
Objective Involving caregivers in trauma-focused treatments for youth has been shown to result in better outcomes, but it is not clear which in-session caregiver behaviors enhance or inhibit this effect. The current study examined the associations between caregiver behaviors during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and youth cognitive processes and symptoms. Method Participants were a racially diverse sample of Medicaid-eligible youth (ages 7–17) and their non-offending caregivers (N= 71 pairs) who received TF-CBT through an effectiveness study in a community setting. Caregiver and youth processes were coded from audio-recorded sessions, and outcomes were measured using the Child Behavior Checklist (CBCL) and UCLA PTSD Reaction Index for DSM-IV (UPID) at 3, 6, 9, and 12 months post-intake. Results Piecewise linear growth curve modeling revealed that during the trauma narrative phase of TF-CBT, caregivers’ cognitive-emotional processing of their own and their child's trauma-related reactions predicted decreases in youth internalizing and externalizing symptoms over treatment. Caregiver support predicted lower internalizing symptoms over follow-up. In contrast, caregiver avoidance and blame of the child predicted worsening of youth internalizing and externalizing symptoms over follow-up. Caregiver avoidance early in treatment also predicted worsening of externalizing symptoms over follow-up. During the narrative phase, caregiver blame and avoidance were correlated with more child overgeneralization of trauma beliefs, and blame was also associated with less child accommodation of balanced beliefs. Conclusions The association between in-session caregiver behaviors and youth symptomatology during and after TF-CBT highlights the importance of assessing and targeting these behaviors to improve clinical outcomes. PMID:27618641
Yasinski, Carly; Hayes, Adele M; Ready, C Beth; Cummings, Jorden A; Berman, Ilana S; McCauley, Thomas; Webb, Charles; Deblinger, Esther
Involving caregivers in trauma-focused treatments for youth has been shown to result in better outcomes, but it is not clear which in-session caregiver behaviors enhance or inhibit this effect. The current study examined the associations between caregiver behaviors during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and youth cognitive processes and symptoms. Participants were a racially diverse sample of Medicaid-eligible youth (ages 7-17) and their nonoffending caregivers (N = 71 pairs) who received TF-CBT through an effectiveness study in a community setting. Caregiver and youth processes were coded from audio-recorded sessions, and outcomes were measured using the Child Behavior Checklist (CBCL) and UCLA PTSD Reaction Index for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV; UPID) at 3, 6, 9, and 12 months postintake. Piecewise linear growth curve modeling revealed that during the trauma narrative phase of TF-CBT, caregivers' cognitive-emotional processing of their own and their child's trauma-related reactions predicted decreases in youth internalizing and externalizing symptoms over treatment. Caregiver support predicted lower internalizing symptoms over follow-up. In contrast, caregiver avoidance and blame of the child predicted worsening of youth internalizing and externalizing symptoms over follow-up. Caregiver avoidance early in treatment also predicted worsening of externalizing symptoms over follow-up. During the narrative phase, caregiver blame and avoidance were correlated with more child overgeneralization of trauma beliefs, and blame was also associated with less child accommodation of balanced beliefs. The association between in-session caregiver behaviors and youth symptomatology during and after TF-CBT highlights the importance of assessing and targeting these behaviors to improve clinical outcomes. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Wonderlich, S A; Peterson, C B; Crosby, R D; Smith, T L; Klein, M H; Mitchell, J E; Crow, S J
The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, 'enhanced' cognitive-behavioral therapy (CBT-E). Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.
Liness, Sheena; Lea, Susan; Nestler, Steffen; Parker, Hannah; Clark, David M
The UK Department of Health Improving Access to Psychological Therapies (IAPT) initiative set out to train a large number of therapists in cognitive behaviour therapies (CBT) for depression and anxiety disorders. Little is currently known about the retention of IAPT CBT trainees, or the use of CBT skills acquired on the course in the workplace after training has finished. This study set out to conduct a follow-up survey of past CBT trainees on the IAPT High Intensity CBT Course at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), one of the largest IAPT High Intensity courses in the UK. Past trainees (n = 212) across 6 cohorts (2008-2014 intakes) were contacted and invited to participate in a follow-up survey. A response rate of 92.5% (n = 196) was achieved. The vast majority of IAPT trainees continue to work in IAPT services posttraining (79%) and to practise CBT as their main therapy modality (94%); 61% have become CBT supervisors. A minority (23%) have progressed to other senior roles in the services. Shortcomings are reported in the use of out-of-office CBT interventions, the use of disorder-specific outcome measures and therapy recordings to inform therapy and supervision. Past trainees stay working in IAPT services and continue to use CBT methods taught on the course. Some NICE recommended treatment procedures that are likely to facilitate patients' recovery are not being routinely implemented across IAPT services. The results have implications for the continued roll out of the IAPT programme, and other future large scale training initiatives.
Törnquist, Anna; Rakovshik, Sarah; Carlsson, Jan; Norberg, Joakim
There is limited research into the effect of supervision in cognitive behavioural therapy (CBT) from the supervisees' perspective. The aim of the study was to acquire knowledge from the supervisees' perspective as to what in particular in the supervision process contributes to the therapy process. Fourteen supervisees on a foundation course participated in the study. A qualitative approach was used with thematic analysis of the participants' written diaries after supervision and therapy sessions. Analyses of supervisees' experiences suggested that a variety of therapeutic interventions were easier to implement if one had the supervisor's support and felt free to decide if and when the suggested interventions could best be implemented. Evaluation in the form of positive feedback from the supervisor indicating that the supervisee was 'doing the right thing' was perceived to be important. A unifying theme when supervisees felt they were not getting anything out of the supervision was that the supervisees did not have a supervision question. The results of this research suggest that the supervisor's support during training is perceived to be important for the supervisee. Receiving positive feedback from one's supervisor in an evaluation is perceived to have a great impact on whether the therapist implements the suggested therapeutic interventions discussed in the previous supervision.
Jónsson, Hjalti; Hougaard, Esben; Bennedsen, Birgit
, as well as reviewers of the literature have focused on within single treatments effect sizes rather between group effect sizes. OBJECTIVES To make a systematic review, and by methods of meta analysis compute a pooled within effect size of studies of group CBT of OCD and compare these to previously.......05 and 1.25 respectively, with an overall combined pooled within effect size across the categories at 1.18. Finally a between effect sizes of the four studies comparing group therapy to waitlist control group was reported at.1.12 CONCLUSION The reported within effect sizes in this meta-analysis (range 1...
Increasing engagement with, and effectiveness of, an online CBT-based stress management intervention for employees through the use of an online facilitated bulletin board: study protocol for a pilot randomised controlled trial.
Carolan, Stephany; Harris, Peter R; Greenwood, Kathryn; Cavanagh, Kate
The evidence for the benefits of online cognitive behaviour therapy (CBT)-based programmes delivered in a clinical context is clear, but this evidence does not translate to online CBT-based stress management programmes delivered within a workplace context. One of the challenges to the delivery of online interventions is programme engagement; this challenge is even more acute for interventions delivered in real-world settings such as the workplace. The purpose of this pilot study is to explore the effect of an online facilitated discussion group on engagement, and to estimate the potential effectiveness of an online CBT-based stress management programme. This study is a three-arm randomised controlled trial (RCT) comparing a minimally guided, online, CBT-based stress management intervention delivered with and without an online facilitated bulletin board, and a wait list control group. Up to 90 employees from six UK-based organisations will be recruited to the study. Inclusion criteria will include age 18 years or over, elevated levels of stress (as measured on the PSS-10 scale), access to a computer or a tablet and the Internet. The primary outcome measure will be engagement, as defined by the number of logins to the site; secondary outcome measures will include further measures of engagement (the number of pages visited, the number of modules completed and self-report engagement) and measures of effectiveness (psychological distress and subjective wellbeing). Possible moderators will include measures of intervention quality (satisfaction, acceptability, credibility, system usability), time pressure, goal conflict, levels of distress at baseline and job autonomy. Measures will be taken at baseline, 2 weeks (credibility and expectancy measures only), 8 weeks (completion of intervention) and 16 weeks (follow-up). Primary analysis will be conducted on intention-to-treat principles. To our knowledge this is the first study to explore the effect of an online
Signorini, Rachel; Sheffield, Jeanie; Rhodes, Natalie; Fleming, Carmel; Ward, Warren
The effectiveness of enhanced cognitive behavioural Therapy (CBT-E) for adults with a range of eating disorder presentations within routine clinical settings has been examined in only two known published studies, neither of which included a follow-up assessment period. The current study aimed to evaluate the effectiveness of CBT-E within an out-patient eating disorder service in Brisbane, Queensland, Australia, and incorporated a follow-up assessment period of approximately 20 weeks post-treatment. The study involved 114 adult females with a diagnosed eating disorder, who attended an average of 20-40 individual CBT-E sessions with a psychologist or a psychiatry registrar between 2009 and 2013. Of those who began treatment, 50% did not complete treatment, and the presence of psychosocial and environmental problems predicted drop-out. Amongst treatment completers, statistically and clinically significant improvements in eating disorder and general psychopathology were observed at post-treatment, which were generally maintained at the 20-week follow-up. Statistically significant improvements in eating disorder and general psychopathology were observed amongst the total sample. The findings, which were comparable to the previous Australian effectiveness study of CBT-E, indicate that CBT-E is an effective treatment for adults with all eating disorders within out-patient settings. Given the high attrition rate, however, minimizing drop-out appears to be an important consideration when implementing CBT-E within clinical settings.
Mosweu, I; Moss-Morris, R; Dennison, L; Chalder, T; McCrone, P
Cognitive Behavioural Therapy (CBT) reduces distress in multiple sclerosis, and helps manage adjustment, but cost-effectiveness evidence is lacking. An economic evaluation was conducted within a multi-centre trial. 94 patients were randomised to either eight sessions of nurse-led CBT or supportive listening (SL). Costs were calculated from the health, social and indirect care perspectives, and combined with additional quality-adjusted life years (QALY) or improvement on the GHQ-12 score, to explore cost-effectiveness at 12 months. CBT had higher mean health costs (£1610, 95% CI, -£187 to 3771) and slightly better QALYs (0.0053, 95% CI, -0.059 to 0.103) compared to SL but these differences were not statistically significant. This yielded £301,509 per QALY improvement, indicating that CBT is not cost-effective according to established UK NHS thresholds. The extra cost per patient improvement on the GHQ-12 scale was £821 from the same perspective. Using a £20,000, threshold, CBT in this format has a 9% probability of being cost effective. Although subgroup analysis of patients with clinical levels of distress at baseline showed an improvement in the position of CBT compared to SL, CBT was still not cost-effective. Nurse delivered CBT is more effective in reducing distress among MS patients compared to SL, but is highly unlikely to be cost-effective using a preference-based measure of health (EQ-5D). Results from a disease-specific measure (GHQ-12) produced comparatively lower Incremental Cost-Effectiveness Ratios, but there is currently no acceptable willingness-to-pay threshold for this measure to guide decision-making.
Koffel, Erin; Kuhn, Eric; Petsoulis, Napoleon; Erbes, Christopher R; Anders, Samantha; Hoffman, Julia E; Ruzek, Josef I; Polusny, Melissa A
There has been growing interest in utilizing mobile phone applications (apps) to enhance traditional psychotherapy. Previous research has suggested that apps may facilitate patients' completion of cognitive behavioral therapy for insomnia (CBT-I) tasks and potentially increase adherence. This randomized clinical trial pilot study ( n = 18) sought to examine the feasibility, acceptability, and potential impact on adherence and sleep outcomes related to CBT-I Coach use. All participants were engaged in CBT-I, with one group receiving the app as a supplement and one non-app group. We found that patients consistently used the app as intended, particularly the sleep diary and reminder functions. They reported that it was highly acceptable to use. Importantly, the app did not compromise or undermine benefits of cognitive behavioral therapy for insomnia and patients in both groups had significantly improved sleep outcomes following treatment.
Arnberg, Alexandra; Ost, Lars-Göran
Pediatric depression entails a higher risk for psychiatric disorders, somatic complaints, suicide, and functional impairment later in life. Cognitive behavior therapy (CBT) is recommended for the treatment of depression in children, yet research is based primarily on adolescents. The present meta-analysis investigated the efficacy of CBT in children aged 8-12 years with regard to depressive symptoms. We included randomized controlled trials of CBT with participants who had an average age of ≤ 12 years and were diagnosed with either depression or reported elevated depressive symptoms. The search resulted in 10 randomized controlled trials with 267 participants in intervention and 256 in comparison groups. The mean age of participants was 10.5 years. The weighted between-group effect size for CBT was moderate, Cohen's d = 0.66. CBT outperformed both attention placebo and wait-list, although there was a significant heterogeneity among studies with regard to effect sizes. The weighted within-group effect size for CBT was large, d = 1.02. Earlier publication year, older participants, and more treatment sessions were associated with a larger effect size. In conclusion, the efficacy of CBT in the treatment of pediatric depression symptoms was supported. Differences in efficacy, methodological shortcomings, and lack of follow-up data limit the present study and indicate areas in need of improvement.
Andrews, Gavin; Williams, Alishia D
Depression is a global health problem but only a minority of people with depression receive even minimally adequate treatment. Internet delivered automated cognitive behaviour therapy (iCBT) which is easily distributed and in which fidelity is guaranteed could be one solution to the problem of
Safren, Steven A.; O'Cleirigh, Conall M.; Bullis, Jacqueline R.; Otto, Michael W.; Stein, Michael D.; Pollack, Mark H.
Objective: Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment adherence. Injection drug users comprise a substantial portion of individuals with HIV in the United States and globally. The present study tested cognitive behavioral therapy for adherence and depression (CBT-AD) in patients…
AR Jamshidzehi ShahBakhsh
Full Text Available Introduction: The mitral valve prolapse is a heart syndrome that is characterized by considerable physical and psychological consequences for affected patients. This study aimed to assess the efficacy of cognitive-behavioral therapy in reducing worrying, generalized anxiety and panic attacks in patients with mitral valve prolapse. Methods: This study is quasi-experimental research with pretest-posttest and control group. 16 patients with mitral valve prolapse divided into to two groups: experimental (n = 8 and control (n = 8 groups. CBT was used during 10 sessions twice a week with a focus on cognitive restructuring, modification of cognitive distortions and training of behavioral techniques for the experimental group. For participants health concerns spot and doush (HCQ, Generalized anxiety disorder (GAD- 7 and Albania panic scales as pre-test, post-test. Results: Data were analyzed by covariance analysis. The results showed that worrying, anxiety, and panic attacks significantly reduced in the experimental group. Discussion: Cognitive behavioral therapy is remarkably effective for reducing fear, anxiety and panic patients with mitral valve prolapse. Therefore, it is recommended for the patients with mitral valve prolapse that cognitive behavioral therapy can be used as a complementary therapy.
behavioral therapy (CBT) interventions have been shown to be effective in alleviating symptoms of Post - Traumatic Stress Disorder ( PTSD ) and related... traumatic stress disorder treatment providers: design and methods for a randomized, prospective intervention study. Implement Sci, 7, 43. doi: 10.1186...Friedman, M. J., Young-Xu, Y., & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder
Trimmer, Chris; Tyo, Richard; Pikard, Jennifer; McKenna, Claire; Naeem, Farooq
Music has the potential to be an effective and engaging therapeutic intervention in the treatment of mental illness. This research area remains underdeveloped. This paper reports the feasibility of an innovative low-intensity CBT-based music (CBT-Music) group targeted to symptoms of depression and anxiety. A total of 28 participants with symptoms of depression and anxiety who were attending community mental health services were recruited for the study and randomized into TAU (treatment as usual) plus low-intensity CBT-Music (treatment) or to TAU alone (control). The treatment group consisted of a 9-week music group that incorporated various components of CBT material into a musical context. Feasibility was the primary outcome. The secondary outcomes were a reduction in depression, anxiety (Hospital Anxiety and Depression Scale) and disability (WHO Disability Assessment Schedule 2.0) assessed at baseline and 10 weeks. Recruitment proved feasible, retention rates were high, and the participants reported a high level of acceptability. A randomized control study design was successfully implemented as there were no significant differences between treatment and control groups at baseline. Participants in the treatment group showed improvement in disability (p = 0.027). Despite a reduction in depression and anxiety scores, these differences were not statistically significant. A low-intensity CBT-based music group can be successfully administered to clients of community mental health services. There are indications of effectiveness in reducing disability, although there appears to be negligible effect on symptoms of anxiety and depression. This is the first report of a trial of a low-intensity CBT-based music group intervention.
Handley, Tonelle E; Kay-Lambkin, Frances J; Baker, Amanda L; Lewin, Terry J; Kelly, Brian J; Inder, Kerry J; Attia, John R; Kavanagh, David J
Depression and alcohol misuse are among the most prevalent diagnoses in suicide fatalities. The risk posed by these disorders is exacerbated when they co-occur. Limited research has evaluated the effectiveness of common depression and alcohol treatments for the reduction of suicide vulnerability in individuals experiencing comorbidity. Participants with depressive symptoms and hazardous alcohol use were selected from two randomised controlled trials. They had received either a brief (1 session) intervention, or depression-focused cognitive behaviour therapy (CBT), alcohol-focused CBT, therapist-delivered integrated CBT, computer-delivered integrated CBT or person-centred therapy (PCT) over a 10-week period. Suicidal ideation, hopelessness, depression severity and alcohol consumption were assessed at baseline and 12-month follow-up. Three hundred three participants were assessed at baseline and 12 months. Both suicidal ideation and hopelessness were associated with higher severity of depressive symptoms, but not with alcohol consumption. Suicidal ideation did not improve significantly at follow-up, with no differences between treatment conditions. Improvements in hopelessness differed between treatment conditions; hopelessness improved more in the CBT conditions compared to PCT and in single-focused CBT compared to integrated CBT. Low retention rates may have impacted on the reliability of our findings. Combining data from two studies may have resulted in heterogeneity of samples between conditions. CBT appears to be associated with reductions in hopelessness in people with co-occurring depression and alcohol misuse, even when it is not the focus of treatment. Less consistent results were observed for suicidal ideation. Establishing specific procedures or therapeutic content for clinicians to monitor these outcomes may result in better management of individuals with higher vulnerability for suicide. © 2013 Elsevier B.V. All rights reserved.
Bodden, D.H.M.; Dirksen, C.D.; Bögels, S.M.; Nauta, M.H.; de Haan, E.; Ringrose, J.; Appelboom, C.; Brinkman, A.G.; Appelboom-Geerts, K.C.M.M.J.
The objective of this study was to investigate the cost-effectiveness of family cognitive-behavioral therapy (CBT) compared with individual CBT in children with anxiety disorders. Clinically anxious children (aged 8—18 years) referred for treatment were randomly assigned to family or individual CBT
A cluster randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of classroom-based cognitive-behavioural therapy (CBT) in reducing symptoms of depression in high-risk adolescents.
Stallard, P; Phillips, R; Montgomery, A A; Spears, M; Anderson, R; Taylor, J; Araya, R; Lewis, G; Ukoumunne, O C; Millings, A; Georgiou, L; Cook, E; Sayal, K
Depression in adolescents is a significant problem that impairs everyday functioning and increases the risk of severe mental health disorders in adulthood. Although this is a major problem, relatively few adolescents with, or at risk of developing, depression are identified and referred for treatment. This suggests the need to investigate alternative approaches whereby preventative interventions are made widely available in schools. To investigate the clinical effectiveness and cost-effectiveness of classroom-based cognitive-behavioural therapy (CBT) in reducing symptoms of depression in high-risk adolescents. Cluster randomised controlled trial. Year groups ( n = 28) randomly allocated on a 1 : 1 : 1 basis to one of three trial arms once all schools were recruited and balanced for number of classes, number of students, Personal, Social and Health Education (PSHE) lesson frequency, and scheduling of PSHE. Year groups 8 to 11 (ages 12-16 years) in mixed-sex secondary schools in the UK. Data were collected between 2009 and 2011. Young people who attended PSHE at participating schools were eligible ( n = 5503). Of the 5030 who agreed to participate, 1064 (21.2%) were classified as 'high risk': 392 in the classroom-based CBT arm, 374 in the attention control PSHE arm and 298 in the usual PSHE arm. Primary outcome data on the high-risk group at 12 months were available for classroom-based CBT ( n = 296), attention control PSHE ( n = 308) and usual PSHE ( n = 242). The Resourceful Adolescent Programme (RAP) is a focused CBT-based intervention adapted for the UK (RAP-UK) and delivered by two facilitators external to the school. Control groups were usual PSHE (usual school curriculum delivered by teachers) and attention control (usual school PSHE with additional support from two facilitators). Interventions were delivered universally to whole classes. Clinical effectiveness: symptoms of depression [Short Mood and Feelings Questionnaire (SMFQ)] in adolescents at high risk
Kishita, Naoko; Laidlaw, Ken
The current meta-analysis compared the efficacy of CBT for GAD between adults of working age and older people. In addition, we conducted a qualitative content analysis of treatment protocols used in studies with older clients to explore potential factors that may enhance treatment outcomes with this particular client group. Applying the inclusion criteria resulted in the identification of 15 studies with 22 comparisons between CBT and control groups (770 patients). When examining overall effect sizes for CBT for GAD between older people and adults of working age there were no statistically significant differences in outcome. However, overall effect size of CBT for GAD was moderate for older people (g=0.55, 95% CI 0.22-0.88) and large for adults of working age (g=0.94, 95% CI 0.52-1.36), suggesting that there is still room for improvement in CBT with older people. The main difference in outcome between CBT for GAD between the two age groups was related to methodological quality in that no older people studies used an intention-to-treat design. The content analysis demonstrated that studies with older clients were conducted according to robust CBT protocols but did not take account of gerontological evidence to make them more age-appropriate. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Bruinsma, A; Kampman, M; Exterkate, C C; Hendriks, G J
Digital technology (e-health or 'blended' care), combined with evidence-based face-to-face CBT, is becoming increasingly implemented into mental health care and is expected to result in improved effectiveness and efficiency. To explore the feasibility of blended CBT for patients with a panic disorder. Nine face-to-face sessions of blended CBT (n = 18), supplemented with the digital support of a tabletcomputer and three e-mail contacts, were compared with 12 weekly sessions of regular CBT (n = 18). Primary outcomes were panic frequency and avoidance behaviour; the secondary outcome was general functioning. Patients' experiences of the treatment were collected in the form of a structured interview. The effect sizes found in both the regular and the blended CBT were medium to high (Cohen's d 0.42-1.60). In both types of treatment there was a significant reduction in patients' symptoms. There were no big differences in patient satisfaction regarding the treatment received. The therapists registered 39 face-to-face minutes in the blended treatment but they registered in total 41 fewer face-to-face minutes; this represented a time reduction of 4%. Blended CBT with help of a tablet computer seems to be a suitable method for treating panic disorder psychologically, although the time saved is only moderate. Much more research is needed to ascertain the feasibility and the cost effectiveness of blended CBT.
Ruocco, Sylvia; Gordon, Jocelynne; McLean, Louise A.
Early manifestations of anxiety in childhood confer significant distress and life interference. This study reports on the first controlled trial of the "Get Lost Mr. Scary" programme, a Cognitive Behavioural Therapy group intervention for children with anxiety aged 5-7 years. Participants were 134 children (65 males and 69 females) drawn…
Navigating the development and dissemination of internet cognitive behavioral therapy (iCBT for anxiety disorders in children and young people: A consensus statement with recommendations from the #iCBTLorentz Workshop Group
Full Text Available Initial internet-based cognitive behavioral therapy (iCBT programs for anxiety disorders in children and young people (CYP have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and dissemination of iCBT has arguably contributed to the difficulty in developing iCBT that is scalable and sustainable beyond academic evaluation and that can ultimately be adopted by healthcare providers. This paper presents a consensus statement and recommendations from a workshop of international experts in CYP anxiety and iCBT (#iCBTLorentz Workshop Group on the development, evaluation, engagement and dissemination of iCBT for anxiety in CYP. Keywords: Children, Adolescents, Anxiety, Cognitive behavioral therapy, Online treatments, Development, Dissemination
Yasinski, Carly; Hayes, Adele M; Alpert, Elizabeth; McCauley, Thomas; Ready, C Beth; Webb, Charles; Deblinger, Esther
Premature dropout is a significant concern in trauma-focused psychotherapy for youth. Previous studies have primarily examined pre-treatment demographic and symptom-related predictors of dropout, but few consistent findings have been reported. The current study examined demographic, symptom, and in-session process variables as predictors of dropout from Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth. Participants were a diverse sample of Medicaid-eligible youth (ages 7-17; n = 108) and their nonoffending caregivers (n = 86), who received TF-CBT through an effectiveness study in a community setting. In-session process variables were coded from audio-recorded sessions, and these and pre-treatment demographic variables and symptom levels were examined as predictors of dropout prior to receiving an adequate dose of TF-CBT (parents or relatives. No other demographic or symptom-related factors predicted dropout. These findings highlight the importance of addressing avoidance and therapeutic relationship difficulties in early sessions of TF-CBT to help reduce dropout, and they have implications for improving efforts to disseminate evidence-based trauma-focused treatments. Copyright © 2018 Elsevier Ltd. All rights reserved.
Garland, Sheila N; Rouleau, Codie R; Campbell, Tavis; Samuels, Charles; Carlson, Linda E
Insomnia is an important but often overlooked side effect of cancer. Dysfunctional sleep beliefs have been identified as an important perpetuating factor for insomnia. Mindfulness practice has been demonstrated to improve sleep quality but it is unknown whether these effects relate to changes in dysfunctional sleep beliefs. This study is a secondary analysis of a randomized controlled trial comparing mindfulness-based cancer recovery (MBCR) to cognitive behavior therapy for insomnia (CBT-I) in cancer patients with insomnia. This present analysis compares program impact on mindfulness, dysfunctional sleep beliefs, and insomnia severity clinical cutoffs. Patients (MBCR, n = 32; CBT-I, n = 40) were assessed at baseline, post-program, and 3-month follow-up. Across both groups, patients showed improvements over time in acting with awareness (P = .021) and not judging experiences (P = .023). Changes in dysfunctional sleep beliefs produced by the CBT-I group exceeded those produced by MBCR at post-program and follow-up (P insomnia severity clinical cutoffs at post-program or follow-up. This study supports the use of both CBT-I and MBCR to reduce insomnia severity and suggests the development of mindfulness facets as a method of reducing dysfunctional sleep beliefs. Copyright © 2015 Elsevier Inc. All rights reserved.
Liang Jun; Yang Shibin; Yue Yu; Chen Tingcong
Objective: To evaluate clinical application of arterial embolotherapy on hyperthyroidism. Methods: 11 patients with hyperthyroidism were performed with thyroid superior and inferior arterial super-selective arteriography and interventional embolization by polyvinyl alcohol (PVA), gelfoam particles and wool coil. Results: The procedures were succeeded in 11 patients. After the embolotherapy, the thyroid function gradually returned to normal level in 10 patients. The symptom was not controlled satisfactorily in 1 patient, who underwent the right thyroid inferior arteries super selective arteriography and interventional embolization, and then the thyroid function gradually returned to normal level. No serious complications occurred in all patients. Conclusions: Arterial embolotherapy is a safe, simple, symptomless, reliable and very effective for treatment of hyperthyroidism
L.G. Jiskoot (Geranne); R. Timman (Reinier); A. Beerthuizen (Annemerle); Dietz de Loos, A (Alexandra); J.J. van Busschbach (Jan); J.S.E. Laven (Joop)
markdownabstract_Context_ Long-term weight loss is important for women with polycystic ovary syndrome. Although no protocol exist for effective and long-term weight loss in this population. Three-component interventions including diet, exercise, and cognitive behavioral therapy (CBT) have shown
Rief, Winfried; Bleichhardt, Gabi; Dannehl, Katharina; Euteneuer, Frank; Wambach, Katrin
The cognitive-behavioral analysis system of psychotherapy (CBASP) was developed for the treatment of chronic, early-onset depression. However, it is unclear whether this approach can be recommended for depression in general (episodic and chronic), and no direct comparisons between CBASP with different versions of cognitive-behavioral therapy (CBT) exist. A randomized controlled trial compared 3 treatment conditions (all lasting 16 sessions) with a waiting list group (WL): CBASP, CBT with a focus on physical exercise (CBT-E), and CBT with a focus on pleasurable, low-energy and mindful activities (CBT-M). We included 173 patients and involved 41 therapists. Assessments were at baseline, after session 8, and at the end of treatment. Our primary outcome Beck Depression Inventory-II indicated a general advantage of the CBT arms compared to CBASP [F(6, 154.5) = 4.2, p = 0.001], with significant contrasts in particular in favor of CBT-E. Effect sizes against WL were d = 0.91 (CBT-E), 0.87 (CBT-M), and 0.47 (CBASP). A triple interaction with an additional factor "chronic versus episodic depression" [F(6, 142.7) = 2.2, p = 0.048] indicated that the treatments resulted in different outcomes, with best results again for CBT-E in particular in episodic depression. Responder rates indicated significant improvements (56% in both CBT arms, 34% in the CBASP arm, 3.4% in WL; intention-to-treat samples). As compared to CBASP, response rates were significantly higher for CBT-E (OR = 2.48; 95% CI = 1.02-6.00) and CBT-M (OR = 2.46; 95% CI = 1.01-6.01). CBASP was more effective than WL, but less effective than the 2 CBT arms. This was mainly caused by an advantage of CBT interventions in episodic depression. © 2018 S. Karger AG, Basel.
Karbasi, Afsaneh; Arman, Soroor; Maracy, Mohamad Reza
BACKGROUND: Anxiety disorders are one of the most psychiatric disorders in children and adolescents that can cause long life functional disability. The first line treatment for this disorder is cognitive behavioral therapy that has primary, secondary and tertiary preventive effect, but is expensive and long time. Today there is some effort to find short term, group, semi-attendance and low cost therapies. METHODS: Subjects were 42 girls (12- 17 y) with at least one anxiety disorder according to DSM-IV-TR with their parents who were divided into two groups randomly: group A which participated in 8 sessions and group B which participated in 4 sessions and the contents of sessions 3, 4, 6, and 7 were recorded on a CD for them. The tests used in this study were: SCARED, CATS, CAIS-C, CAIS-P, conducted before (T0), just after (T1) and three months after the treatment (T2). The collected data were analyzed by multivariate analysis of covariance test using SPSS software package, version 15.0. RESULTS: There was no significant difference between efficacy of semi-attendance group CBT and attendance group CBT in T0, T1 and T2 according to 4 tests (p = 0.311). The difference between the scores of these tests between T0 andT1 and T0 and T2 was significant in both groups (p < 0.001) but the difference between T1 and T2 was not significant. (p = 0.771). CONCLUSIONS: The efficacy of semi-attendance group CBT and attendance group CBT is similar and would sustain after 3 months. PMID:21526093
Full Text Available Background: Anxiety disorders are one of the most psychiatric disorders in children and adolescents that can cause long life functional disability. The first line treatment for this disorder is cognitive behavioral therapy that has primary, secondary and tertiary preventive effect, but is expensive and long time. Today there is some effort to find short term, group, semi-attendance and low cost therapies. Methods: Subjects were 42 girls (12- 17 y with at least one anxiety disorder according to DSM-IV-TR with their parents who were divided into two groups randomly: group A which participated in 8 sessions and group B which participated in 4 sessions and the contents of sessions 3, 4, 6, and 7 were recorded on a CD for them. The tests used in this study were: SCARED, CATS, CAIS-C, CAIS-P, conducted before (T0, just after (T1 and three months after the treatment (T2. The collected data were analyzed by multivariate analysis of covariance test using SPSS software package, version 15.0. Results: There was no significant difference between efficacy of semi-attendance group CBT and attendance group CBT in T0, T1 and T2 according to 4 tests (p = 0.311. The difference between the scores of these tests between T0 andT1 and T0 and T2 was significant in both groups (p < 0.001 but the difference between T1 and T2 was not significant. (p = 0.771. Conclusions: The efficacy of semi-attendance group CBT and attendance group CBT is similar and would sustain after 3 months.
Pavuluri, Mani N.; Graczyk, Patricia A.; Henry, David B.; Carbray, Julie A.; Heidenreich, Jodi; Miklowitz, David J.
Objective: To describe child- and family-focused cognitive-behavioral therapy (CFF-CBT), a new developmentally sensitive psychosocial intervention for pediatric bipolar disorder (PBD) that is intended for use along with medication. CFF-CBT integrates principles of family-focused therapy with those of CBT. The theoretical framework is based on (1)…
Nardi, Bernardo; Massei, Micaela; Arimatea, Emidio; Moltedo-Perfetti, Andrés
Depression is among the most common psychological disorders of adolescents. Its management is based on pharmacological treatment, psychological therapy, or a combination thereof. Cognitive behavioral therapy (CBT) is the most extensively tested intervention for adolescent depression. A PubMed search was conducted for randomized controlled trials (RCT) of the efficacy of CBT in treating adolescents with depressive symptoms published in 2005-2015. Keywords were "cognitive behavioral therapy", "group therapy", "depression" and "adolescent". Of the 23 papers that were retrieved, only six met all inclusion criteria. Three of them reported a significant reduction in depressive symptom severity after either individual or group (G)-CBT compared with the control group, even with a small number of CBT sessions (six rather than 10-12), with a medium or medium-to-large effect size. One study reported improved self-awareness and a significantly greater increase in perceived friend social support compared with bibliotherapy and check with brochure. Two studies reported clinical symptom reduction without significant differences compared with the control group (activity contrast). This review highlighted primarily that very few RCT have applied CBT in adolescents; moreover, it confirmed the effectiveness of G-CBT, especially as psychotherapy, although it was not always superior to other interventions (e.g. other activities in prevention programs). Comparison showed that G-CBT and group interpersonal psychotherapy were both effective in reducing depressive symptoms. Successful G-CBT outcomes were related to the presence of peers, who were an important source of feedback and support to observe, learn, and practice new skills to manage depressive symptoms and improve social-relational skills.
Lopez-Gomez, Irene; Chaves, Covadonga; Hervas, Gonzalo; Vazquez, Carmelo
There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI-D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty-eight women with a DSM-IV diagnosis of major depression or dysthymia were allocated to a 10-session IPPI-D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI-D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message This study sheds light on the client satisfaction and adherence to a positive intervention. For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations. Copyright © 2017 John Wiley & Sons, Ltd.
Bethany M. Wootton
Full Text Available Internet-delivered cognitive behavior therapy (iCBT may reduce barriers to treatment faced by people with obsessive–compulsive disorder (OCD. To date, most research on iCBT for OCD has evaluated clinician-guided treatments. However, self-guided treatments, which do not involve contact with a clinician, have considerable public health potential and may be particularly advantageous for those patients who report stigma as a principal barrier to treatment. The findings of a recent trial of self-guided iCBT for symptoms of OCD highlighted the potential of this approach and found large within-group effect sizes from pre- to post-treatment on the YBOCS-SR (d = 1.37, sustained at 3-month follow-up (d = 1.17. In addition, 32% of participants met criteria for clinically significant change at 3-month follow-up. The present study reports the long-term outcomes of that trial (N = 28. Twelve out of 28 participants (43% completed the 12 month follow-up. A large within-group effect size was found on the YBOCS-SR (d = 1.08 and 33% met criteria for clinically significant change at 12-month follow-up. No significant changes in symptoms were found between 3-month follow-up and 12-month follow-up, demonstrating that participants maintained their treatment gains in the long term. These results add to the emerging literature supporting the potential of self-guided iCBT for individuals with symptoms of OCD.
Chavira, Denise A; Golinelli, Daniela; Sherbourne, Cathy; Stein, Murray B; Sullivan, Greer; Bystritsky, Alexander; Rose, Raphael D; Lang, Ariel J; Campbell-Sills, Laura; Welch, Stacy; Bumgardner, Kristin; Glenn, Daniel; Barrios, Velma; Roy-Byrne, Peter; Craske, Michelle
In the current study, we compared measures of treatment outcome and engagement for Latino and non-Latino White patients receiving a cognitive behavioral therapy (CBT) program delivered in primary care. Participants were 18-65 years old and recruited from 17 clinics at 4 different sites to participate in a randomized controlled trial for anxiety disorders, which compared the Coordinated Anxiety Learning and Management (CALM) intervention (consisting of CBT, medication, or both) with usual care. Of those participants who were randomized to the intervention arm and selected CBT (either alone or in combination with medication), 85 were Latino and 251 were non-Latino White; the majority of the Latino participants received the CBT intervention in English (n = 77). Blinded assessments of clinical improvement and functioning were administered at baseline and at 6, 12, and 18 months after baseline. Measures of engagement, including attendance, homework adherence, understanding of CBT principles, and commitment to treatment, were assessed weekly during the CBT intervention. Findings from propensity-weighted linear and logistic regression models revealed no statistically significant differences between Latinos and non-Latino Whites on symptom measures of clinical improvement and functioning at almost all time points. There were significant differences on 2 of 7 engagement outcomes, namely, number of sessions attended and patients' understanding of CBT principles. These findings suggest that CBT can be an effective treatment approach for Latinos who are primarily English speaking and likely more acculturated, although continued attention should be directed toward engaging Latinos in such interventions. PsycINFO Database Record (c) 2014 APA, all rights reserved.
van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke
Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual. In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life. The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared
Berg, Selina Kikkenborg; Herning, Margrethe; Svendsen, Jesper Hastrup
by Structured Clinical Interview for DSM Disorders (SCID). (3) Investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive–behavioural therapy (CBT) performed by a cardiac nurse with CBT training, plus usual care or usual care alone...... of starting relevant intervention. Methods and analysis: Screen-ICD consists of 3 parts: (1) screening of all hospitalised and outpatient patients at two university hospitals using the Hospital Anxiety and Depression Scale (HADS), scores ≥8 are invited to participate. (2) Assessment of type of anxiety...
Sigmon, Scott B.
Cognitive behavioral psychology is a new theoretical orientation and when applied in treatment it is known as cognitive behavior therapy (CBT). Theoretically CBT seeks primarily to change cognitions to alter behaviors and to modify cognitions to affect emotions. In general CBT is considered to be an information processing psychology because it…
Brown, Lily A; Craske, Michelle G; Glenn, Daniel E; Stein, Murray B; Sullivan, Greer; Sherbourne, Cathy; Bystritsky, Alexander; Welch, Stacy S; Campbell-Sills, Laura; Lang, Ariel; Roy-Byrne, Peter; Rose, Raphael D
This study explores the relationships between therapist variables (cognitive behavioral therapy [CBT] competence, and CBT adherence) and clinical outcomes of computer-assisted CBT for anxiety disorders delivered by novice therapists in a primary care setting. Participants were recruited for a randomized controlled trial of evidence-based treatment, including computer-assisted CBT, versus treatment as usual. Therapists (anxiety clinical specialists; ACSs) were nonexpert clinicians, many of whom had no prior experience in delivering psychotherapy (and in particular, very little experience with CBT). Trained raters reviewed randomly selected treatment sessions from 176 participants and rated therapists on measures of CBT competence and CBT adherence. Patients were assessed at baseline and at 6-, 12-, and 18-month follow-ups on measures of anxiety, depression, and functioning, and an average Reliable Change Index was calculated as a composite measure of outcome. CBT competence and CBT adherence were entered as predictors of outcome, after controlling for baseline covariates. Higher CBT competence was associated with better clinical outcomes whereas CBT adherence was not. Also, CBT competence was inversely correlated with years of clinical experience and trended (not significantly, though) down as the study progressed. CBT adherence was inversely correlated with therapist tenure in the study. Therapist competence was related to improved clinical outcomes when CBT for anxiety disorders was delivered by novice clinicians with technology assistance. The results highlight the value of the initial training for novice therapists as well as booster training to limit declines in therapist adherence. © 2012 Wiley Periodicals, Inc.
Hallberg, Jonas; Kaldo, Viktor; Arver, Stefan; Dhejne, Cecilia; Öberg, Katarina Görts
The proposed criteria of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition for hypersexual disorder (HD) included symptoms reported by patients seeking help for excessive and out-of-control non-paraphilic sexual behavior, including sexual behaviors in response to dysphoric mood states, impulsivity, and risk taking. Although no prior studies of cognitive-behavioral therapy (CBT) for the treatment of HD have been performed, CBT has been found effective for dysphoric mood states and impulsivity. To investigate the feasibility of a CBT manual developed for HD explored through symptom decrease, treatment attendance, and clients' treatment satisfaction. Ten men with a diagnosis of HD took part in the CBT group program. Measurements were taken before, during, and at the end of treatment and 3 and 6 months after treatment. The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD:CAS) score that measured the severity of problematic hypersexual symptoms and secondary outcomes were the Hypersexual Disorder Screening Inventory (HDSI) score, the proportion of attended sessions, and the Client Satisfaction Questionnaire (CSQ-8) score. Main results were significant decreases of HD symptoms from before to after treatment on HD:CAS and HDSI scores and a decrease in the number of problematic sexual behaviors during the course of therapy. A high attendance rate of 93% and a high treatment satisfaction score on CSQ-8 also were found. The CBT program seemed to ameliorate the symptoms of HD and therefore might be a feasible treatment option. This study provides data from a CBT program for the treatment of the specific proposed criteria of HD. Because of the small sample and lack of a control group, the results can be considered only preliminary. Although participants reported decreased HD symptoms after attending the CBT program, future studies should evaluate the treatment program with a larger sample and a randomized controlled procedure
van der Sluis, C.M.; van der Bruggen, C.O.; Brechman-Toussaint, M.L.; Thissen, M.A.P.; Bögels, S.M.
Anxiety in children age 8 years and above has been successfully treated with cognitive behavioral therapy (CBT). However, the efficacy of CBT for anxious children ages 4-7 years has not, to date, been fully investigated. This paper piloted a CBT intervention targeting child anxiety that was
Conclusion: The results support the effectiveness of MBCT and CBT in decreasing pain, depression and anxiety. Therefore, taking account of these two therapeutic methods is very important for patients with chronic low back pain.
Tyler, Elizabeth; Lobban, Fiona; Sutton, Chris; Depp, Colin; Johnson, Sheri; Laidlaw, Ken; Jones, Steven H
Bipolar disorder is a severe and chronic mental health problem that persists into older adulthood. The number of people living with this condition is set to rise as the UK experiences a rapid ageing of its population. To date, there has been very little research or service development with respect to psychological therapies for this group of people. A parallel two-arm randomised controlled trial comparing a 14-session, 6-month Recovery-focused Cognitive-Behavioural Therapy for Older Adults with bipolar disorder (RfCBT-OA) plus treatment as usual (TAU) versus TAU alone. Participants will be recruited in the North-West of England via primary and secondary mental health services and through self-referral. The primary objective of the study is to evaluate the feasibility and acceptability of RfCBT-OA; therefore, a formal power calculation is not appropriate. It has been estimated that randomising 25 participants per group will be sufficient to be able to reliably determine the primary feasibility outcomes (eg, recruitment and retention rates), in line with recommendations for sample sizes for feasibility/pilot trials. Participants in both arms will complete assessments at baseline and then every 3 months, over the 12-month follow-up period. We will gain an estimate of the likely effect size of RfCBT-OA on a range of clinical outcomes and estimate parameters needed to determine the appropriate sample size for a definitive, larger trial to evaluate the effectiveness and cost-effectiveness of RfCBT-OA. Data analysis is discussed further in the Analysis section in the main paper. This protocol was approved by the UK National Health Service (NHS) Ethics Committee process (REC ref: 15/NW/0330). The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and local, participating NHS trusts. ISRCTN13875321; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already
Linardon, Jake; Wade, Tracey D; de la Piedad Garcia, Xochitl; Brennan, Leah
This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders. Randomized controlled trials of CBT were searched. Seventy-nine trials were included. Therapist-led CBT was more efficacious than inactive (wait-lists) and active (any psychotherapy) comparisons in individuals with bulimia nervosa and binge eating disorder. Therapist-led CBT was most efficacious when manualized CBT-BN or its enhanced version was delivered. No significant differences were observed between therapist-led CBT for bulimia nervosa and binge eating disorder and antidepressants at posttreatment. CBT was also directly compared to other specific psychological interventions, and therapist-led CBT resulted in greater reductions in behavioral and cognitive symptoms than interpersonal psychotherapy at posttreatment. At follow-up, CBT outperformed interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no evidence that CBT was more efficacious than behavior therapy or nonspecific supportive therapies. CBT is efficacious for eating disorders. Although CBT was equally efficacious to certain psychological treatments, the fact that CBT outperformed all active psychological comparisons and interpersonal psychotherapy specifically, offers some support for the specificity of psychological treatments for eating disorders. Conclusions from this study are hampered by the fact that many trials were of poor quality. Higher quality RCTs are essential. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Kroon Van Diest, Ashley M; Ernst, Michelle M; Vaughn, Lisa; Slater, Shalonda; Powers, Scott W
The goal of this study was to determine which cognitive behavioral therapy (CBT-HA) treatment components pediatric headache patient stakeholders would report to be most helpful and essential to reducing headache frequency and related disability to develop a streamlined, less burdensome treatment package that would be more accessible to patients and families. Pediatric migraine is a prevalent and disabling condition. CBT-HA has been shown to reduce headache frequency and related disability, but may not be readily available or accepted by many migraine sufferers due to treatment burden entailed. Research is needed to determine systematic ways of reducing barriers to CBT-HA. Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT-HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were 13-17.5 years of age (M = 15.4, SD = 1.63) and had undergone CBT-HA ∼1-2 years prior to participating in the study. Overall, patients and their parents reported that CBT-HA was helpful in reducing headache frequency and related disability. Although patients provided mixed reports on the effectiveness of different CBT-HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT-HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills. Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable. Results from these qualitative interviews indicate that mind and body CBT-HA relaxation skills emerged as popular and effective based on patient and parent report. Future research examining the effectiveness of streamlined pediatric migraine nonpharmacological interventions should include these patient-preferred skills. © 2018 American Headache Society.
Rector, Neil A; Richter, Margaret A; Lerman, Bethany; Regev, Rotem
The majority of "responders" to first-line cognitive-behavioural therapy (CBT) and pharmacological treatments for obsessive-compulsive disorder (OCD) are left with residual symptoms that are clinically relevant and disabling. Therefore, there is pressing need for widely accessible efficacious alternative and/or adjunctive treatments for OCD. Accumulating evidence suggests that physical exercise may be one such intervention in the mood and anxiety disorders broadly, although we are aware of only two positive small-scale pilot studies that have tested its clinical benefits in OCD. This pilot study aimed to test the feasibility and preliminary efficacy of adding a structured physical exercise programme to CBT for OCD. A standard CBT group was delivered concurrently with a 12-week customized exercise programme to 11 participants. The exercise regimen was individualized for each participant based on peak heart rate measured using an incremental maximal exercise test. Reports of exercise adherence across the 12-week regimen exceeded 80%. A paired-samples t-test indicated very large treatment effects in Yale-Brown Obsessive-Compulsive Scale scores from pre- to post-treatment in CBT group cohorts led by expert CBT OCD specialists (d = 2.55) and junior CBT clinician non-OCD specialists (d = 2.12). These treatment effects are very large and exceed effects typically observed with individual and group-based CBT for OCD based on leading meta-analytic reviews, as well as previously obtained treatment effects for CBT using the same recruitment protocol without exercise. As such, this pilot work demonstrates the feasibility and significant potential clinical utility of a 12-week aerobic exercise programme delivered in conjunction with CBT for OCD.
Reynolds, Shirley A; Clark, Sarah; Smith, Holly; Langdon, Peter E; Payne, Ruth; Bowers, Gemma; Norton, Elisabeth; McIlwham, Harriet
Obsessive-compulsive disorder (OCD) in young people can be effectively treated with Cognitive Behavior Therapy (CBT). Practice guidelines in the United Kingdom recommend that CBT be delivered with parental or family involvement; however, there is no evidence from randomized trials that this enhances effectiveness. The aim of this trial was to assess if CBT with high parental involvement was more effective than CBT with low parental involvement (individual CBT) in reducing symptoms of OCD. Fifty young people ages 12-17 years with OCD were randomly allocated to individual CBT or parent-enhanced CBT. In parent-enhanced CBT parents attended all treatment sessions; in individual CBT, parents attended only Sessions 1, 7, and the final session. Participants received up to 14 sessions of CBT. Data were analyzed using intent-to-treat and per-protocol methods. The primary outcome measure was the Children's Yale-Brown Obsessive Compulsion Scale (Scahill et al., 1997). Both forms of CBT significantly reduced symptoms of OCD and anxiety. Change in OCD symptoms was maintained at 6 months. Per-protocol analysis suggested that parent-enhanced CBT may be associated with significantly larger reductions in anxiety symptoms. High and low parental involvement in CBT for OCD in young people were both effective, and there was no evidence that 1 method of delivery was superior on the primary outcome measure. However, this study was small. Future trials should be adequately powered and examine interactions with the age of the young person and comorbid anxiety disorders.
Arnfred, Sidse Marie Hemmingsen; Aharoni, Ruth; Pedersen, Morten Hvenegaard
Background: Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the “The Unified Protocol for Transdiagnostic Treatment of Emotional...... Disorders” (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared...... to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. Methods/design: The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression...
Grenier, Sébastien; Forget, Hélène; Bouchard, Stéphane; Isere, Sébastien; Belleville, Sylvie; Potvin, Olivier; Rioux, Marie-Ève; Talbot, Mélissa
Cognitive-behavioral therapy (CBT) using traditional exposure techniques (i.e. imaginal and in vivo) seems less effective to treat anxiety in older adults than in younger ones. This is particularly true when imaginal exposure is used to confront the older patient to inaccessible (e.g. fear of flying) or less tangible/controllable anxiety triggers (e.g. fear of illness). Indeed, imaginal exposure may become less effective as the person gets older since normal aging is characterized by the decline in cognitive functions involved in the creation of vivid/detailed mental images. One way to circumvent this difficulty is to expose the older patient to a virtual environment that does not require the ability to imagine the frightening situation. In virtuo exposure has proven to be efficient to treat anxiety in working-age people. In virtuo exposure could be employed to improve the efficacy of CBT with exposure sessions in the treatment of late-life anxiety? The current paper explores this question and suggests new research avenues.
Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness.
Full Text Available Obsessive-compulsive disorder (OCD is prevalent and without adequate treatment usually follows a chronic course. "High-intensity" cognitive-behaviour therapy (CBT from a specialist therapist is current "best practice." However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for "low-intensity" interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV criteria for OCD.This study was approved by the National Research Ethics Service Committee North West-Lancaster (reference number 11/NW/0276. All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual. Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support through "OCFighter" or guided self-help (written CBT materials with limited telephone or face-to-face support. Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale-Observer-Rated (Y-BOCS-OR at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and
Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness
Gellatly, Judith; Byford, Sarah; Bee, Penny; McMillan, Dean; Gilbody, Simon; Gega, Lina; Hardy, Gillian; Reynolds, Shirley; Barkham, Michael; Mottram, Patricia; Molle, Jo; Knopp-Hoffer, Jasmin; Connell, Janice; Heslin, Margaret; Foley, Christopher; Plummer, Faye
Background Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. “High-intensity” cognitive-behaviour therapy (CBT) from a specialist therapist is current “best practice.” However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for “low-intensity” interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. Methods and findings This study was approved by the National Research Ethics Service Committee North West–Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through “OCFighter” or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale–Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health
Liu, Jun; Nie, Jing; Wang, Yafeng
To evaluate the effects of group counseling programs, cognitive behavioral therapy (CBT), and sports intervention on Internet addiction (IA), a systematic search in ten databases was performed to identify eligible studies without language restrictions up to January 2017. A meta-analysis and trial sequential analysis (TSA) was performed, respectively. A total of 58 randomized controlled trials (RCTs), which included 2871 participants, were incorporated into our meta-analysis. The results showed that group counseling programs, CBT, and sports intervention could significantly reduce IA levels (group counseling program: standardized mean difference (SMD), -1.37; 95% confidence interval (CI), -1.89 to -0.85; CBT: SMD, -1.88; 95% CI, -2.53 to -1.23; sports intervention: SMD, -1.70; 95% CI, -2.14 to -1.26). For group counseling programs, this treatment was more effective in four dimensions of IA, including time management, interpersonal and health issues, tolerance, and compulsive Internet use. For CBT, this treatment yielded a positive change in depression, anxiousness, aggressiveness, somatization, social insecurity, phobic anxiety, paranoid ideation, and psychoticism. For sports intervention, the significant effects were also observed in all dimensions of the IA scale. Each of group counseling programs, cognitive behavioral therapy, and sports intervention had a significant effect on IA and psychopathological symptoms. Sports intervention could improve withdrawal symptoms especially.
Full Text Available To evaluate the effects of group counseling programs, cognitive behavioral therapy (CBT, and sports intervention on Internet addiction (IA, a systematic search in ten databases was performed to identify eligible studies without language restrictions up to January 2017. A meta-analysis and trial sequential analysis (TSA was performed, respectively. A total of 58 randomized controlled trials (RCTs, which included 2871 participants, were incorporated into our meta-analysis. The results showed that group counseling programs, CBT, and sports intervention could significantly reduce IA levels (group counseling program: standardized mean difference (SMD, −1.37; 95% confidence interval (CI, −1.89 to −0.85; CBT: SMD, −1.88; 95% CI, −2.53 to −1.23; sports intervention: SMD, −1.70; 95% CI, −2.14 to −1.26. For group counseling programs, this treatment was more effective in four dimensions of IA, including time management, interpersonal and health issues, tolerance, and compulsive Internet use. For CBT, this treatment yielded a positive change in depression, anxiousness, aggressiveness, somatization, social insecurity, phobic anxiety, paranoid ideation, and psychoticism. For sports intervention, the significant effects were also observed in all dimensions of the IA scale. Each of group counseling programs, cognitive behavioral therapy, and sports intervention had a significant effect on IA and psychopathological symptoms. Sports intervention could improve withdrawal symptoms especially.
Obsessive Compulsive Disorder; Body Dysmorphic Disorder; Tourette Syndrome; Trichotillomania; Panic Disorder; Social Phobia; Generalized Anxiety Disorder; Depression; Post-Traumatic Stress Disorder; Attention Deficit Hyperactivity Disorder; Eating Disorder; Specific Phobia; General Medical Condition
Navigating the development and dissemination of internet cognitive behavioral therapy (iCBT) for anxiety disorders in children and young people: A consensus statement with recommendations from the #iCBTLorentz Workshop Group
Hill, Claire; Creswell, Cathy; Vigerland, Sarah; Nauta, Maaike H.; March, Sonja; Donovan, Caroline; Wolters, Lidewij; Spence, Susan H.; Martin, Jennifer L.; Wozney, Lori; McLellan, Lauren; Kreuze, Leonie; Gould, Karen; Jolstedt, Maral; Nord, Martina; Hudson, Jennifer L.; Utens, Elisabeth; Ruwaard, Jeroen; Albers, Casper; Khanna, Muniya; Albano, Anne Marie; Serlachius, Eva; Hrastinski, Stefan; Kendall, Philip C.
Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and
Schlarb, Angelika A; Bihlmaier, Isabel; Velten-Schurian, Kerstin; Poets, Christian F; Hautzinger, Martin
This intervention study evaluates the short- and long-term effects of cognitive behavior therapy for insomnia (CBT-I) in groups for school-age children and their parents, named the KiSS-program. CBT-I was implemented in three sessions for children and three sessions for parents. All in all, 112 children with chronic childhood insomnia were randomly assigned to a wait-list (WL) control or treatment condition. According to subjective measures as well as objective wrist actigraphy, children in the CBT-I condition reported greater improvements in sleep behavior immediately after the treatment compared to the WL group. Improvements in sleep behavior after CBT-I persisted over the 3-, 6-, and 12-month follow-up assessments. The present study is the first randomized controlled trial that provides evidence for the long-term effectiveness of CBT-I in treating school-age children with chronic insomnia.
Brenninkmeijer, Veerle; Lagerveld, Suzanne E; Blonk, Roland W B; Schaufeli, Wilmar B; Wijngaards-de Meij, Leoniek D N V
Purpose This study examined who benefits most from a cognitive behavioural therapy (CBT)-based intervention that aims to enhance return to work (RTW) among employees who are absent due to common mental disorders (CMDs) (e.g., depression, anxiety, or adjustment disorder). We researched the influence of baseline work-related self-efficacy and mental health (depressive complaints and anxiety) on treatment outcomes of two psychotherapeutic interventions. Methods Using a quasi-experimental design, 12-month follow-up data of 168 employees were collected. Participants either received work-focused cognitive behavioural therapy (W-CBT) that integrated work aspects early into the treatment (n = 89) or regular cognitive behavioural therapy (R-CBT) without a focus on work (n = 79). Results Compared with R-CBT, W-CBT resulted in a faster partial RTW, irrespective of baseline self-efficacy. Among individuals with high self-efficacy, W-CBT also resulted in faster full RTW. The effectiveness of W-CBT on RTW did not depend on baseline depressive complaints or anxiety. The decline of mental health complaints did not differ between the two interventions, nor depended on baseline self-efficacy or mental health. Conclusions Considering the benefits of W-CBT for partial RTW, we recommend this intervention as a preferred method for employees with CMDs, irrespective of baseline self-efficacy, depression and anxiety. For individuals with high baseline self-efficacy, this intervention also results in higher full RTW. For those with low self-efficacy, extra exercises or components may be needed to promote full RTW.
Comparison of the Effects of Religious Cognitive Behavioral Therapy (RCBT, Cognitive Behavioral Therapy (CBT, and Sertraline on Depression and Anxiety in Patients after Coronary Artery Bypass Graft Surgery: A Study Protocol for a Randomized Controlled T
Full Text Available Objectives: Our objective is to compare the effects of RCBT, CBT, and sertraline on depression, anxiety, biomarker levels, and the quality of life in patients after coronary artery bypass graft (CABG surgery.Method/Design: This is a randomized controlled trial with parallel groups. A total of 160 patients after CABG surgery will be screened for anxiety and depression according to clinical interviews based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV criteria and Hospital Anxiety Depression Scale (HADS scores (≥ 8. To assess religious attitude, Golriz and Baraheni’s religious attitude questionnaire will be used. Participants will be randomly allocated to four groups of 40 including three intervention groups (RCBT, CBT, and sertraline and one control group (usual care. RCBT and CBT programs will consist of 12 one-hour weekly sessions. The participants in the pharmacological intervention group will receive 25-200 mg/d of sertraline for three months. The (SF-36 will be administered to assess the patients’ quality of life. Blood samples will be taken and biomarker levels will be determined using the enzyme-linked immunosorbent assay (ELISA. The primary outcome will be the reduction in anxiety and depression scores after the interventions. The secondary outcomes will be increases in quality of life scores and normalized biomarker levels after the interventions.Discussion: If RCBT is found to be more effective than the other methods, it can be used to improve patients’ health status after CABG surgery.Irct ID: IRCT201404122898N5
Berardelli, Isabella; Bloise, Maria Carmela; Bologna, Matteo; Conte, Antonella; Pompili, Maurizio; Lamis, Dorian A; Pasquini, Massimo; Fabbrini, Giovanni
The aim of the current study was to evaluate whether cognitive behavioral group therapy has a positive impact on psychiatric, and motor and non-motor symptoms in Parkinson's disease (PD). We assigned 20 PD patients with a diagnosis of psychiatric disorder to either a 12-week cognitive behavioral therapy (CBT) group or a psychoeducational protocol. For the neurological examination, we administered the Unified Parkinson's Disease Rating Scale and the non-motor symptoms scale. The severity of psychiatric symptoms was assessed by means of the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Brief Psychiatric Rating Scale, and the Clinical Global Impressions. Cognitive behavioral group therapy was effective in treating depression and anxiety symptoms as well as reducing the severity of non-motor symptoms in PD patients; whereas, no changes were observed in PD patients treated with the psychoeducational protocol. CBT offered in a group format should be considered in addition to standard drug therapy in PD patients.
Rutledge, Thomas; Atkinson, J Hampton; Holloway, Rachael; Chircop-Rollick, Tatiana; D'Andrea, John; Garfin, Steven R; Patel, Shetal; Penzien, Donald B; Wallace, Mark; Weickgenant, Anne L; Slater, Mark
This study evaluated a nurse-delivered, telehealth intervention of cognitive behavioral therapy versus supportive psychotherapy for chronic back pain. Participants (N=61) had chronic back pain (pain "daily" ≥ 6 months at an intensity ≥4/10 scale) and were randomized to an 8-week, 12-session, Cognitive Behavioral Therapy (CBT) or to Supportive Care (SC) matched for frequency, format, and time, with each treatment delivered by a primary care nurse. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included the Numerical Rating Scale (NRS) and the Patient Global Impressions Scale (CGI). CBT participants (n=30) showed significant improvements on the RMDQ (means=11.4[5.9] vs. 9.4[6.1] at baseline and post-treatment, respectively, p.10). The results suggest that telehealth, nurse-delivered CBT and SC treatments for chronic back pain can offer significant and relatively comparable benefits. ClinicalTrials.gov: NCT00608530. This article describes the benefits of training primary care nurses to deliver evidence-based behavioral therapies for low back pain. Due to the high prevalence of chronic pain and the growing emphasis on non-opioid therapies, training nurses to provide behavior therapies could be a cost-effective way to improve pain management. Copyright © 2018. Published by Elsevier Inc.
This thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention was designed to supplement usual care following an episode of DSH. The study involved 90 people (95%
Yang Wei; Liu Qiyu; Wang Zhong; Lin Hua; Xie Budong; Zhou Xi
Objective: To study the safety and efficiency of interventional therapy of hyperthyroidism. Methods: 70 cases of hyperthyroidism were selected and treated with embolization of the thyroid gland artery. The efficacy and complications of the therapy were observed. Results: The therapy was effect in 60 of all the 70 patients, while failed in 1 patient and relapsed in 9 cases. Specifically speaking, 2 of them hyperthyroidism crisis occurred in 2 cases, hypoparathyroidism occurred in 1 case and hypothyroidism occurred in 2 cases. Conclusion: Intervention therapy of hyperthyroidism is of advantage such as good effect, safety, microtrauma, little complication. (authors)
Rizvi, Sakina J; Zaretsky, Ari; Schaffer, Ayal; Levitt, Anthony
Cognitive-behavioral therapy (CBT) is an efficacious first-line therapy for patients with major depressive disorder (MDD). Due to the limited accessibility of CBT, long wait lists result in delayed treatment, which may affect treatment outcomes. The goal of this pilot study was to obtain preliminary data from a randomized controlled trial to determine whether delayed CBT reduces the effectiveness of the therapy compared to immediate CBT in patients with MDD receiving pharmacotherapy. Patients were randomized to receive immediate CBT (n=18) or to begin CBT after 6 months (n=20) and received 14 weekly sessions, followed by two additional booster sessions. During the active treatment months, patients in the immediate group demonstrated reductions in scores on the Beck Depression Inventory II (BDI-II) that were similar to those in the delayed CBT group. However, when the analysis was performed using only data from patients in the delayed group who were still in a depressive episode, there was an overall greater decrease in BDI-II scores in the immediate group vs. the delayed group over the active treatment months, but not specifically at the 6-month endpoint. These findings suggest delays in depression treatment, similar to what occurs with real-world wait list times, may not have a significant impact on the effectiveness of CBT in patients who are already receiving treatment as usual. However, such delays may affect the effectiveness of CBT in those patients who remain depressed during the time delay. A larger trial is necessary to confirm these findings. (Journal of Psychiatric Practice 2015;21:107-113).
Hinton, Devon E; Rivera, Edwin I; Hofmann, Stefan G; Barlow, David H; Otto, Michael W
In this article, we illustrate how cognitive behavioral therapy (CBT) can be adapted for the treatment of PTSD among traumatized refugees and ethnic minority populations, providing examples from our treatment, culturally adapted CBT, or CA-CBT. CA-CBT has a unique approach to exposure (typical exposure is poorly tolerated in these groups), emphasizes the treatment of somatic sensations (a particularly salient part of the presentation of PTSD in these groups), and addresses comorbid anxiety disorders and anger. To accomplish these treatment goals, CA-CBT emphasizes emotion exposure and emotion regulation techniques such as meditation and aims to promote emotional and psychological flexibility. We describe 12 key aspects of adapting CA-CBT that make it a culturally sensitive treatment of traumatized refugee and ethnic minority populations. We discuss three models that guide our treatment and that can be used to design culturally sensitive treatments: (a) the panic attack-PTSD model to illustrate the many processes that generate PTSD in these populations, highlighting the role of arousal and somatic symptoms; (b) the arousal triad to demonstrate how somatic symptoms are produced and the importance of targeting comorbid anxiety conditions and psychopathological processes; and (c) the multisystem network (MSN) model of emotional state to reveal how some of our therapeutic techniques (e.g., body-focused techniques: bodily stretching paired with self-statements) bring about psychological flexibility and improvement.
Skubik-Peplaski, Camille Louise; Howell, Dana; Hunter, Elizabeth
The purpose of this study was to investigate how the environment influenced the intervention choices occupational therapists made for patients recovering from a stroke in an inpatient rehabilitation hospital. Three occupational therapists were observed providing intervention for six patients over a 16-month period. Treatment spaces included a therapy gym, gym with kitchen combination, and a home-like space. Furniture was added to the therapy gym to be more home-like midway through the study. Observations included therapist selection of treatment location and interventions, and observational data of the environment and interactions among therapists and patients. This study found that inpatient rehabilitation environments did influence interventions. The occupational therapists provided therapy in the standard therapy gym environment most often, whether it was enhanced to be more home-like or not, and predominately used preparatory methods.
Hoogsteder, L.M.; Stams, G.J.J.M.; Figge, M.A.; Changoe, K.; van Horn, J.E.; Hendriks, J.; Wissink, I.B.
This meta-analysis, including six studies (13 effect sizes) and 164 adolescents, examined the effectiveness of individually oriented treatment (which means that the intervention contained at least an individual component, possibly in combination with group and/or family therapy) with CBT-elements
Passons, William R.
The author offers a brief introduction to some of the basic tenets of Gestalt therapy, noting goals that are similar to those in counseling theories. He also suggests several interventions from Gestalt therapy to be considered for group counseling and discusses their applications. (Author)
Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder: Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial.
Arnfred, Sidse M; Aharoni, Ruth; Hvenegaard, Morten; Poulsen, Stig; Bach, Bo; Arendt, Mikkel; Rosenberg, Nicole K; Reinholt, Nina
Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the "The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders" (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in
Full Text Available Depression is one of the most common mental disorders and will become one of the leading causes of disability in the world. Internet-based CBT programs for depression have been classified as "well established" following the American Psychological Association criteria for empirically supported treatments. The aim of this study is to analyze the cost effectiveness at 12-month follow-up of the Internet-based CBT program "Smiling is fun" with (LITG and without psychotherapist support (TSG compared to usual care. The perspective used in our analysis is societal. A sample of 296 depressed patients (mean age of 43.04 years; 76% female; BDI-II mean score = 22.37 from primary care services in four Spanish regions were randomized in the RCT. The complete case and intention-to-treat (ITT perspectives were used for the analyses. The results demonstrated that both Internet-based CBT interventions exhibited cost utility and cost effectiveness compared with a control group. The complete case analyses revealed an incremental cost-effectiveness ratio (ICER of €-169.50 and an incremental cost-utility ratio (ICUR of €-11389.66 for the TSG group and an ICER of €-104.63 and an ICUR of €-6380.86 for the LITG group. The ITT analyses found an ICER of €-98.37 and an ICUR of €-5160.40 for the TSG group and an ICER of €-9.91 and an ICUR of €496.72 for the LITG group. In summary, the results of this study indicate that the two Internet-based CBT interventions are appropriate from both economic and clinical perspectives for depressed patients in the Spanish primary care system. These interventions not only help patients to improve clinically but also generate societal savings.clinicaltrials.gov NCT01611818.
Archer, Marc; Brown, June S L; Idusohan, Helen; Coventry, Shirley; Manoharan, Andiappan; Espie, Colin A
Whilst effective psychological treatments such as CBT-I have been developed for insomnia, few services provide CBT-I and awareness of CBT-I is low among referrers. In addition, men tend to seek help less frequently for their insomnia than women. This paper describes the development and evaluation of psycho-educational CBT-I workshops, each for up to 25 people, and designed to be acceptable to men. The CBT-I programme was based on Morin and Espie (2003), and adapted into a self-referral one-day workshop format designed specifically to improve access. Workshops were held on Saturdays in leisure centres. A one group pretest-posttest design was used and assessments were collected before and 6 weeks after each workshop. Over a 6-month period, 74 men self-referred, and attended the Introductory Talks preceding the workshops. Of these, 49.3% had never sought help from their GP, 66.2% suffered from clinical insomnia (ISI) and 61.6% were experiencing elevated depression symptoms (BDI over 10). At follow-up, the workshops were found to be effective in reducing insomnia and depression. Satisfaction ratings with the workshops were very high. Given these promising results, further work is now proposed for a larger controlled study with a longer-term follow-up.
Full Text Available The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random-ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured interview schedule, Asthma Symptom Checklist, Asthma di-ary, Asthma Bother Profile, Hospital Anxiety & Depression Scale, AQLQ and Peak Expiratory Flow Rate. Within group comparison showed significant improvement in both groups at the post assessment. Between group comparisons showed that CBT group reported significantly greater change than that of SM group. Cognitive behavior therapy helps in improving the managment of asthma.
Murphy, Suzanne M.; Chowdhury, Uttom; White, Susan W.; Reynolds, Laura; Donald, Louisa; Gahan, Hilary; Iqbal, Zeinab; Kulkarni, Mahesh; Scrivener, Louise; Shaker-Naeeni, Hadi; Press, Dee A.
The use of cognitive-behavioural therapy (CBT) as a treatment for children and adolescents with autism spectrum disorder (ASD) has been explored in a number of trials. Whilst CBT appears superior to no treatment or treatment as usual, few studies have assessed CBT against a control group receiving an alternative therapy. Our randomised controlled…
Full Text Available Abstract Background In the Netherlands, the prevalence of anxiety disorders is 20%; and children with anxiety are at increased risk for psychopathology throughout adulthood. Recently, a revised version of a cognitive behavioral therapy manualized program called 'Thinking + Doing = Daring' (TDD was developed for children between 8 and 12 years old with an anxiety disorder. The main aim of this project is to conduct a Randomized Controlled Trial (RCT to evaluate the effectiveness of TDD. Methods/Design The CBT program will be tested with a RCT with 120 clinically anxious children (8-12 years old referred to one of three mental health care agencies. Children will be randomly assigned to the experimental (N = 60, TDD or to the control condition (N = 60, treatment as usual. The primary outcome measure will be the child's anxiety symptoms level. Secondary outcome measures will be externalizing (e.g. aggression and internalizing problems (e.g. depression. Two potential mediators of change will be examined in the current study: therapeutic alliance and parenting. Mother and child in both the experimental and control condition will be surveyed at baseline, post treatment and after 6 and 12 months (follow-up. It is hypothesized that children in the experimental condition will show a stronger decrease in anxiety symptoms compared to children that receive treatment as usual. Moreover, we expect that a strong therapeutic alliance and decreases in parental control and rejection will contribute to treatment success. Discussion Early treatment for anxiety problems has the potential to not only result in anxiety reductions, but also to prevent future problems such as substance abuse and psychopathology throughout adulthood. Our results will be immediately relevant to practice, since we are partnering with 'real world' community agencies. If the CBT program proves more effective than treatment as usual, it could be implemented in community mental health care
Full Text Available Background: Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa. Cognitive behavioral therapy (CBT is the treatment of choice for bulimia nervosa, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with bulimia nervosa, examining the effectiveness of using a videogame (Playmancer as an additional intervention designed to address impulsivity. Design: Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an A-B-A-C-A single case experimental design. Impulsivity levels were assessed with the Conners’ Continuous Performance Test II (CPT-II. After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. Results: After the videogame intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the videogame intervention. Discussion: This case report suggests that using the Playmancer videogame to reduce impulsivity prior to CBT may enhance the final results of the treatment for bulimia nervosa.
Giner-Bartolomé, Cristina; Fagundo, Ana B; Sánchez, Isabel; Jiménez-Murcia, Susana; Santamaría, Juan J; Ladouceur, Robert; Menchón, José M; Fernández-Aranda, Fernando
Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity. Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an "A-B-A-C-A" single case experimental design. Impulsivity levels were assessed with the Conner's Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention. This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.
van Bastelaar, Kim M P; Pouwer, Frans; Cuijpers, Pim
BACKGROUND: Depression is common among people with diabetes, negatively affecting quality of life, treatment adherence and diabetes outcomes. In routine clinical care, diabetes patients have limited access to mental health services and depression therefore often remains untreated. Web-based therapy...
Hofmann, Stefan G.; Suvak, Michael K.; Barlow, David H.; Shear, M. Katherine; Meuret, Alicia E.; Rosenfield, David; Gorman, Jack M.; Woods, Scott W.
Cognitive–behavioral therapy (CBT) and pharmacotherapy are similarly effective for treating panic disorder with mild or no agoraphobia, but little is known about the mechanism through which these treatments work. The present study examined some of the criteria for cognitive mediation of treatment change in CBT alone, imipramine alone, CBT plus imipramine, and CBT plus placebo. Ninety-one individuals who received 1 of these interventions were assessed before and after acute treatment, and after a 6-month maintenance period. Multilevel moderated mediation analyses provided preliminary support for the notion that changes in panic-related cognitions mediate changes in panic severity only in treatments that include CBT. PMID:17563154
Flessner, Christopher A
This article provides an overview of cognitive-behavioral therapy (CBT) for repetitive behavior disorders. Because tic disorders and trichotillomania are the most often studied and most debilitating of these conditions, this article focuses on the efficacy of CBT for these 2 conditions. An overview of CBT for children presenting with these concerns is provided. This review focuses particularly on habit reversal training, which is at the core of most CBT-based interventions. Two recent empirical studies on the immense potential of CBT in treating childhood repetitive behavior disorders and future areas of research are also discussed. Copyright © 2011 Elsevier Inc. All rights reserved.
Mathiasen, Kim; Andersen, Tonny E; Riper, Heleen; Kleiboer, Annet A M; Roessler, Kirsten K
Internet based cognitive behavioural therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (ftf) consultations in a blended format (B-CBT) may produce a new treatment format with multiple benefits from both traditional CBT and iCBT such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation. The primary aim of the present study is to compare directly the clinical effectiveness of B-CBT with face-to-face CBT for adult major depressive disorder. The study is designed as a two arm randomised controlled non-inferiority trial comparing blended CBT for adult depression with treatment as usual (TAU). In the blended condition six sessions of ftf CBT is alternated with six to eight online modules (NoDep). TAU is defined as 12 sessions of ftf CBT. The primary outcome is symptomatic change of depressive symptoms on the patient-health questionnaire (PHQ-9). Additionally, the study will include an economic evaluation. All participants must be 18 years of age or older and meet the diagnostic criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental disorders 4th edition. Participants are randomised on an individual level by a researcher not involved in the project. The primary outcome is analysed by regressing the three-month follow-up PHQ-9 data on the baseline PHQ-9 score and a treatment group indicator using ancova. A sample size of 130 in two balanced groups will yield a power of at least 80% to detect standardised mean differences above 0.5 on a normally distributed variable. This study design will compare B-CBT and ftf CBT in a concise and direct manner with only a minimal of the variance explained by differences in therapeutic content. On the other hand, while situated in routine care
Chiu, Angela W.; Langer, David A.; McLeod, Bryce D.; Har, Kim; Drahota, Amy; Galla, Brian M.; Jacobs, Jeffrey; Ifekwunigwe, Muriel; Wood, Jeffrey J.
Most randomized controlled trials of cognitive-behavioral therapy (CBT) for children with anxiety disorders have evaluated treatment efficacy using recruited samples treated in research settings. Clinical trials in school settings are needed to determine if CBT can be effective when delivered in real world settings. This study evaluated a modular…
Elkins, R. Meredith; McHugh, R. Kathryn; Santucci, Lauren C.; Barlow, David H.
Research provides strong support for the efficacy and effectiveness of cognitive behavioral therapy (CBT) for the treatment of childhood internalizing disorders. Given evidence for limited dissemination and implementation of CBT outside of academic settings, efforts are underway to improve its transportability so that more children with mental…
Lepping, P.; Whittington, R.; Sambhi, R.S.; Lane, S.; Poole, R.; Leucht, S.; Cuijpers, P.; McCabe, R.; Waheed, W.
Cognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We
Mao Aiwu; Gao Zhongdu; Li Guofen; Jiang Tinghui; Hu Xuan; Wu Jieru; Yang Renjie; Xiao Xiangsheng
Objective: To explore the feasibility of microinvasive technique in high level malignant esophageal obstruction and to provide the palliative therapy that can't be dredged by traditional methods. Methods: There were 39 patients suffered from high level esophageal obstruction, involving the segments from esophageal circular pharynx to 12 mm below. Tube-reticular nitinol metal stents woven by single thread were placed in orally to dredge the esophagus under fluoroscopic guidance after repeated tolerant expanding performance through expandable catheter. Interventional chemical therapy were administrated through blood-supply vessels. Results: Thirty nine patients were grafted with 46 high level esophageal stents. 34 patients accepted 156 times of interventional chemical therapy. All patients restored with fine residue diet without showing side-effects except slight pain and tolerant uncomfortable feeling. The survival rate of the patients with both interventional chemical therapy and stents was longer than those with stent therapy alone. Conclusion: Cervical high level segment of esophagus shouldn't be the restricted zone in the management of inner-stents. Interventional chemical therapy showed tumor-inhibiting effect in the cervical malignant diseases
Elizabeth C. Mason
Full Text Available There is evidence from randomized control trials that internet-based cognitive behavioral therapy (iCBT is efficacious in the treatment of anxiety and depression, and recent research demonstrates the effectiveness of iCBT in routine clinical care. The aims of this study were to implement and evaluate a new pathway by which patients could access online treatment by completing an automated assessment, rather than seeing a specialist health professional. We compared iCBT treatment outcomes in patients who received an automated pre-treatment questionnaire assessment with patients who were assessed by a specialist psychiatrist prior to treatment. Participants were treated as part of routine clinical care and were therefore not randomized. The results showed that symptoms of anxiety and depression decreased significantly with iCBT, and that the mode of assessment did not affect outcome. That is, a pre-treatment assessment by a psychiatrist conferred no additional treatment benefits over an automated assessment. These findings suggest that iCBT is effective in routine care and may be implemented with an automated assessment. By providing wider access to evidence-based interventions and reducing waiting times, the use of iCBT within a stepped-care model is a cost-effective way to reduce the burden of disease caused by these common mental disorders.
Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioural therapy (iCBT) versus control CBM and iCBT for depression: study protocol for a parallel-group randomised controlled trial.
Williams, Alishia D; Blackwell, Simon E; Holmes, Emily A; Andrews, Gavin
The current randomised controlled trial will evaluate the efficacy of an internet-delivered positive imagery cognitive bias modification (CBM) intervention for depression when compared with an active control condition and help establish the additive benefit of positive imagery CBM when delivered in combination with internet cognitive behavioural therapy for depression. Patients meeting diagnostic criteria for a current major depressive episode will be recruited through the research arm of a not-for-profit clinical and research unit in Australia. The minimum sample size for each group (α set at 0.05, power at 0.80) was identified as 29, but at least 10% more will be recruited to hedge against expected attrition. We will measure the impact of CBM on primary measures of depressive symptoms (Beck Depression Inventory-second edition (BDI-II), Patient Health Questionnaire (PHQ9)) and interpretive bias (ambiguous scenarios test-depression), and on a secondary measure of psychological distress (Kessler-10 (K10)) following the 1-week CBM intervention. Secondary outcome measures of psychological distress (K10), as well as disability (WHO disability assessment schedule-II), repetitive negative thinking (repetitive thinking questionnaire), and anxiety (state trait anxiety inventory-trait version) will be evaluated following completion of the 11-week combined intervention, in addition to the BDI-II and PHQ9. Intent-to-treat marginal and mixed effect models using restricted maximum likelihood estimation will be used to evaluate the primary hypotheses. Clinically significant change will be defined as high-end state functioning (a BDI-II score reduction greater than the reliable change index score. Maintenance of gains will be assessed at 3-month follow-up. The current trial protocol has been approved by the Human Research Ethics Committee of St Vincent's Hospital and the University of New South Wales, Sydney. Australian New Zealand Clinical Trials Registry: ACTRN12613000139774
Full Text Available The implantable cardioverter defibrillator (ICD has currently become the standard treatment for preventing sudden cardiac death. There are some psychological consequences in patients with ICD such as posttraumatic stress disorder (PTSD after the shocks induced by ICD. This report aimed to present the case of a 54-year-old man with ICD who had developed PTSD; his PTSD was treated, using cognitive-behavioral psychotherapy consisting of relaxation, mindfulness and problem solving techniques. In patients with ICD who are experiencing PTSD using cognitive behavioral interventions may be helpful to reduce their psychological sufferings.
A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an At Risk Mental State for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial
Rietdijk, J.; Dragt, S.; Klaassen, R.; Ising, H; Nieman, D.; Wunderink, L.; Delespaul, P.; Cuijpers, P.; Linszen, D.; van der Gaag, M.
Background: Psychotic disorders are a serious mental health problem. Intervention before the onset of psychosis might result in delaying the onset, reducing the impact or even preventing the first episode of psychosis. This study explores the effectiveness of cognitive behavioural therapy (CBT) in
Full Text Available Neuropathic pain (NP is a common clinical refractory pain for which there are limited methods to treat. In this article, based on typical diseases, such as postherpetic neuralgia (PHN, trigeminal neuralgia, complex regional pain syndrome (CRPS, lower back pain with radiculopathy and failed back surgery syndrome (FBSS, phantom pain, the general treatment principle and method for NP are expatiated. Interventional methods for NP, including intraspinal block, radiofrequeney rhizotomy of trigeminal neuralgia, selective nerve root block, spinal cord stimulation (SCS and motor cortex stimulation (MCS are introduced, especially their indications, complications and matters needing attention.
van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke
BACKGROUND: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often.
van der Zweerde, T.; Lancee, J.; Slottje, P.; Bosmans, J.; van Someren, E.; Reynolds, C.; Cuijpers, Pim; van Straten, A.
BACKGROUND: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often.
van der Zweerde, T.; Lancee, J.; Slottje, P.; Bosmans, J.; Van Someren, E.; Reynolds, C.; Cuijpers, P.; van Straten, A.
Background: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often.
Sosic-Vasic, Zrinka; Abler, Birgit; Grön, Georg; Plener, Paul; Straub, Joana
A number of neuroimaging studies have identified altered regional cerebral blood flow (rCBF) related to major depressive disorder (MDD) in adult samples, particularly in the lateral prefrontal, cingular and temporal regions. In contrast, neuroimaging investigations in adolescents with MDD are rare, although investigating young patients during a significant period of brain maturation might offer valuable insights into the neural mechanisms of MDD. We acquired perfusion images obtained with continuous arterial spin labelling in 21 medication-naive adolescents with MDD before and after a five-session cognitive behavioural group therapy (group CBT). A control group included medication-naive patients under treatment as usual while waiting for the psychotherapy. We found relatively increased rCBF in the right dorsolateral prefrontal cortex (DLPFC; BA 46), the right caudate nucleus and the left inferior parietal lobe (BA 40) after CBT compared with before CBT. Relatively increased rCBF in the right DLPFC postgroup CBT was confirmed by time (post vs. pre)×group (intervention/waiting list) interaction analyses. In the waiting group, relatively increased rCBF was found in the thalamus and the anterior cingulate cortex (BA 24). The relatively small number of patients included in this pilot study has to be considered. Our findings indicate that noninvasive resting perfusion scanning is suitable to identify CBT-related changes in adolescents with MDD. rCBF increase in the DLPFC following a significant reduction in MDD symptoms in adolescents might represent the core neural correlate of changes in 'top-down' cognitive processing, a possible correlate of improved self-regulation and cognitive control.
Webb, Christian A.; Auerbach, Randy P.; DeRubeis, Robert J.
A growing body of research supports the efficacy of cognitive-behavioral therapy (CBT) for adolescent depression. The mechanisms through which CBT exerts its beneficial effects on adolescent patients suffering from depression, however, remain unclear. The current article reviews the CBT for adolescent depression process literature. Our review…
Full Text Available Abstract Background NICE recommends computerised cognitive behavioural therapy (cCBT for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. Methods A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. Results Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. Conclusions Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.
Wahyu Nanda Eka Saputra
Full Text Available Cognitive behavior therapy (CBT is one of the major counseling theories today. However, reliability of this theory has received criticism from other theories, which claim to cognitive interventions do not provide added value on behavioral interventions. The theory criticized and showed dissatisfaction with the practice of CBT is the theory of Acceptance and Commitment Therapy (ACT. Furthermore, ACT is known to a new generation of CBT.ACT is one of the new counseling approach that can be applied to school counselors to deal with the issues of students in the school.
Li Jian; Xu Ke; Xiao Liang
Objective: To investigate the effectiveness of interventional therapy for the atherosclerotic renal artery occlusion (ARAO). Methods: During the period of June 2001-Dec. 2007, 16 patients with ARAO (total of 16 occluded arteries) underwent interventional managements, including percutaneous endovascular renal artery revascularization, balloon dilatation angioplasty and stent placement. Follow-up survey was made at regular intervals. The patent condition of the renal artery was evaluated with ultrasonography and digital subtraction angiography. The blood pressure and the renal function were determined and the data were statistically analyzed in order to assess the intermediate and long-term effect of the interventional therapy. Results: Of 16 patients, technical success was achieved in 15 (93.8%) and failure occurred in one. During a follow-up period of 9 - 24 months, 3 patients died. According to the data obtained at each patient's last follow-up survey, the hypertension fell to normal in 3 (25.0%), was improved in 7 (58.3%) and showed no marked change in 2 patients (16.7%), with a clinical efficacy of 83.3% (10 / 12). The renal function was improved in 2 (16.7%), stabilized in 6 (50%) and deteriorated in 4 patients (33.3%), with an effective rate of 66.7% (8 / 12). Conclusion: For the treatment of atherosclerotic renal artery occlusion, the interventional therapy carries high successful rate and can effectively lower the blood pressure level, in addition, it can also protect the renal function in a certain degree. (authors)
Objective: To observe the therapeutic effect of chronic lung abscess by interventional therapy under CT guidance. Methods: The group consisted of 12 patients. Firstly, the positions of abscess were localized by CT, secondly under CT guidance puncturing into the abscess with a needle and then thirdly, drain aging through the abscess and injecting some antibiotics through the needle. The treatment consisted by 16 times with an average drawing volume out 10-100 ml, during 18-28 days as a course. All patients were cured. Conclusion: The interventional therapy under CT guidance for chronic lung abscess can increase the therapeutic effect, decrease the course of treatment and avoid the operation. Therefore, it is a safe, simple and convenient method
Harris, A; Moe, T F; Eriksen, H R; Tangen, T; Lie, S A; Tveito, T H; Reme, S E
Cognitive-behavioural treatments (CBT) and physical group exercise (PE) have both shown promising effects in reducing disability and increasing work participation among chronic low back pain (CLBP) patients. A brief cognitive intervention (BI) has previously been demonstrated to reduce work disability in CLBP. The aim of this study was to test if the effect of BI could be further increased by adding either group CBT or group PE. A total of 214 patients, all sick listed 2-10 months due to CLBP, were randomized to BI (n = 99), BI + group CBT (n = 55) or BI + group PE (n = 60). Primary outcome was increased work participation at 12 months, whereas secondary outcomes included pain-related disability, subjective health complaints, anxiety, depression, coping and fear avoidance. There were no significant differences between the groups in work participation at 12 months follow-up (χ 2 = 1.15, p = 0.56). No significant differences were found on the secondary outcomes either, except for a statistically significant reduction (time by group) in pseudoneurology one domain of subjective health complaints (sleep problems, tiredness, dizziness, anxiety, depression, palpitation, heat flushes) (F 2,136 = 3.109, p = 0.048) and anxiety (F 2,143 = 4.899, p = 0.009) for the groups BI + group CBT and BI + group PE, compared to BI alone. However, these differences were not significant in post hoc analyses (Scheffé adjusted). There was no support for an effect of the added group CBT or group PE treatments to a brief cognitive intervention in this study of patients on sick leave due to low back pain. Our study demonstrates that treatments that previously were found to be effective and are included in most treatment guidelines, such as group cognitive-behavior therapy and exercise, were not effective in this given context compared to a brief, cognitive intervention. This implies that an optimized brief intervention is difficult to outperform in patients on
Larsen, Stina Meyer; Petersen, Anne Karin
Describe and demonstrate Occupational Therapy (OT) intervention for patients with Chronic Obstructive Pulmonary Disease (COPD).......Describe and demonstrate Occupational Therapy (OT) intervention for patients with Chronic Obstructive Pulmonary Disease (COPD)....
Parker, Zachary J; Waller, Glenn
Clinicians commonly fail to use cognitive behavioural therapy (CBT) adequately, but the reasons for such omissions are not well understood. The objective of this study was to create and validate a measure to assess clinicians' attitudes towards CBT - the Negative Attitudes towards CBT Scale (NACS). The participants were 204 clinicians from various mental healthcare fields. Each completed the NACS, measures of anxiety and self-esteem, and a measure of therapists' use of CBT and non-CBT techniques and their confidence in using those techniques. Exploratory factor analysis was used to determine the factor structure of the NACS, and scale internal consistency was tested. A single, 16-item scale emerged from the factor analysis of the NACS, and that scale had good internal consistency. Clinicians' negative attitudes and their anxiety had different patterns of association with the use of CBT and other therapeutic techniques. The findings suggest that clinicians' attitudes and emotions each need to be considered when understanding why many clinicians fail to deliver the optimum version of evidence-based CBT. They also suggest that training effective CBT clinicians might depend on understanding and targeting such internal states.
Full Text Available BACKGROUND: Telephone helplines are frequently and repeatedly used by individuals with chronic mental health problems and web interventions may be an effective tool for reducing depression in this population. AIM: To evaluate the effectiveness of a 6 week, web-based cognitive behaviour therapy (CBT intervention with and without proactive weekly telephone tracking in the reduction of depression in callers to a helpline service. METHOD: 155 callers to a national helpline service with moderate to high psychological distress were recruited and randomised to receive either Internet CBT plus weekly telephone follow-up; Internet CBT only; weekly telephone follow-up only; or treatment as usual. RESULTS: Depression was lower in participants in the web intervention conditions both with and without telephone tracking compared to the treatment as usual condition both at post intervention and at 6 month follow-up. Telephone tracking provided by a lay telephone counsellor did not confer any additional advantage in terms of symptom reduction or adherence. CONCLUSIONS: A web-based CBT program is effective both with and without telephone tracking for reducing depression in callers to a national helpline. TRIAL REGISTRATION: Controlled-Trials.comISRCTN93903959.
Mendoza, M E; Capafons, A; Gralow, J R; Syrjala, K L; Suárez-Rodríguez, J M; Fann, J R; Jensen, M P
This study evaluated the efficacy of an intervention combining the Valencia model of waking hypnosis with cognitive-behavioral therapy (VMWH-CBT) in managing cancer-related pain, fatigue, and sleep problems in individuals with active cancer or who were post-treatment survivors. We hypothesized that four sessions of VMWH-CBT would result in greater improvement in participants' symptoms than four sessions of an education control intervention. Additionally, we examined the effects on several secondary outcome domains that are associated with increases in these symptoms (depression, pain interference, pain catastrophizing, and cancer treatment distress). The study design was a randomized controlled crossover clinical trial comparing the VMWH-CBT intervention with education control. Participants (N = 44) received four sessions of both treatments, in a counterbalanced order (n = 22 per order condition). Participants were 89% female (N = 39) with mean age of 61 years (SD = 12.2). They reported significantly greater improvement after receiving the active treatment relative to the control condition in all the outcome measures. Treatment gains were maintained at 3-month follow-up. This study supports the beneficial effects of the VMWH-CBT intervention relative to a control condition and that treatment gains remain stable. VMWH-CBT-trained clinicians should be accessible for managing symptoms both during and after cancer treatment, though the findings need to be replicated in larger samples of cancer survivors. Copyright © 2016 John Wiley & Sons, Ltd.
van Apeldoorn, F. J.; Stant, A. D.; van Hout, W. J. P. J.; Mersch, P. P. A.; den Boer, J. A.
Objective The objective of this study was to assess the cost-effectiveness of three empirically supported treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both
Spangler, Diane L.; Baldwin, Scott A.; Agras, W. Stewart
Cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) has received considerable empirical support for its efficacy. However, few investigators have examined the mechanisms proposed to account for the reduction of BN symptoms during CBT. The current study examined the associations between therapist interventions, client mechanisms, and…
Using the proven techniques of cognitive behavioural therapy, this book will show you how to manage your anxiety, in whatever form it appears, from phobias to panic attacks and general anxiety disorder. You will receive support for understanding with and coping with different types of anxiety, using CBT to manage your symptoms and alleviate much of your distress. You will also learn how to be more resilient and accepting of all your thoughts, fears and emotions, and discover new, healthier wa...
Salomonsson, Sigrid; Santoft, Fredrik; Lindsäter, Elin; Ejeby, Kersti; Ljótsson, Brjánn; Öst, Lars-Göran; Ingvar, Martin; Lekander, Mats; Hedman-Lagerlöf, Erik
Common mental disorders (CMDs) cause great individual suffering and long-term sick leave. Cognitive-behavioural therapy (CBT) effectively treats CMDs, but sick leave is not reduced to the same extent as psychiatric symptoms. Research results regarding return-to-work interventions (RTW-Is) and their effect on sick leave are inconclusive. The aim of this study was to evaluate CBT, a RTW-I and combined CBT and RTW-I (COMBO) for primary care patients on sick leave due to CMDs. Patients with CMDs (n=211) were randomised to CBT (n=64), RTW-I (n=67) or COMBO (n=80). Sick-leave registry data after 1 year and blinded Clinician's Severity Rating (CSR) of symptoms post-treatment and at follow-ups after 6 and 12 months were primary outcomes. There was no significant difference between treatments in days on sick leave 1 year after treatment start (mean difference in sick-leave days range=9-27). CBT led to larger reduction of symptoms post-treatment (CSR; Cohen's d=0.4 (95% CI 0.1 to 0.8)) than RTW-I, whereas COMBO did not differ from CBT or RTW-I. At follow-up, after 1 year, there was no difference between groups. All treatments were associated with large pre-treatment to post-treatment improvements, and results were maintained at 1-year follow-up. No treatment was superior to the other regarding reducing sick leave. All treatments effectively reduced symptoms, CBT in a faster pace than RTW-I, but at 1-year follow-up, all groups had similar symptom levels. Further research is needed regarding how CBT and RTW-I can be combined more efficiently to produce a larger effect on sick leave while maintaining effective symptom reduction. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
BREEDEN, LORI E.
Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions. Sessions were recorded and transcribed. Data were examined using content analysis. The content analysis identified the following themes: the value of photos to support learning; the value of narrative learning related to home safety education; and abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention. PMID:27563389
Schakel, L.; Veldhuijzen, D.S.; Middendorp, H. van; Prins, C.; Joosten, S.A.; Ottenhoff, T.H.; Visser, L.G.; Evers, A.W.M.
BACKGROUND: Previous research has provided evidence for the link between psychological processes and psychophysiological health outcomes. Psychological interventions, such as face-to-face or online cognitive behavioral therapy (CBT) and serious games aimed at improving health, have shown promising
Kennard, B; Brown, L; Hawkins, L; Risi, A; Radcliffe, J; Emslie, G; Mayes, T; King, J; Foxwell, A; Buyukdura, J; Bethel, J; Naar-King, S; Xu, J; Lee, S; Garvie, P; London, C; Tanney, M; Thornton, S
Rates of depression are reported to be between 22-33% in adults with HIV, which is double that of the general population. Depression negatively affects treatment adherence and health outcomes of those with medical illnesses. Further, it has been shown in adults that reducing depression may improve both adherence and health outcomes. To address the issues of depression and non-adherence, Health and Wellness (H&W) Cognitive Behavioral Therapy (CBT) and medication management (MM) treatment strategies have been developed specifically for youth living with both HIV and depression. H&W CBT is based on other studies with uninfected youth and upon research on adults with HIV. H&W CBT uses problem-solving, motivational interviewing, and cognitive-behavioral strategies to decrease adherence obstacles and increase wellness. The intervention is delivered in 14 planned sessions over a 6-month period, with three different stages of CBT. This paper summarizes the feasibility and acceptability data from an open depression trial with 8 participants, 16-24 years of age, diagnosed with HIV and with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of depression, conducted at two treatment sites in the Adolescent Trials Network (ATN). Both therapists and subjects completed a Session Evaluation Form (SEF) after each session, and results were strongly favorable. Results from The Quick Inventory of Depressive Symptomatology-Clinician (QIDS-C) also showed noteworthy improvement in depression severity. A clinical case vignette illustrates treatment response. Further research will examine the use of H&W CBT in a larger trial of youth diagnosed with both HIV and depression.
Hinton, Devon E; Hofmann, Stefan G; Rivera, Edwin; Otto, Michael W; Pollack, Mark H
We examined the therapeutic efficacy of a culturally adapted form of CBT (CA-CBT) for PTSD as compared to applied muscle relaxation (AMR) for female Latino patients with treatment-resistant PTSD. Participants were randomized to receive either CA-CBT (n = 12) or AMR (n = 12), and were assessed before treatment, after treatment, and at a 12-week follow-up. The treatments were manualized and delivered in the form of group therapy across 14 weekly sessions. Assessments included a measure of PTSD, anxiety, culturally relevant idioms of distress (nervios and ataque de nervios), and emotion regulation ability. Patients receiving CA-CBT improved significantly more than in the AMR condition. Effect size estimates showed very large reductions in PTSD symptoms from pretreatment to posttreatment in the CA-CBT group (Cohen's d = 2.6) but only modest improvements in the AMR group (0.8). These results suggest that CA-CBT can be beneficial for previously treatment-resistant PTSD in Latino women. Copyright © 2011 Elsevier Ltd. All rights reserved.
Teng Gaojun; Lu Qin
Interventional techniques not only provide opportunity of treatment for many diseases, but also alter the traditional therapeutic pattern. With the new century of wide application of biological therapies, interventional technique also shows extensive roles. The current biological therapy, including gene therapy, cell transplantation therapy, immunobiologic molecule therapy containing cell factors, tumor antibody or vaccine, recombined proteins, radioactive-particles and targeting materials therapy, can be locally administrated by interventional techniques. The combination of targeting biological therapies and high-targeted interventional technique holds advantages of minimal invasion, accurate delivery, vigorous local effect, and less systemic adverse reactions. Authors believe that the biological therapy may arise a great opportunity for interventional radiology, therefore interventional colleagues should grasp firmly and promptly for the development and extension in this field. (authors)
Therapists in Improving Access to Psychological Therapies (IAPT) services are often expected to treat complex presentations of post-traumatic stress disorder (PTSD), such as individuals with multiple, prolonged or early life trauma histories and significant co-morbidity, for which they have received minimal training. Although high recovery rates for PTSD have been demonstrated in randomized controlled trials, these are not always replicated in routine practice, suggesting that training interventions are required to fill the research-practice gap. This study investigated the outcomes of a therapist training programme on treating PTSD with trauma-focused cognitive behavioural therapy (TF-CBT). Twenty therapists from ten IAPT services participated in the training, which consisted of workshops, webinars and consultation sessions over a 6-month period. Feedback indicated that participants found the training highly acceptable. PTSD knowledge and self- and supervisor-rated competence on TF-CBT measures improved following the training and improvements were maintained a year later. Client outcomes on a PTSD measure improved following the training. Participants reported attempts to disseminate learning from the course back to their teams. The findings indicate that the training programme was successful in improving TF-CBT knowledge, skills and outcomes for IAPT therapists. Tentative support for training 'trauma experts' within IAPT services was found, although institutional constraints and staff turnover may limit the sustainability of the model.
Weck, Florian; Kaufmann, Yvonne M; Höfling, Volkmar
The development and improvement of therapeutic competencies are central aims in psychotherapy training; however, little is known about which training interventions are suitable for the improvement of competencies. In the current pilot study, the efficacy of feedback regarding therapeutic competencies was investigated in cognitive behavioural therapy (CBT). Totally 19 trainee therapists and 19 patients were allocated randomly to a competence feedback group (CFG) or control group (CG). Two experienced clinicians and feedback providers who were blind to the treatment conditions independently evaluated therapeutic competencies on the Cognitive Therapy Scale at five treatment times (i.e., at Sessions 1, 5, 9, 13, and 17). Whereas CFG and CG included regular supervision, only therapists in the CFG additionally received written qualitative and quantitative feedback regarding their demonstrated competencies in conducting CBT during treatment. We found a significant Time × Group interaction effect (η² = .09), which indicates a larger competence increase in the CFG in comparison to the CG. Competence feedback was demonstrated to be suitable for the improvement of therapeutic competencies in CBT. These findings may have important implications for psychotherapy training, clinical practice, and psychotherapy research. However, further research is necessary to ensure the replicability and generalizability of the findings.
Double blinding requirement for validity claims in cognitive-behavioral therapy intervention trials for major depressive disorder. Analysis of Hollon S, et al., Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial [version 1; referees: 2 approved
Full Text Available This paper will focus on problems in the inability to double-blind cognitive-behavioral therapy (CBT studies for major depressive disorder (MDD, and provides an analysis of a recently published study to show how this problem can lead to faulty conclusions. A study by Hollon et al. published in JAMA Psychiatry that compared an antidepressant medication-only arm with a combined CBT/antidepressant arm concluded that the cognitive therapy/antidepressant combination enhanced the recovery rates compared with antidepressant alone, and that the magnitude of this increment nearly doubled for patients with more severe depression. We propose that for subjects with greater severity, there could have been both antidepressant efficacy as well as more hope and expectation in the group who knew they had received combined cognitive therapy/medication, leading to an erroneous conclusion of greater efficacy for the combined group. The large subject number in this study could easily lead to an erroneous finding on statistical testing as a small amount of bias in the subjects adds-up. We opine that the conclusions of unblind CBT outcome research in conditions with subjective endpoints such as MDD need to be given with great caution. The validity of CBT (and its derivatives such as dialectical behavioral therapy for indications other than MDD is also part of a larger problem in the inability to blind outcome studies for these interventions.
Lori E. Breeden
Full Text Available Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions each. Sessions were recorded and transcribed. Data were examined using content analysis. A content analysis identified the following themes as well as an understanding of the learning process. Analyses yielded themes of: the value of photos to support learning, the value of narrative learning related to home safety education, abstract versus concrete learners. Procedural findings are included to support future endeavors. Findings indicate that within a wellness context, home safety education for older adults can be delivered effectively via telehealth when using photography as a part of an occupational therapy intervention.
Spek, V.; Cuijpers, P.; Nyklicek, I.; Smits, N; Riper, H.; Keyzer, J.; Pop, V.
Background. Internet-based cognitive behaviour therapy (CBT) is a promising new approach for the treatment of depressive symptoms. The current study had two aims: (1) to determine whether, after 1 year, an internet-based CBT intervention was more effective than a waiting-list control group; and (2)
Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: results of a randomized, controlled, multicenter trial
Duijts, S.F.A.; van Beurden, M.; Oldenburg, H.S.A.; Hunter, M.S.; Kieffer, J.M.; Stuiver, M.M.; Gerritsma, M.A.; Menke-Pluymers, M.B.E.; Plaisier, P.W.; Rijna, H.; Lopes Cardozo, A.M.F.; Timmers, G.; van der Meij, S.; van der Veen, H.; Bijker, N.; de Widt-Levert, L.M.; Geenen, M.M.; Heuff, G.; van Dulken, E.J.; Boven, E.; Aaronson, N.K.
Purpose The purpose of our study was to evaluate the effect of cognitive behavioral therapy (CBT), physical exercise (PE), and of these two interventions combined (CBT/PE) on menopausal symptoms (primary outcome), body image, sexual functioning, psychological well-being, and health-related quality
Efficacy of Cognitive Behavioral Therapy and Physical Exercise in Alleviating Treatment-Induced Menopausal Symptoms in Patients With Breast Cancer: Results of a Randomized, Controlled, Multicenter Trial
Duijts, S.F.A.; van Beurden, M.; Oldenburg, H.S.; Hunter, M.S.; Kieffer, J.M.; Stuiver, M.M.; Gerritsma, MA; Menke-Pluymers, M.B.E.; Plaisier, P.W.; Rijna, H.; Cardozo, A.M.F.L.; Timmers, G.; van der Meij, S.; van der Veen, H.; Bijker, N.; de Widt-Levert, L.M.; Geenen, M.M.; Heuff, G.; van Dulken, E.J.; Boven, E.; Aaronson, N.K.
Purpose: The purpose of our study was to evaluate the effect of cognitive behavioral therapy (CBT), physical exercise (PE), and of these two interventions combined (CBT/PE) on menopausal symptoms (primary outcome), body image, sexual functioning, psychological well-being, and health-related quality
Efficacy of Cognitive Behavioral Therapy and Physical Exercise in Alleviating Treatment-Induced Menopausal Symptoms in Patients With Breast Cancer: Results of a Randomized, Controlled, Multicenter Trial
Duijts, Saskia F. A.; van Beurden, Marc; Oldenburg, Hester S. A.; Hunter, Myra S.; Kieffer, Jacobien M.; Stuiver, Martijn M.; Gerritsma, Miranda A.; Menke-Pluymers, Marian B. E.; Plaisier, Peter W.; Rijna, Herman; Lopes Cardozo, Alexander M. F.; Timmers, Gertjan; van der Meij, Suzan; van der Veen, Henk; Bijker, Nina; de Widt-Levert, Louise M.; Geenen, Maud M.; Heuff, Gijsbert; van Dulken, Eric J.; Boven, Epie; Aaronson, Neil K.
Purpose The purpose of our study was to evaluate the effect of cognitive behavioral therapy (CBT), physical exercise (PE), and of these two interventions combined (CBT/PE) on menopausal symptoms (primary outcome), body image, sexual functioning, psychological well-being, and health-related quality
Cognitive Behavioral Therapy Compared with Non-specialized Therapy for Alleviating the Effect of Auditory Hallucinations in People with Reoccurring Schizophrenia: A Systematic Review and Meta-analysis.
Kennedy, Laura; Xyrichis, Andreas
Cognitive behavioral therapy (CBT) is recommended as a psychological intervention for those diagnosed with schizophrenia. The prevalence of auditory hallucinations is high among this group, many of whom are cared for by community mental health teams that may not have easy access to qualified CBT practitioners. This systematic review examined the evidence for the superiority of CBT compared to non-specialized therapy in alleviating auditory hallucinations in community patients with schizophrenia. Two RCTs met the inclusion criteria totaling 105 participants. The Positive and Negative Syndrome Scale (PANSS)-Positive Scale was the outcome measure examined. A meta-analysis revealed a pooled mean difference of -0.86 [95 % CI -2.38, 0.65] in favor of CBT, although this did not reach statistical significance. This systematic review concluded there is no clinically significant difference in the reduction of positive symptoms of schizophrenia when treated by CBT compared to a non-specialized therapy for adults experiencing auditory hallucinations.
Wiltsey Stirman, Shannon; Marques, Luana; Creed, Torrey A; Gutner, Cassidy A; DeRubeis, Robert; Barnett, Paul G; Kuhn, Eric; Suvak, Michael; Owen, Jason; Vogt, Dawne; Jo, Booil; Schoenwald, Sonja; Johnson, Clara; Mallard, Kera; Beristianos, Matthew; La Bash, Heidi
Identifying scalable strategies for assessing fidelity is a key challenge in implementation science. However, for psychosocial interventions, the existing, reliable ways to test treatment fidelity quality are often labor intensive, and less burdensome strategies may not reflect actual clinical practice. Cognitive behavioral therapies (CBTs) provide clinicians with a set of effective core elements to help treat a multitude of disorders, which, evidence suggests, need to be delivered with fidelity to maximize potential client impact. The current "gold standard" for rating CBTs is rating recordings of therapy sessions, which is extremely time-consuming and requires a substantial amount of initial training. Although CBTs can vary based on the target disorder, one common element employed in most CBTs is the use of worksheets to identify specific behaviors and thoughts that affect a client's ability to recover. The present study will develop and evaluate an innovative new approach to rate CBT fidelity, by developing a universal CBT scoring system based on worksheets completed in therapy sessions. To develop a scoring system for CBT worksheets, we will compile common CBT elements from a variety of CBT worksheets for a range of psychiatric disorders and create adherence and competence measures. We will collect archival worksheets from past studies to test the scoring system and assess test-retest reliability. To evaluate whether CBT worksheet scoring accurately reflects clinician fidelity, we will recruit clinicians who are engaged in a CBT for depression, anxiety, and/or posttraumatic stress disorder. Clinicians and clients will transmit routine therapy materials produced in session (e.g., worksheets, clinical notes, session recordings) to the study team after each session. We will compare observer-rated fidelity, clinical notes, and fidelity-rated worksheets to identify the most effective and efficient method to assess clinician fidelity. Clients will also be randomly
Full Text Available It is difficult for obese (body mass index of more than 30 and overweight (body mass index of 25–30 people to reduce and maintain their weight. The aim of this case series was to examine the effectiveness of a new cognitive behavioral therapy (CBT program that combines mindfulness exercises (e.g., the raisin exercise and breathing exercises and an online intervention to prevent dropout and subsequent weight gain in overweight participants. This case series included three participants, for whom previous weight reduction programs had been unsuccessful. All participants completed the program (60-min, group sessions provided weekly for 9 weeks and an 18-month follow-up assessment. Results showed that all participants succeeded in losing weight (loss ranged from 5.30 to 8.88% of their total body weight. Although rebound weight gain is commonly observed in the first year following initial weight loss, the follow-up assessment showed that participants achieved further weight loss during the 18-month follow-up period. These results suggest that a CBT program that comprises mindfulness and an online intervention may be an effective method for weight loss and maintenance, and may prevent dropout in obese and overweight individuals.Trial Registration: This case series was registered at www.umin.ac.jp with identifier UMIN000029664.
The original and enhanced cognitive model of eating disorders proposes that cognitive-behavioral therapy (CBT) "works" through modifying dietary restraint and dysfunctional attitudes towards shape and weight. However, evidence supporting the validity of this model is limited. This meta-analysis examined whether CBT can effectively modify these proposed maintaining mechanisms. Randomized controlled trials that compared CBT to control conditions or non-CBT interventions, and reported dietary restraint and shape and weight concern outcomes were searched. Twenty-nine trials were included. CBT was superior to control conditions in reducing shape (g=0.53) and weight (g=0.63) concerns, and dietary restraint (g=0.36). These effects occurred across all diagnoses and treatment formats. Improvements in shape and weight concerns and restraint were also greater in CBT than non-CBT interventions (g's=0.25, 0.24, 0.31, respectively) at post-treatment and follow-up. The magnitude of improvement in binge/purge symptoms was related to the magnitude of improvement in these maintaining mechanisms. Findings demonstrate that CBT has a specific effect in targeting the eating disorder maintaining mechanisms, and offers support to the underlying cognitive model. If changes in these variables during treatment are shown to be causal mechanisms, then these findings show that CBT, relative to non-CBT interventions, is better able to modify these mechanisms.
Spendelow, Jason S; Butler, Lisa J
The aim of the current study was to identify outcomes of a self-practice/self-reflection (SP/SR) exercise for trainee clinical psychologists. Thirty-two trainees enrolled in their first year of a UK university doctoral clinical psychology training programme completed an online questionnaire following an eight-week exercise. Findings indicated an endorsement of many previously reported benefits of exercise participation, but also the identification of negative outcomes. Thematic analysis of qualitative data revealed that outcomes could be grouped into two main thematic domains (individual task outcomes and task organization issues) along with several subordinate themes. SP/SR is a useful tool in the development of trainee CBT therapist competences. There has been limited previous recognition of potential negative outcomes from this type of exercise. However, these can provide additional impetus for therapist skill development.
Full Text Available Abstract Background Depression is common among people with diabetes, negatively affecting quality of life, treatment adherence and diabetes outcomes. In routine clinical care, diabetes patients have limited access to mental health services and depression therefore often remains untreated. Web-based therapy could potentially be an effective way to improve the reach of psychological care for diabetes patients, at relatively low costs. This study seeks to test the effectiveness of a web-based self-help depression programme for people with diabetes and co-morbid depression. Methods/Design The effectiveness of a web-based self-help course for adults with diabetes with co-morbid depression will be tested in a randomised trial, using a wait-list controlled design. The intervention consists of an 8-week, moderated self-help course that is tailored to the needs of persons living with diabetes and is offered on an individual basis. Participants receive feedback on their homework assignments by e-mail from their coach. We aim to include 286 patients (143/143, as power analyses showed that this number is needed to detect an effect size of 0.35, with measurements at baseline, directly after completing the web-based intervention and at 1, 3, 4 and 6 months follow-up. Patients in the control condition are placed on a waiting list, and follow the course 12 weeks after randomisation. Primary outcomes are depressive symptoms and diabetes-specific emotional distress. Secondary outcomes are satisfaction with the course, perceived health status, self-care behaviours, glycaemic control, and days in bed/absence from work. Questionnaires are administered via the Internet. Discussion The intervention being trialled is expected to help improve mood and reduce diabetes-specific emotional distress in diabetes patients with depression, with subsequent beneficial effects on diabetes self-care and glycaemic outcomes. When proven efficacious, the intervention could be
Full Text Available Nilamadhab KarDepartment of Psychiatry, Wolverhampton City Primary Care Trust, Wolverhampton, UKBackground: Post-traumatic stress disorder (PTSD is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD.Methods: Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites.Results: The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT.Conclusion: There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action.Keywords: post-traumatic stress disorder, cognitive behavioral therapy
Hamilton, Kate E.; Wershler, Julie L.; Macrodimitris, Sophie D.; Backs-Dermott, Barb J.; Ching, Laurie E.; Mothersill, Kerry J.
Depression and anxiety are the most common mental health disorders seen in clinical practice and they are highly comorbid. Cognitive behavioral therapy (CBT) has been demonstrated as an effective treatment for both depression and anxiety but is often not available to all individuals who could benefit from it. This paper investigates the…
The evidence base for cognitive behaviour therapy (CBT)1 and other psychotherapeutic interventions in child and adolescent populations in low to middle income countries such as in South Africa is almost non-existent. In this review we explored the transportability of cognitive behaviour therapy interventions into the South ...
Full Text Available cbt Larvae + dm3 http://dbarchive.biosciencedbc.jp/kyushu-u/dm3/target/cbt.1.tsv ht...tp://dbarchive.biosciencedbc.jp/kyushu-u/dm3/target/cbt.5.tsv http://dbarchive.biosciencedbc.jp/kyushu-u/dm3/target/cbt....10.tsv http://dbarchive.biosciencedbc.jp/kyushu-u/dm3/colo/cbt.Larvae.tsv http://dbarchive.biosciencedbc.jp/kyushu-u/dm3/colo/Larvae.gml ...
Zahn, R; Zeymer, U
Currently an acute myocardial infarction has to be differentiated into ST-elevation myocardial infarction (STEMI) or non ST-elevation myocardial infarction (NSTEMI). However, there exists another definition of acute coronary syndromes (ACS), which is more important in clinical practice, for all recommendations from the guidelines of the cardiac societies concerning the invasive strategies rely on this one. Here one has to differentiate an ACS with ST-elevation (STE-ACS = STEMI) from an ACS without ST-elevation (NSTE-ACS). The last one is further divided into an NSTE-ACS with or without high risk. In patients with an NSTE-ACS with high risk an early invasive strategy is recommended within 72 h after the diagnosis. In patients with an NSTE-ACS without high risk a more conservative approach can be pursued. In STE-ACS patients primary angioplasty is the reperfusion therapy of choice, if it can be performed in a timely fashion within 2 h after diagnosis at an interventional centre with experienced interventionalists and short "door-to-balloon" times. In Germany this goal is achievable almost everywhere. Therefore it is currently the most important task to establish local networks to reach this goal.
Charkhandeh, Mansoureh; Talib, Mansor Abu; Hunt, Caroline Jane
The main aim of the study was to investigate the effectiveness of two psychotherapeutic approaches, cognitive behavioral therapy (CBT) and a complementary medicine method Reiki, in reducing depression scores in adolescents. We recruited 188 adolescent patients who were 12-17 years old. Participants were randomly assigned to CBT, Reiki or wait-list. Depression scores were assessed before and after the 12 week interventions or wait-list. CBT showed a significantly greater decrease in Child Depression Inventory (CDI) scores across treatment than both Reiki (peffect for Reiki than did female participants. Both CBT and Reiki were effective in reducing the symptoms of depression over the treatment period, with effect for CBT greater than Reiki. These findings highlight the importance of early intervention for treatment of depression using both cognitive and complementary medicine approaches. However, research that tests complementary therapies over a follow-up period and against a placebo treatment is required. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Abdul Rahim, Mohamad R; James, Melissa L; Hickey, Brigid E
The aim of this study was to maximise the benefits from clinical trials involving technological interventions such as radiation therapy. High compliance to the quality assurance protocols is crucial. We assessed whether the quality of radiation therapy intervention was evaluated in Cochrane systematic reviews. We searched 416 published Cochrane systematic reviews and identified 67 Cochrane systematic reviews that investigated radiation therapy or radiotherapy as an intervention. For each systematic review, either quality assurance or quality control for the intervention was identified by a description of such processes in the published systematic reviews. Of the 67 Cochrane systematic reviews studied, only two mentioned quality assurance or quality control. Our findings revealed that 65 of 67 (97%) Cochrane systematic reviews of radiation therapy interventions failed to consider the quality of the intervention. We suggest that advice about the evaluation of intervention quality be added to author support materials. © 2017 The Royal Australian and New Zealand College of Radiologists.
Lepping, P; Whittington, R; Sambhi, R S; Lane, S; Poole, R; Leucht, S; Cuijpers, P; McCabe, R; Waheed, W
Cognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression - Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD. Copyright © 2017. Published by Elsevier Masson SAS.
Rodriguez, James; Hoagwood, Kimberly Eaton; Gopalan, Geetha; Olin, Serene; McKay, Mary M.; Marcus, Sue M.; Radigan, Marleen; Chung, Michelle; Legerski, Joanna
Treatment participation was examined among youth enrolled in an evaluation of cognitive behavioral therapy (CBT) for trauma following the 9/11 World Trade Center disaster. Staff at nine agencies serving a predominantly low-income, ethnically diverse population were trained to deliver CBT and structured engagement strategies. A total of 445 youth…
Manassis, Katharina; Ickowicz, Abel; Picard, Erin; Antle, Beverley; McNeill, Ted; Chahauver, Anu; Mendlowitz, Sandra; Monga, Suneeta; Adler-Nevo, Gili
Objective: Cognitive behavior therapy (CBT) for children has been shown efficacious, but community access to it is often limited by the lack of trained therapists. This study evaluated a child, CBT-focused, 20-session weekly group supervision seminar with a didactic component which was provided to community mental health practitioners by…
Wanders, F.; Serra, M.; de Jongh, A.
This study compared eye movement desensitization and reprocessing (EMDR) with cognitive-behavioral therapy (CBT). Twenty-six children (average age 10.4 years) with behavioral problems were randomly assigned to receive either 4 sessions of EMDR or CBT prior to usual treatment provided in outpatient
Khanna, Muniya S.; Kendall, Philip C.
Empirical data support the efficacy of cognitive-behavioral therapy (CBT) for child anxiety, but there is need and merit in the development and evaluation of cost-effective and transportable CBT approaches. Relatedly, a widely endorsed goal is the dissemination of evidence-based treatments from research clinics to community settings.…
Maddox, Brenna B.; Miyazaki, Yasuo; White, Susan W.
Anxiety interventions involving social skills training and CBT for youth with ASD have shown promise, but few studies have examined the effects on social functioning or the maintenance of treatment gains. This study evaluated change in social skills during a randomized controlled trial of CBT and during the 1-year follow-up for 25 adolescents with…
Kamen, Charles; Garland, Sheila N; Heckler, Charles E; Peoples, Anita R; Kleckner, Ian R; Cole, Calvin L; Perlis, Michael L; Morrow, Gary R; Mustian, Karen M; Roscoe, Joseph A
While cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be efficacious in treating cancer survivors' insomnia, 30-60% of individuals have difficulty adhering to intervention components. Psychosocial predictors of adherence and response to CBT-I, such as social support, have not been examined in intervention studies for cancer survivors. Data from a randomized placebo-controlled 2 x 2 trial of CBT-I and armodafinil (a wakefulness promoting agent) were used to assess adherence. Ninety-six cancer survivors participated in the trial (mean age 56, 86% female, 68% breast cancer). CBT-I and armodafinil were administered over the course of seven weeks, and participants were assessed at baseline, during intervention, postintervention, and at a three-month follow-up. Social support was assessed using a Functional Assessment of Chronic Illness Therapy subscale, insomnia severity was assessed using the Insomnia Severity Index, and adherence was measured based on CBT-I sleep prescriptions. At baseline, social support was negatively correlated with insomnia severity (r = -0.30, p = 0.002) and associations between social support, CBT-I, and insomnia were maintained through the three-month follow-up. Social support was positively associated with adherence to CBT-I during intervention weeks 3, 4, and 5, and with overall intervention adherence. At postintervention, both social support and treatment with CBT-I independently predicted decreased insomnia severity (p adherence and improved sleep independent of CBT-I. Additional research is needed to determine whether social support can be leveraged to improve adherence and response to CBT-I.
de Hullu, Eva; Sportel, B. Esther; Nauta, Maaike H.; de Jong, Peter J.
Background and Objectives: This two-year follow-up study evaluated the long-term outcomes of two early interventions that aimed at reducing social and test anxiety in young adolescents at risk for developing social anxiety disorder. Methods: In this RCP, moderately socially anxious adolescents
Background: Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD. Methods: Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites. Results: The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT. Conclusion: There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action. PMID:21552319
Sørensen, Per; Birket-Smith, M; Wattar, U
Hypochondriasis is common in the clinic and in the community. Cognitive behavioural therapy (CBT) has been found to be effective in previous trials. Psychodynamic psychotherapy is a treatment routinely offered to patients with hypochondriasis in many countries, including Denmark. The aim of this ......Hypochondriasis is common in the clinic and in the community. Cognitive behavioural therapy (CBT) has been found to be effective in previous trials. Psychodynamic psychotherapy is a treatment routinely offered to patients with hypochondriasis in many countries, including Denmark. The aim...... of this study was to test CBT for hypochondriasis in a centre that was not involved in its development and compare both CBT and short-term psychodynamic psychotherapy (STPP) to a waiting-list control and to each other. CBT was modified by including mindfulness and group therapy sessions, reducing the therapist...
Barnes, Thomas Bryan
Music plays a significant role in the lives of individuals across the lifespan. Some healthcare providers may not appreciate music therapy and the positive benefits it can have on the environment, patients, caregivers, and healthcare staff. Integrative Music Therapy (IMT) has proven to be effective in multiple settings, offering therapy for behavioral, emotional, physiological, psychological, and psychosocial needs. IMT, performed by a trained, certified professional (MT-BC), does not seek to replace medication or other procedures, but works synergistically with provided healthcare.
Braveman, Brent; Hunter, Elizabeth G; Nicholson, Jennifer; Arbesman, Marian; Lieberman, Deborah
This Evidence Connection describes a case report of a man with non-Hodgkin's lymphoma who underwent an allogenic stem cell transplant. The occupational therapy assessment and treatment processes for an outpatient rehabilitation setting are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Project. Copyright © 2017 by the American Occupational Therapy Association, Inc.
Ponsford, J; Lee, N K; Wong, D; McKay, A; Haines, K; Alway, Y; Downing, M; Furtado, C; O'Donnell, M L
Anxiety and depression are common following traumatic brain injury (TBI), often co-occurring. This study evaluated the efficacy of a 9-week cognitive behavioral therapy (CBT) program in reducing anxiety and depression and whether a three-session motivational interviewing (MI) preparatory intervention increased treatment response. A randomized parallel three-group design was employed. Following diagnosis of anxiety and/or depression using the Structured Clinical Interview for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean post-traumatic amnesia 22 days) were randomly assigned to an Adapted CBT group: (1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a (3) waitlist control (WC, n = 23) group. Groups did not differ in baseline demographics, injury severity, anxiety or depression. MI and CBT interventions were guided by manuals adapted for individuals with TBI. Three CBT booster sessions were provided at week 21 to intervention groups. Using intention-to-treat analyses, random-effects regressions controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and NDC + CBT) showed significantly greater reduction in anxiety on the Hospital Anxiety and Depression Scale [95% confidence interval (CI) -2.07 to -0.06] and depression on the Depression Anxiety and Stress Scale (95% CI -5.61 to -0.12) (primary outcomes), and greater gains in psychosocial functioning on Sydney Psychosocial Reintegration Scale (95% CI 0.04-3.69) (secondary outcome) over 30 weeks post-baseline relative to WC. The group receiving MI + CBT did not show greater gains than the group receiving NDC + CBT. Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI.
Tovote, K. Annika; Schroevers, Maya J.; Snippe, Evelien; Emmelkamp, Paul M.G.; Links, Thera P.; Sanderman, Robbert; Fleer, Joke
Objective: Cognitive Behavior Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) have shown to be effective interventions for treating depressive symptoms in patients with diabetes. However, little is known about which intervention works best for whom (i.e., moderators of efficacy). The
Broach, Ellen; Dattilo, John
Reviews literature on the effects of aquatic therapy (swimming and exercise) to improve function. Research shows that aquatic therapy has numerous psychological and physical benefits, and it supports the belief that participation can provide a realistic solution to maintaining physical fitness and rehabilitation goals while engaging in enjoyable…
Nov 23, 2017 ... Laughter therapy is being used as an intervention to positively influence individuals experiencing various forms of .... to facilitate healing or coping, whether physical, emotional, cognitive, social or ...... Geriatrics & Geron-.
Skilbeck, William M.
It was proposed that existing therapeutic procedures may influence attributions about emotional states. Therefore an attributional analysis of crisis intervention, a model of community-based, short-term consultation, was presented. This analysis suggested that crisis intervention provides attributionally-relevant information about both the source…
Imamura, Kotaro; Kawakami, Norito; Furukawa, Toshi A; Matsuyama, Yutaka; Shimazu, Akihito; Kasai, Kiyoto
The aim of this study is to examine the effects of an internet-based cognitive behavioural therapy (iCBT) program on decreasing the risk of major depressive episodes (MDEs) among workers employed in a private corporate group in Japan, using a randomised controlled trial design. All of the workers in a corporate group (n=20,000) will be recruited through an invitation email. Participants who fulfil the inclusion criteria will be randomly allocated to intervention or control groups (planned N=4050 for each group). They will be allowed to complete the six lessons of the iCBT program within 10 weeks after the baseline survey. Those in the control group will receive the same iCBT after 12 months. The program includes several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem-solving and relaxation. The primary outcome measure is no new onset of MDE (using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)/DSM-5 criteria) during the 12-month follow-up. Assessment will use the web version of the WHO Composite International Diagnostic Interview V.3.0 depression section. The Research Ethics Review Board of Graduate School of Medicine, the University of Tokyo (No. 3083-(2)), approved the study procedures. The study protocol is registered at the UMIN Clinical Trials Registry (UMIN-CTR; ID=UMIN000014146). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Miller, Katherine E; Kuhn, Eric; Owen, Jason E; Taylor, Katherine; Yu, Jessica S; Weiss, Brandon J; Crowley, Jill J; Trockel, Mickey
Clinicians' perceptions of CBT-I Coach, a patient-facing mobile app for cognitive-behavioral therapy for insomnia (CBT-I), are critical to its adoption and integration into practice. Diffusion of innovations theory emphasizes the influence of perceptions, including the relative advantage to current practice, the compatibility to clinicians' needs, the complexity, the innovation's trialability, and observability. This study intended to evaluate the use and perceptions of CBT-I Coach among Veterans Affairs (VA)-trained CBT-I clinicians. Clinicians (N = 108) were surveyed about their use, feedback, and perceptions of CBT-I Coach a year after the app became available. Overall perceptions of CBT-I Coach were favorable. Fifty percent of clinicians reported using CBT-I Coach, with 98% intending to continue use. The app was perceived to increase sleep diary completion and homework compliance. Clinicians viewed the app as providing accessibility to helpful tools and improving patient engagement. Of those not using the app, 83% endorsed intention to use it. Reasons for nonuse were lack of patient access to smart phones, not being aware of the app, not having time to learn it, and inability to directly access app data. Those who reported using CBT-I Coach had more favorable perceptions across all constructs (p CBT-I Coach, as well as study if reported benefits can be evidenced more directly.
Dwi Indah Iswanti
Full Text Available The violence that occurs in education is known as bullying. Violence can occur in mild degrees such as cheating on exams, to fights or beatings that result in death. Bullying in children often leads to school phobias (ask for school change, reduced learning concentration, decreased learning achievement, and likes to carry certain items. Interventions that can be done include Problem Solving Therapy (PST, Behavior Modification (behavior modification, and Cognitive Behavior Therapy (CBT. The purpose of this study was to produce CBT modules in school-aged children that were useful for reducing bullying behavior, using a pre-post test with control group design. The subject of this research is 52 elementary school age children in Tembalang District Semarang selected by purposive sampling technique. Data were collected using bullying behavior checklist, CBT module and workbook, then analyzed using T-Test. The results showed a decrease in bullying behavior in the intervention group after CBT Individual therapy was given.
Filges, Trine; Knudsen, Anne-Sofie Due; Svendsen, Majken
), Multidimensional Family Therapy (MDFT), and Psychoeducational Therapy (PET)). RESULTS Our main objective was to evaluate the current evidence on the effect of CBT on abstinence and drug use reduction for young people in outpatient treatment for non-opioid drug use. Seven randomised trials, involving 953......, and PET ) with respect to reduction in young people’s drug use. The evidence drawn from this systematic review is based on seven included studies analysed in two separate analyses, depending on whether the intervention was CBT with an add-on component such as motivational interviewing (four studies......) or CBT without an add-on component (three studies). The seven studies are very different in terms of their findings regarding the effects of CBT interventions compared to other interventions (ACRA, CBOP (+ACC), DHPE, FFT, IT, MDFT, and PET ) on young people’s drug use. Therefore, the overall conclusion...
Vannoy, Steven D.; Hoyt, William T.
An anger therapy intervention was developed for incarcerated adult males. The therapy was an extension of cognitive-behavioral approaches, incorporating principles and practices drawn from Buddhist psychology. Adult males from a Midwestern low-security prison were randomly assigned to either a treatment group (n= 16) or a waiting list control…
The study explores the experiences of volunteer community care workers working with HIV-affected families, participating in laughter therapy. Laughter therapy is being used as an intervention to positively influence individuals experiencing various forms of emotional distress. Community care workers play a vital role in the ...
Kaymen, Maria S.
This study is an examination of animal-assisted therapy in an attempt to explore the ways it may serve as reading intervention program for struggling readers. Due to the low rate of literacy in the U.S., children are often put into reading intervention programs where they are required to read to an adult; potentially creating anxiety that may act…
Narang, Puneet; Glowacki, Anna; Lippmann, Steven
Electroconvulsive therapy is an established means to improve function in a variety of psychiatric and neurologic conditions, particularly for patients who remain treatment-refractory. Parkinson's disease is a neurodegenerative disorder that sometimes does not respond well to conventional pharmacotherapies. Reports have indicated that electroconvulsive therapy may be an effective and safe treatment for those patients with Parkinson's disease who are not optimally responding to first-line treatments. Despite these reports, however, electroconvulsive therapy is not often used by clinicians in patients with treatment-resistant Parkinson's disease, perhaps due to stigma, lack of knowledge regarding its safety and efficacy, and/or inability to predict the duration of therapeutic benefit. Our objective was to determine if the available literature on ECT supports it as a safe and effective treatment option in patients with treatment-refractory Parkinson's disease. Motoric improvement induced by electroconvulsive therapy has been documented for decades in persons with Parkinson's disease. Efficacy and safety are reported following electroconvulsive therapy in people with Parkinson's disease who have sub-optimal response to medicines or experience the "on/off" phenomenon to L-dopa. Electroconvulsive therapy is an effective option for acute and maintenance treatment of Parkinson's disease in select patients. Inability to predict how long the beneficial effects of ECT therapy will last in patients with Parkinson's disease may be a reason why this treatment is underutilized by clinicians. More research is warranted to clarify parameters for application and duration of therapeutic benefit in individuals with difficult-to-treat Parkinson's disease.
Linardon, Jake; Hindle, Annemarie; Brennan, Leah
Cognitive-behavioral therapy (CBT) is efficacious for a range of eating disorder presentations, yet premature dropout is one factor that might limit CBTs effectiveness. Improved understanding of dropout from CBT for eating disorders is important. This meta-analysis aimed to study dropout from CBT for eating disorders in randomized controlled trials (RCTs), by (a) identifying the types of dropout definitions applied, (b) providing estimates of dropout, (c) comparing dropout rates from CBT to non-CBT interventions for eating disorders, and (d) testing moderators of dropout. RCTs of CBT for eating disorders that reported rates of dropout were searched. Ninety-nine RCTs (131 CBT conditions) were included. Dropout definitions varied widely across studies. The overall dropout estimate was 24% (95% CI = 22-27%). Diagnostic type, type of dropout definition, baseline symptom severity, study quality, and sample age did not moderate this estimate. Dropout was highest among studies that delivered internet-based CBT and was lowest in studies that delivered transdiagnostic enhanced CBT. There was some evidence that longer treatment protocols were associated with lower dropout. No significant differences in dropout rates were observed between CBT and non-CBT interventions for all eating disorder subtypes. Present study dropout estimates are hampered by the use of disparate dropout definitions applied. This meta-analysis highlights the urgency for RCTs to utilize a standardized dropout definition and to report as much information on patient dropout as possible, so that strategies designed to minimize dropout can be developed, and factors predictive of CBT dropout can be more easily identified. © 2018 Wiley Periodicals, Inc.
Maric, Marija; van Steensel, Francisca J A; Bögels, Susan M
The objective of this study was to examine the efficacy of child cognitive-behavioral therapy (CCBT) versus family CBT (FCBT) in anxiety-disordered youth with high and low comorbid ADHD symptoms. Youth with anxiety disorders ( n = 123, aged 8-18) were classified in four groups according to (a) the type of CBT received (child vs. family) and (b) their comorbid ADHD symptoms, measured with the Child Behavior Checklist (CBCL) Attention Problems syndrome scale level (normal vs. [sub]clinical). Severity of anxiety disorders was assessed with Anxiety Disorders Interview Schedule-Child and Parent (ADIS-C/P) version and anxiety symptoms via a 71-item anxiety symptom questionnaire, the Screen for Child Anxiety and Related Emotional Disorders (SCARED-71), before and after CBT, and at 3 months and 1-year follow-ups. Based on the severity of anxiety disorders, children with high ADHD symptoms profit more from FCBT than CCBT in the long term. For children low on ADHD symptoms, and for anxiety symptoms and attention problems, no differences between CCBT and FCBT occurred. Family involvement seems a valuable addition to CBT for children with comorbid anxiety and ADHD symptoms.
Misurell, Justin R.; Springer, Craig; Tryon, Warren W.
This preliminary investigation examined the efficacy of a game-based cognitive-behavioral therapy group program for elementary school-aged children who have experienced sexual abuse. Treatment aimed to improve: (a) internalizing symptoms, (b) externalizing behaviors, (c) sexually inappropriate behaviors, (d) social skills deficits, (e) self-esteem…
Springer, Craig; Misurell, Justin R.; Hiller, Atara
This study examined the efficacy of a game-based cognitive-behavioral group therapy program for addressing problems typically found among elementary school-aged victims of child sexual abuse immediately after treatment and at three months following treatment. It was hypothesized that positive gains would be observed among the following domains:…
van Bastelaar, K.M.P.; Pouwer, F.; Cuijpers, P.; Twisk, J.W.R.; Snoek, F.J.
Background: Depression is common among people with diabetes, negatively affecting quality of life, treatment adherence and diabetes outcomes. In routine clinical care, diabetes patients have limited access to mental health services and depression therefore often remains untreated. Web-based therapy
Shin, Juh Hyun
The use of dolls as a therapeutic intervention for nursing home residents with dementia is relatively new. The current article describes a research study implemented with nursing home residents in Korea to examine the effects of doll therapy on their mood, behavior, and social interactions. A one-group, pretest-posttest design was used to measure the impact of doll therapy on 51 residents with dementia. Linear regression demonstrated statistically significant differences in aggression, obsessive behaviors, wandering, negative verbalization, negative mood, and negative physical appearance after introduction of the doll therapy intervention. Interactions with other individuals also increased over time. Findings support the benefits of doll therapy for nursing home residents with dementia; however, further research is needed to provide more empirical evidence and explore ethical considerations in the use of doll therapy in this vulnerable population. Copyright 2015, SLACK Incorporated.
Beissner, Katherine; Henderson, Charles R; Papaleontiou, Maria; Olkhovskaya, Yelena; Wigglesworth, Janet; Reid, MC
Background: Increasing evidence supports the use of cognitive-behavioral therapy (CBT) for patients with chronic pain. Objective: This study determined whether physical therapists incorporate CBT techniques (eg, relaxation, activity pacing) when treating older patients with chronic pain, ascertained their interest in and barriers to using CBT, and identified participant-related factors associated with interest in CBT. Design: This cross-sectional study used a telephone survey. Methods: One hundred fifty-two members of the Geriatrics and Orthopaedics sections of the American Physical Therapy Association completed the survey. Associations between participant-related factors and interest in CBT were assessed in statistical general linear models. Results: Commonly used CBT interventions included activity pacing and pleasurable activity scheduling, frequently used by 81% and 30% of the respondents, respectively. Non-CBT treatments included exercises focusing on joint stability (94%) and mobility (94%), and strengthening and stretching programs (91%). Respondents’ overall interest in CBT techniques was 12.70 (SD=3.4, scale range=5–20). Barriers to use of CBT included lack of knowledge of and skill in the techniques, reimbursement concerns, and time constraints. Practice type and the interaction of percentage of patients with pain and educational degree of the physical therapist were independently associated with provider interest in CBT in a general linear model that also included 6 other variables specified a priori. Limitations: Data are based on self-report without regard to treatment emphasis. Conclusions: Although only a minority of physical therapists reported use of some CBT techniques when treating older patients with chronic pain, their interest in incorporating these techniques into practice is substantial. Concerns with their skill level using the techniques, time constraints, and reimbursement constitute barriers to use of the interventions. PMID:19270046
Miller, Tracy; Deary, Vincent; Patterson, Jo
The improving access to psychological therapies initiative has highlighted the importance of managing mental health problems effectively, and research has shown excellent outcomes from cognitive behavioural therapy (CBT) interventions. Patients presenting with functional dysphonia will often also describe psychological distress including anxiety, depression and reduced general well-being, and it is felt that effective voice therapy needs to include the management of psychological well-being. The evidence for the use of CBT enhanced voice therapy is limited to date. Recent research has only started to identify the benefits of this approach and questions regarding how to achieve and maintain competence are essential. Voice therapy outcomes are positive and patients receiving CBT with voice therapy have shown more improvement in their general well-being and distress. CBT is a very well evidenced therapy and recommended by The National Institute for Health and Care Excellence (NICE) as the treatment of choice for mental health difficulties and medically unexplained symptoms. Allied health professionals are increasingly being trained to use CBT skills in the management of a number of symptoms/illnesses, and this should be considered for the management of functional dysphonia. However, there is a need for more research and detailed consideration of how therapists should be trained and supervised and how cost-effective this approach may be.
Nowak, Izabela; Sabariego, Carla; ?witaj, Piotr; Anczewska, Marta
Background Schizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and ?third wave? cognitive ? behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO?s International Classification of F...
Lori E. Breeden
Photography can be an effective addition for education-based telehealth services delivered by an occupational therapist. In this study, photography was used as antecedent to telehealth sessions delivered by an occupational therapist focused on narrative learning about home safety. After taking photographs of past home safety challenges, six participants experienced three web-based occupational therapy sessions each. Sessions were recorded and transcribed. Data were examined using content ...
Kananian, Schahryar; Ayoughi, Sarah; Farugie, Arieja; Hinton, Devon; Stangier, Ulrich
Background : Approximately half of all asylum seekers suffer from trauma-related disorders requiring treatment, among them Posttraumatic Stress Disorder (PTSD), depression, anxiety, and somatic symptoms. There is a lack of easily accessible, low-threshold treatments taking the cultural background into account. Culturally Adapted CBT (CA CBT) is a well evaluated, transdiagnostic group intervention for refugees, using psychoeducation, meditation, and Yoga-like exercises. Objective: An uncontrolled pilot study with male Farsi-speaking refugees from Afghanistan and Iran was conducted to investigate feasibility with this ethnic group; a group for which no previous CBT trials have been reported. Method : The participants were nine Farsi-speaking, male refugees with M.I.N.I./DSM-IV diagnoses comprising PTSD, major depressive disorder, and anxiety disorders. Treatment components were adapted to the specific cultural framework of perception of symptoms, causes, ideas of healing, and local therapeutic processes. Before and after 12 weeks of treatment, the primary outcome was assessed using the General Health Questionnaire (GHQ-28). Secondary outcome measures were the Posttraumatic Checklist, Patient Health Questionnaire, Somatic Symptom Scale, World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Affective Style Questionnaire (ASQ), and Emotion Regulation Scale (ERS). Results : Seven participants completed treatment. In the completer analysis, improvements were found on almost all questionnaires. Large effect sizes were seen for the GHQ-28 ( d = 2.0), WHOQOL-BREF scales ( d = 1.0-2.3), ASQ tolerating subscale ( d = 2.2), and ERS ( d = 1.7). With respect to feasibility, cultural adaptation seemed to be a crucial means to promote effectiveness. Conclusion : CA CBT may reduce general psychopathological distress and improve quality of life. Improvement in emotion regulation strategies may mediate treatment effects. More support should be provided to
Williams, Christopher; McClay, Carrie-Anne; Martinez, Rebeca; Morrison, Jill; Haig, Caroline; Jones, Ray; Farrand, Paul
Low mood is a common mental health problem with significant health consequences. Studies have shown that cognitive behavioural therapy (CBT) is an effective treatment for low mood and anxiety when delivered one-to-one by an expert practitioner. However, access to this talking therapy is often limited and waiting lists can be long, although a range of low-intensity interventions that can increase access to services are available. These include guided self-help materials delivered via books, classes and online packages. This project aims to pilot a randomized controlled trial of an online CBT-based life skills course with community-based individuals experiencing low mood and anxiety. Individuals with elevated symptoms of depression will be recruited directly from the community via online and newspaper advertisements. Participants will be remotely randomized to receive either immediate access or delayed access to the Living Life to the Full guided online CBT-based life skills package, with telephone or email support provided whilst they use the online intervention. The primary end point will be at 3 months post-randomization, at which point the delayed-access group will be offered the intervention. Levels of depression, anxiety, social functioning and satisfaction will be assessed. This pilot study will test the trial design, and ability to recruit and deliver the intervention. Drop-out rates will be assessed and the completion and acceptability of the package will be investigated. The study will also inform a sample size power calculation for a subsequent substantive randomized controlled trial. ISRCTN ISRCTN12890709.
McKee, Sherry A.; Carroll, Kathleen M.; Sinha, Rajita; Robinson, Jane E.; Nich, Charla; Cavallo, Dana; O’Malley, Stephanie
Background We investigated the impact of enhancing brief cognitive behavioral therapy with motivational interviewing techniques for cocaine abuse or dependence, using a focused intervention paradigm. Methods Participants (n=74) who met current criteria for cocaine abuse or dependence were randomized to 3-session cognitive behavioral therapy (CBT) or 3-session enhanced CBT (MET + CBT), which included an initial session of motivational enhancement therapy (MET). Outcome measures included treatment retention, process measures (e.g., commitment to abstinence, satisfaction with treatment), and cocaine use. Results Participants who received the MET+CBT intervention attended more drug treatment sessions following the study interventions, reported significantly greater desire for abstinence and expectation of success, and they expected greater difficulty in maintaining abstinence compared to the CBT condition. There were no differences across treatment conditions on cocaine use. Conclusions These findings offer mixed support for the addition of MET as an adjunctive approach to CBT for cocaine users. In addition, the study provides evidence for the feasibility of using short-term studies to test the effects of specific treatment components or refinements on measures of therapy process and outcome. PMID:17573205
Song Tian; Yin Shimeng; Sun Rongyue; Shen Lan; Qian Yu
Objective: To evaluate the efficacy of interventional therapy for advanced pancreatic carcinoma. Methods: 33 cases of advanced pancreatic carcinoma accepted interventional therapy from April 2005 were retrospectively analyzed. All patients were unoperable and accepted one or more times of celiac and superior mesenteric arterial chemotheraputics perfusion with dosage of 2:1. The embolization was further introduced with the addition of liver invasion. The repetition interval was kept at 6 weeks with no severe complications. Results: The one with follow-up CT imagings showed obvious decrease of the lesion size, together with release or disappearance of the sensation of abdominal pain and abdominal distention. The life span prolonged with average survival of 13 months, including the longest of 22 months and the life quality improved. Conclusions: The interventional therapy could be the first method of choice in the management of advanced pancreatic carcinoma. (authors)
Qin Zenhui; Huang Sui; Liu Fan; Yang Jinyuan
Objective: To investigate the interventional therapy in children's congenital urinary obstruction and its efficacy. Methods: Thirty-three children with congenital obstruction of ureteropelvic junction were treated through percutaneous dilation and/or stent placement, and 42 cases with posterior urethral valves were treated through trans-urethra dilation. Results: Thirty-three cases with upper urinary obstruction were improved with symptoms disappeared and stable efficacy on long-term follow-up of 1-7 years. Another 2 cases with the upper urethral obstruction had not been relieved of symptoms and resorted to surgical operation. For patients with posterior urethral valves, the lower urethral obstruction was totally got rid of after interventional therapy with stable efficacy on long-term follow-up of 1-10 years. Conclusions: Interventional therapy is safe , micro-invasive and efficient in treating congenital urinary obstruction with stable efficacy on long-term follow-up. (authors)
Alavi, Nazanin; Hirji, Alyssa; Sutton, Chloe; Naeem, Farooq
The goal of this study was to evaluate the efficacy of weekly email in delivering online cognitive behavioral therapy (CBT) to treat mild to moderately depressed individuals. The effectiveness of the online CBT was measured following treatment and then again at a 6-month follow-up and was compared with outcomes in a waitlist control group. Participants were recruited through announcements on psychology Web sites, Iranian organization Web sites, and weblogs and flyers. Ninety-three individuals who met inclusion criteria, including a score >18 on the Beck Depression Inventory (BDI), participated in the study, with 47 randomly assigned to the CBT group and 46 to the control group. The CBT group received 10 to 12 sessions of online CBT conducted by a psychiatrist and a psychiatry resident. Following completion of the CBT, a second BDI was sent to participants. Another BDI was then sent to participants 6 months after the completion of treatment. Email-based CBT significantly reduced BDI scores compared with results in a waitlist control group following 10 to 12 weeks of treatment and at 6-month follow-up. Email is a viable method for delivering CBT to individuals when face-to-face interaction is not possible. Limitations and future directions are discussed.
Gustavo Artur Monzeli
Full Text Available Introduction: Parkinson disease-PD has affected an increasing number of individuals, compromising their functional skills progressively and irreversibly, requiring preventive and rehabilitative actions. Objective: To present and discuss the effect of occupational therapy intervention with a 70-year old patient diagnosed with PD. Method: This is an experience report with a single subject. An intervention plan including an exercise program for extra-care activities and home visits for observation of possible difficulties and risk of falls in the environment has been prepared. The measurement of independence was performed using the Functional Independence Measure-FIM. The intervention occurred during six months. Results: It was identified improvement in eating and writing activities. There was one score of improvement documented in FIM. Conclusion: The importance of the intervention of occupational therapy is enforced, which in this context improved the occupational performance of this subject in the daily life activities, contributing for maintaining functional performance.
Struffert, T.; Engelhorn, T.; Doelken, M.; Doerfler, A.; Holbach, L.
Carotid cavernous fistulas are pathologic connections between the internal and/or external carotid artery and the cavernous sinus. According to Barrow one can distinguish between direct (high flow) and indirect (low flow) fistulas, whereby direct fistulas are often traumatic while indirect fistulas more frequently occur spontaneously in postmenopausal women. Diagnosis can easily be established using MRI and angiography, which allow exact visualization of the anatomy of fistulas to plan the interventional neurological therapy that in recent years has replaced surgical therapy. This article provides an overview on imaging findings, diagnosis using MRI and angiography as well as interventional treatment strategies. (orig.) [de
Cornelius, Jack R; Douaihy, Antoine B; Kirisci, Levent; Daley, Dennis C
Cognitive Behavioral Therapy (CBT) is a commonly used therapy among persons with major depressive disorder (MDD) and also among those with alcohol use disorders (AUD). However, less is known regarding the efficacy of CBT for treating persons with co-occurring disorders involving both MDD and an AUD. Studies assessing the efficacy of CBT in adolescent populations with co-occurring disorders are particularly sparse, especially studies designed to assess the potential longer-term efficacy of an acute phase trial of CBT therapy in that youthful comorbid population. We recently conducted a first acute phase treatment study involving comorbid AUD/MDD adolescents, which involved the medication fluoxetine as well as manualized CBT therapy. The results of that acute phase study suggested efficacy for CBT therapy but not for fluoxetine for treating the depressive symptoms and the excessive alcohol use of study subjects (Cornelius et al., 2009). The current chapter provides an assessment of the long-term efficacy of CBT for treating comorbid AUD/MDD adolescents, based on results from our own long-term (four-year) follow-up study, which was conducted following the completion of our recent acute phase treatment study. The results of the study suggest long-term efficacy for acute phase CBT/MET therapy for treating both the depressive symptoms and the excessive alcohol use of comorbid AUD/MDD adolescents, but demonstrate no evidence of long-term efficacy for fluoxetine for treating either the depressive symptoms or the excessive alcohol use of that population.
The theory of rational-emotive therapy (RET) and of cognitive-behavioral therapy (CBT) is briefly explained and is applied to group therapy. It is shown how RET and CBT therapy groups deal with transference, countertransference, levels of group intervention, process versus content orientation, identifying underlying group process themes, here-and-now activation, working with difficult group members, activity levels of therapist and group members, and other group problems. Although they particularly concentrate on people's tendencies to construct and create their own "emotional" difficulties, RET and CBT group procedures fully acknowledge the interactions of human thoughts, feelings, and actions and active-directively employ a variety of cognitive, emotive, and behavioral group therapy techniques.
Heapy, Alicia A; Wandner, Laura; Driscoll, Mary A; LaChappelle, Kathryn; Czlapinski, Rebecca; Fenton, Brenda T; Piette, John D; Aikens, James E; Janevic, Mary R; Kerns, Robert D
Patient-generated treatment goals describe what patients value, yet the content of these goals, and the relationship among goal types, goal accomplishment, and treatment outcomes has received little examination. We used inductive sorting to categorize patient-generated goals made by 147 adults receiving cognitive-behavioral therapy for chronic pain. The resulting goal categories were: Physical Activity (29.0%), Functional Status (24.6%), Wellness (16.3%), Recreational Activities (11.3%), House/Yard Work (9.7%), Socializing (7.1%), and Work/School (2.0%). Next, we examined associations between number of goals by category, goal accomplishment, and clinically meaningful improvements in pain-related interference, pain intensity and depressive symptoms. Improvement in all outcome domains was related to goal accomplishment. Additionally, depressive symptoms were related to number of Physical Activity, House/Yard Work, Recreational Activities, and Wellness goals, whereas improved pain-intensity was significantly related to House/Yard Work. Classifying patient-generated goals facilitates investigation of the relationships among goal type, goal accomplishment and treatment outcomes.
Dai Dingke; Zhai Renyou; Yu Ping; You Kaitao; Ma Fengzao
Purpose: To evaluate the intra-arterial infusion of pancreatic enzyme inhibitor and antibiotics in the treatment of acute necrotizing pancreatitis (ANP). Method: 23 patients with ANP were treated by arterial infusion, by placing a catheter in the celiac artery, spleen artery or gastroduodenal artery. 5-Fu and antibiotics was used continuously for 6 to 20 days. According to the site of the inflammation on the CT scan, the top of the catheter was positioned in the celiac artery in 21 cases, splenic artery in one, and gastroduodenal artery in one. Results: The mortality rate in this study was 0% and no procedure related complication was observed. 20 of 23 patients had good effect without severe complications. In 2 cases, drainage of parapancreatic abscess was performed after improvement of the acute inflammation with the arterial infusion antibiotics, one patient died of multi-organ failure before arterial infusion was started. Conclusion: Arterial infusion therapy of 5-Fu and antibiotics for ANP offers good therapeutic effect and creates the possibility for subsequent operation on abscess
Piersol, Catherine Verrier; Jensen, Lou; Lieberman, Deborah; Arbesman, Marian
Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person with Alzheimer's disease. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic reviews on this topic were published in the November/December 2017 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning. Copyright © 2018 by the American Occupational Therapy Association, Inc.
Hall-Craggs, M.A. [MR Unit, Middlesex Hospital, London (United Kingdom)
In recent years a variety of minimally invasive therapies have been applied to the treatment of breast lesions. These therapies include thermal treatments (interstitial laser coagulation, focused ultrasound, radiofrequency and cryotherapy), percutaneous excision, and interstitial radiotherapy. Magnetic resonance has been used in these treatments to visualize lesions before, during and after therapy and to guide interventions. ''Temperature-sensitive'' sequences have shown changes with thermal ablation which broadly correlate with areas of tumour necrosis. Consequently, MR has the potential to monitor treatment at the time of therapy. To date, experience in the treatment of breast cancer has been restricted to small studies. Large controlled studies are required to validate the efficacy and safety of these therapies in malignant disease. (orig.)
In recent years a variety of minimally invasive therapies have been applied to the treatment of breast lesions. These therapies include thermal treatments (interstitial laser coagulation, focused ultrasound, radiofrequency and cryotherapy), percutaneous excision, and interstitial radiotherapy. Magnetic resonance has been used in these treatments to visualize lesions before, during and after therapy and to guide interventions. ''Temperature-sensitive'' sequences have shown changes with thermal ablation which broadly correlate with areas of tumour necrosis. Consequently, MR has the potential to monitor treatment at the time of therapy. To date, experience in the treatment of breast cancer has been restricted to small studies. Large controlled studies are required to validate the efficacy and safety of these therapies in malignant disease. (orig.)
Dong, Lu; Zhao, Xin; Ong, Stacie L; Harvey, Allison G
The current study examined whether and which specific contents of patients' memory for cognitive therapy (CT) were associated with treatment adherence and outcome. Data were drawn from a pilot RCT of forty-eight depressed adults, who received either CT plus Memory Support Intervention (CT + Memory Support) or CT-as-usual. Patients' memory for treatment was measured using the Patient Recall Task and responses were coded into cognitive behavioral therapy (CBT) codes, such as CBT Model and Cognitive Restructuring, and non-CBT codes, such as individual coping strategies and no code. Treatment adherence was measured using therapist and patient ratings during treatment. Depression outcomes included treatment response, remission, and recurrence. Total number of CBT codes recalled was not significantly different comparing CT + Memory Support to CT-as-usual. Total CBT codes recalled were positively associated with adherence, while non-CBT codes recalled were negatively associated with adherence. Treatment responders (vs. non-responders) exhibited a significant increase in their recall of Cognitive Restructuring from session 7 to posttreatment. Greater recall of Cognitive Restructuring was marginally significantly associated with remission. Greater total number of CBT codes recalled (particularly CBT Model) was associated with non-recurrence of depression. Results highlight the important relationships between patients' memory for treatment and treatment adherence and outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.
Discusses structure, credibility, and use of the Computer Based Training (CBT) Advisor, an expert system designed to help managers make judgements about course selection, system selection, cost/benefits, development effort, and probable success of CBT projects. (MBR)
The three papers in the thesis were based on two randomised controlled trials (RCTs) on in-hospital clinical pharmacist interventions for improvement of adherence to thrombopreventive therapy in two different populations: outpatients with hypertension and patients with acute stroke/transient isch......The three papers in the thesis were based on two randomised controlled trials (RCTs) on in-hospital clinical pharmacist interventions for improvement of adherence to thrombopreventive therapy in two different populations: outpatients with hypertension and patients with acute stroke...... individualised interventions and team-based care, e.g. integrating a clinical pharmacist with particular focus on patients’ drug-related problems. One approach with growing evidence of improving medication adherence is motivational interviewing (MI). So far, no clinical pharmacist intervention using MI has...... targeted patients with hypertension or stroke in a hospital care setting. Thus, the aim of this thesis was to develop and evaluate in-hospital pharmacist interventions including MI to improve adherence to primary and secondary thrombopreventive therapy. The first study was a RCT, which investigated...
Xiang Guangze; Xiao Yiming; Wen Zhilin
Objective: To evaluate the clinical efficacy and safety of interventional therapy for acute cerebral infarction. Method: Using urokinase, 35 patients with acute cerebral infarction within 24 hours were treated by intra-artery thrombolytic therapy. Europe stroke scale (ESS), Barthel index (BI) were used to evaluate the recovery of neurological functions. Result: ESS score increase rapidly after thrombolytisis, and there were significant difference between the two teams. Thirteen of 13 cases treated within 6 hours from onset showed complete/partial recanalization in cerebral angiography and intraparenchymal hemorrhagic rate were 0%, twenty-six of 35 cases treated within 24 hours showed complete/partial recanalization and intraparenchymal hemorrhagic rate were 5.71%. Conclusion: Interventional therapy for acute cerebral infarction within 6h were safe and effective. (authors)
Carroll, Kathleen M; Kiluk, Brian D
Cognitive-behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As Psychology of Addictive Behaviors marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. Technology may provide a means for CBT interventions to circumvent the "implementation cliff" in Stages III-V by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage I to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather 1 that constantly evolves and is refined through the stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Alhassan, Munkaila; Habib, Abdallah Mohammed
Polytechnics in Ghana view Competency Based Training (CBT) as a major intervention to the perennial constraints confronting its education and training. On the basis of this, and by government policy, a pilot programme of CBT was instituted in all the 10 polytechnics of Ghana, and was pilot tested in, at least, one department. Agricultural…
clinician applicants occurred. b. SP baseline interviews with eligible clinicians occurred. c. Automated random assignment of participants with Completed SP...intervention without web-centered supervision and a wait-list control with regard to improvements in two CBT-based skill areas (behavioral task...Secondary Aim #1: To compare improvements in knowledge and attitudes following internet- based training with or without web-centered supervision and
Full Text Available To determine and compare costs of a nurse-administered behavioral intervention for pregnant substance users that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT to brief advice (BA administered by an obstetrical provider. Both interventions were provided concurrent with prenatal care.We conducted a micro-costing study that prospectively collected detailed resource utilization and unit cost data for each of the two intervention arms (MET-CBT and BA within the context of a randomized controlled trial. A three-step approach for identifying, measuring and valuing resource utilization was used. All cost estimates were inflation adjusted to 2011 U.S. dollars.A total of 82 participants received the MET-CBT intervention and 86 participants received BA. From the societal perspective, the total cost (including participants' time cost of the MET-CBT intervention was $120,483 or $1,469 per participant. In contrast, the total cost of the BA intervention was $27,199 or $316 per participant. Personnel costs (nurse therapists and obstetric providers for delivering the intervention sessions and supervising the program composed the largest share of the MET-CBT intervention costs. Program set up costs, especially intervention material design and training costs, also contributed substantially to the overall cost.Implementation of an MET-CBT program to promote drug abstinence in pregnant women is associated with modest costs. Future cost effectiveness and cost benefit analyses integrating costs with outcomes and benefits data will enable a more comprehensive understanding of the intervention in improving the care of substance abusing pregnant women.
Beresford, Bryony; Clarke, Susan; Maddison, Jane
Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015; 5 :e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this. The objectives were to (1) describe the current practice, approaches and schools of thought in relation to physiotherapy, occupational therapy and speech and language therapy for children with neurodisability; (2) explore clinical decision-making; (3) investigate views on outcomes and their measurement, particularly participation as an outcome, that is, the child's ability to have the opportunity to be involved in life situations and activities (e.g. communication, mobility, interpersonal interactions, self-care, learning and applying knowledge); (4) seek views on the aspects of therapy interventions that have an impact on outcomes; and (5) elicit stakeholder views on research needs and priorities. More than 70 professionals (therapists, service leads, paediatricians and education staff) and 25 parents participated in a qualitative interview (either individually or as part of a focus group). Professional thinking and models of service delivery are in a state of flux and development. There is a move towards goals-focused, family-centred approaches. Work tends to be highly individualised, with few protocols. Parents are certain of the value of therapies, although they may experience difficulties with provision and may seek (additional) private provision. Therapy interventions are conceived as three components: the therapist, the procedures/equipment, etc., and the wider
Roscoe, Joseph A; Garland, Sheila N; Heckler, Charles E; Perlis, Michael L; Peoples, Anita R; Shayne, Michelle; Savard, Josée; Daniels, Nina P; Morrow, Gary R
Insomnia is a distressing and often persisting consequence of cancer. Although cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice in the general population, the use of CBT-I in patients with cancer is complicated, because it can result in transient but substantial increases in daytime sleepiness. In this study, we evaluated whether CBT-I, in combination with the wakefulness-promoting agent armodafinil (A), results in better insomnia treatment outcomes in cancer survivors than CBT-I alone. We report on a randomized trial of 96 cancer survivors (mean age, 56 years; female, 87.5%; breast cancer, 68%). The primary analyses examined whether ≥ one of the 7-week intervention conditions (ie, CBT-I, A, or both), when compared with a placebo capsule (P) group, produced significantly greater clinical gains. Insomnia was assessed by the Insomnia Severity Index and sleep quality by the Pittsburgh Sleep Quality Inventory. All patients received sleep hygiene instructions. Analyses controlling for baseline differences showed that both the CBT-I plus A (P = .001) and CBT-I plus P (P = .010) groups had significantly greater reductions in insomnia severity postintervention than the P group, with effect sizes of 1.31 and 1.02, respectively. Similar improvements were seen for sleep quality. Gains on both measures persisted 3 months later. CBT-I plus A was not significantly different from CBT-I plus P (P = .421), and A alone was not significantly different from P alone (P = .584). CBT-I results in significant and durable improvements in insomnia and sleep quality. A did not significantly improve the efficacy of CBT-I or independently affect insomnia or sleep quality. © 2014 by American Society of Clinical Oncology.
McGuinty, Everett; Armstrong, David; Carrière, Anne-Marie
The purpose of this article is to explore a novel, short-term treatment intervention for internalizing behaviours. This intervention is primarily based upon an externalizing process, transforming of metaphoric imagery, and shifting of underlying maladaptive emotional schemas. This article addresses the clinical population of children and youth, specifically through outlining the protocol, externalizing metaphors therapy. A selective review of significant works regarding the efficacy of short-term therapy was conducted, including the process of change within narrative therapy. It is proposed that two specific processes account for the mental health change experienced by clients who receive this new treatment intervention: (1) externalization of problems and (2) purposeful client-generated metaphor manipulation, impacting upon underlying schemas. From these theoretical constructs, the present article outlines a three-session treatment protocol that manualizes these key clinical processes. A case study is presented to illustrate this intervention for anxiety and depression. Further clinical research is underway to address the testable hypotheses resulting from the current theoretical model. Clinical trials in brief psychotherapy are suggested to empirically evaluate the efficacy of this new treatment intervention for dysphoria. This article outlines a short-term treatment intervention for anxiety and depression (dysphoira) through a novel 3-session model, where the clinician-practitioner can obtain competency through a one-day workshop.Its relevance for the clinical researcher and the mental health community is in its versatility in addressing internalizing behavior for four clinical populations: (1) children and adolescents; (2) children and adolescents on the autism spectrum; (3) adults in general; and, (4) adults with a dual-diagnosis. The treatment protocol described within is based upon the externalizing and deconstructive properties of Narrative Therapy, and the
Complementary and alternative medicine (CAM) is not generally associated with the complexity and intensity of critical care. Most CAM therapies involve slow, calming techniques that seem to be in direct contrast with the fast-paced, highly technical nature of critical care. However, patients in critical care often find themselves coping with the pain and stress of their illness exacerbated by the stress of the critical care environment. Complementary and alternative medicine-related research reveals that complementary therapies, such as Reiki, relieve pain and anxiety and reduce symptoms of stress such as elevated blood pressure and pulse rates. Patients and health care professionals alike have become increasingly interested in complementary and alternative therapies that do not rely on expensive, invasive technology, and are holistic in focus. Reiki is cost-effective, noninvasive, and can easily be incorporated into patient care. The purpose of this article is to examine the science of Reiki therapy and to explore Reiki as a valuable nursing intervention.
Full Text Available The article briefly reviews the changes that occurred in the field of grief and bereavement, viewing it as a process of searching for a "rational" meaning to life without the deceased in line with the concept of continuing bonds and thus replacing that of Fred’s concept of decathexis. Cognitive-behavioral therapy (CBT evidenced-based studies for PTSD and complicated grief and the Cognitive-behavioral therapy − Rational-emotion behavior therapy (CBT-REBT model for grief are reviewed. The focus of intervention based on CBT-REBT is to facilitate a healthy adaptation to loss following death. A distinction is made between rational (adaptive and irrational (maladaptive grief processes. Case example illustrating the application of the model specifically a dialogue with repetitive thoughts, are presented.
Acute abdomen means a set of clinical emergency with acute abdominalgia as the primary characteristic symptom of onset, including others as the acute onset, quick symptom changes, severe illness, and oftenly need surgical treatment; therefore, acute abdomen ought to be designated within surgery domain. As interventional therapy is extensively applied in clinical medicine, now a days many victims of acute abdomen, especially those with ambiguous clinical diagnosis requiring an initial invasive examination (angiography, PTC, etc), should be referred to interventional therapy before taking an item of invasive measures. This new concept management has achieved good clinical curative effect and become one of the remarkable achievements in acute abdomen therapeutics. Such predominance finds proper expression in the following two aspects: (1) The evolution of contemporary medical iconography has made it possible to duly and accurately diagnose acute abdomen, and thus created a diagnostic predominance for us-interventionalists; (2) Intervention therapy is featured with its unique minimal invasion and massive effectiveness, and thus provides high leading edge than conventional surgical operation. The authors believe that intervention management ought to become the first-choice for treating the above mentioned acute abdomen. (authors)
Fan Weijun; Wu Peihong; Zhang Liang; Huang Jinhua; Zhang Fujun; Gu Yangkui; Zhao Ming; Huang Xianglong; Guo Changyu
Objective: To explore the role of synthetic interventional therapy for hilar cholangiocarcinoma in type III and IV. Methods: Twenty-one patients with obstructive cholestasis were pathological confirmed as cholangioadenocarcinoma, and they were classified as type III and IV cholangioadenocarcinoma by CT, MRCP, and percutaneous transhepatic cholangiography. Percutaneous transhepatic cholangiography with internal and external drainage (PTCD), multipolar radiofrequency (RF) ablation, biliary stent endoprosthesis, and interventional adjuvant chemotherapy were applied sequentially. Results: All masses presented with density diminution in CT one month after RF ablation, in which 13 masses had about 30% reduction in size, 4 masses had about 20% reduction in size, and 4 masses remained unchanged. All the masses presented with size reduction with an average of 37% in follow-up CT after 6 months, and the most remarkable size reduction was 60%. The direct and indirect bilirubin levels prompt returned to normal range in 17 cases one month after synthetic interventional therapy and returned to normal range in all cases 6 months later. All patients survived with the follow-up period ranging from 9 to 24 months, with the mean survival time of 14 months. Conclusion: Synthetic interventional therapy is a micro-invasive and effective treatment for type III and IV cholangiocarcinoma. (authors)
Bucci, Sandra; Barrowclough, Christine; Ainsworth, John; Morris, Rohan; Berry, Katherine; Machin, Matthew; Emsley, Richard; Lewis, Shon; Edge, Dawn; Buchan, Iain; Haddock, Gillian
Cognitive behaviour therapy (CBT) is recommended for the treatment of psychosis; however, only a small proportion of service users have access to this intervention. Smartphone technology using software applications (apps) could increase access to psychological approaches for psychosis. This paper reports the protocol development for a clinical trial of smartphone-based CBT. We present a study protocol that describes a single-blind randomised controlled trial comparing a cognitive behaviour therapy-informed software application (Actissist) plus Treatment As Usual (TAU) with a symptom monitoring software application (ClinTouch) plus TAU in early psychosis. The study consists of a 12-week intervention period. We aim to recruit and randomly assign 36 participants registered with early intervention services (EIS) across the North West of England, UK in a 2:1 ratio to each arm of the trial. Our primary objective is to determine whether in people with early psychosis the Actissist app is feasible to deliver and acceptable to use. Secondary aims are to determine whether Actissist impacts on predictors of first episode psychosis (FEP) relapse and enhances user empowerment, functioning and quality of life. Assessments will take place at baseline, 12 weeks (post-treatment) and 22-weeks (10 weeks post-treatment) by assessors blind to treatment condition. The trial will report on the feasibility and acceptability of Actissist and compare outcomes between the randomised arms. The study also incorporates semi-structured interviews about the experience of participating in the Actissist trial that will be qualitatively analysed to inform future developments of the Actissist protocol and app. To our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake, attrition and potential efficacy of a CBT-informed smartphone app for early psychosis. Mobile applications designed to deliver a psychologically-informed intervention offer new possibilities to
Kim, Seog Ju; Lee, Yu Jin; Kim, Nambeom; Kim, Soohyun; Choi, Jae-Won; Park, Juhyun; Gwak, Ah Reum; Kang, Chang-Ki; Kang, Seung-Gul; Jeong, Do-Un
Psychophysiological insomnia (PI) includes arousal to sleep-related stimuli (SS), which can be treated by cognitive behavioral therapy for insomnia (CBT-I). The present study was an exploratory, prospective intervention study that aimed to explore brain response to visual SS in PI before and after CBT-I. Blood oxygen level dependent (BOLD) signal differences in response to SS and neutral stimuli (NS) were compared between 14 drug-free PI patients and 18 good sleepers (GS) using functional mag...
Bryant, Richard A.; Moulds, Michelle L.; Guthrie, Rachel M.; Nixon, Reginald D. V.
This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N = 87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure,…
Full Text Available Louise Mewton,1 Gavin Andrews2 1National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 2Clinical Research Unit for Anxiety and Depression (CRUfAD, St Vincent's Hospital, Sydney, NSW, Australia Abstract: This systematic review provides an overview of the effectiveness of cognitive behavioral therapy (CBT in reducing suicidal cognitions and behavior in the adult population. We identified 15 randomized controlled trials of CBT for adults (aged 18 years and older that included suicide-related cognitions or behaviors as an outcome measure. The studies were identified from PsycINFO searches, reference lists, and a publicly available database of psychosocial interventions for suicidal behaviors. This review identified some evidence of the use of CBT in the reduction of both suicidal cognitions and behaviors. There was not enough evidence from clinical trials to suggest that CBT focusing on mental illness reduces suicidal cognitions and behaviors. On the other hand, CBT focusing on suicidal cognitions and behaviors was found to be effective. Given the current evidence, clinicians should be trained in CBT techniques focusing on suicidal cognitions and behaviors that are independent of the treatment of mental illness. Keywords: suicidal behaviors, suicidal cognitions, CBT
Bennett-Levy, James; McManus, Freda; Westling, Bengt E; Fennell, Melanie
A theoretical and empirical base for CBT training and supervision has started to emerge. Increasingly sophisticated maps of CBT therapist competencies have recently been developed, and there is evidence that CBT training and supervision can produce enhancement of CBT skills. However, the evidence base suggesting which specific training techniques are most effective for the development of CBT competencies is lacking. This paper addresses the question: What training or supervision methods are perceived by experienced therapists to be most effective for training CBT competencies? 120 experienced CBT therapists rated which training or supervision methods in their experience had been most effective in enhancing different types of therapy-relevant knowledge or skills. In line with the main prediction, it was found that different training methods were perceived to be differentially effective. For instance, reading, lectures/talks and modelling were perceived to be most useful for the acquisition of declarative knowledge, while enactive learning strategies (role-play, self-experiential work), together with modelling and reflective practice, were perceived to be most effective in enhancing procedural skills. Self-experiential work and reflective practice were seen as particularly helpful in improving reflective capability and interpersonal skills. The study provides a framework for thinking about the acquisition and refinement of therapist skills that may help trainers, supervisors and clinicians target their learning objectives with the most effective training strategies.
Sadler, Paul; McLaren, Suzanne; Klein, Britt; Jenkins, Megan; Harvey, Jack
Cognitive behaviour therapy for insomnia (CBT-I) is a well-established treatment; however, the evidence is largely limited to homogenous samples. Although emerging research has indicated that CBT-I is also effective for comorbid insomnia, CBT-I has not been tested among a complex sample of older adults with comorbid insomnia and depression. Furthermore, no study has explored whether modifying CBT-I to target associated depressive symptoms could potentially enhance sleep and mood outcomes. Therefore, this study aims to report a protocol designed to test whether an advanced form of CBT for insomnia and depression (CBT-I-D) is more effective at reducing insomnia and depressive symptoms compared to a standard CBT-I and psychoeducation control group (PCG) for older adults in a community mental health setting. We aim to recruit 150 older adults with comorbid insomnia who have presented to community mental health services for depression. Eligible participants will be randomly allocated via block/cluster randomisation to one of three group therapy conditions: CBT-I, CBT-I-D, or PCG. Participants who receive CBT-I will only practice strategies designed to improve their sleep, whereas participants who receive CBT-I-D will practice additional strategies designed to also improve their mood. This trial will implement a mixed-methods design involving quantitative outcome measures and qualitative focus groups. The primary outcome measures are insomnia and depression severity, and secondary outcomes are anxiety, hopelessness, beliefs about sleep, comorbid sleep conditions, and health. Outcomes will be assessed at pre-intervention (week 0), post-intervention (week 8), and 3-month follow-up (week 20). This CBT study protocol has been designed to address comorbid insomnia and depression for older adults receiving community mental health services. The proposed trial will determine whether CBT-I is more effective for older adults with comorbid insomnia and depression compared to a PCG
An investigator-blinded, randomized study to compare the efficacy of combined CBT for alcohol use disorders and social anxiety disorder versus CBT focused on alcohol alone in adults with comorbid disorders: the Combined Alcohol Social Phobia (CASP) trial protocol.
Baillie, Andrew J; Sannibale, Claudia; Stapinski, Lexine A; Teesson, Maree; Rapee, Ronald M; Haber, Paul S
Alcohol use disorders and social anxiety disorder are common and disabling conditions that frequently co-exist. Although there are efficacious treatments for each disorder, only two randomized controlled trials of interventions for these combined problems have been published. We developed a new integrated treatment for comorbid Social Anxiety Disorder and Alcohol Use Disorder based on established Motivational Interviewing (MI) and Cognitive Behaviour Therapy (CBT) interventions for the separate disorders. Compared to established MI/CBT for alcohol use disorders this new intervention is hypothesised to lead to greater reductions in symptoms of social anxiety and alcohol use disorder and to produce greater improvements in quality of life. Higher levels of alcohol dependence will result in relatively poorer outcomes for the new integrated treatment. A randomised controlled trial comparing 9 sessions of individual integrated treatment for alcohol and social phobia with 9 sessions of treatment for alcohol use problems alone is proposed. Randomisation will be stratified for stable antidepressant use. Post treatment clinical assessments of alcohol consumption and diagnostic status at 3 and 6 month follow-up will be blind to allocation. The proposed trial addresses a serious gap in treatment evidence and could potentially define the appropriate treatment for a large proportion of adults affected by these problems. Australian New Zealand Clinical Trials Registry: ACTRN12608000228381.
Young, Kimberly S
Internet Gaming Disorder, a subtype of Internet Addiction, is now classified in Section 3 of the DSM-5. Cognitive behavioral therapy (CBT) has been suggested in treating Internet addiction as this modality has been shown to be an effective treatment for similar impulse control disorders. Given the daily and necessary use of the Internet and technology in general compared to other compulsive syndromes, a specialized form of CBT has been developed called Cognitive-Behavioral Therapy for Internet Addiction (CBT-IA). CBT-IA is a comprehensive three phase approach that includes behavior modification to control compulsive Internet use, cognitive restructuring to identify, challenge, and modify cognitive distortions that lead to addictive use, and harm reduction techniques to address and treat co-morbid issues associated with the disorder. As the first model of its kind, this study examines 128 clients to measure treatment outcomes using CBT-IA. Clients were evaluated using the Internet Addiction Test (IAT) to classify subjects and were administered twelve weekly sessions of CBT-IA. Treatment outcomes were measured at the end of the twelve weeks, one-month, three months and at six month post-treatment. RESULTS showed that over 95% of clients were able to manage symptoms at the end of the twelve weeks and 78% sustained recovery six months following treatment. RESULTS found that CBT-IA was effective at ameliorating symptoms associated with Internet addiction after twelve weekly sessions and consistently over one-month, three months, and six months after therapy. Further research implications such as investigating long-term outcome effects of the model with larger client populations and treatment differences among the subtypes of Internet addiction or with other cultural populations using CBT-IA are discussed.
Ren Weixin; Xiao Xiangsheng; Chen Peng; Ma Jun
Objective: To analyse the DSA findings of hepatic alveolar echinococcus (HAE) and evaluate the feasibility of the interventional therapy. Methods: Eight patients with HAE were all examined by DSA, CT and lab test. Three of them were performed the transcatheter arterial embolization by iodized oil. All of them were confirmed by surgical operation and followed-up for three months. Results: The DSA findings of HAE included hepatic arterial curling and enlargement with hypertrophied circled encircling as typical 'handed ball'. Eight cases presented the ring stain during the capillary stage. After embolization, the retention of iodized oil was revealed by DSA in 3 cases. CT three months later showed fine iodized oil retention and the enlarged necrosis. Ischemic necrosis around the lesion and the cut margins were clearly seen in operation biopsy. Conclusions: HAE possesses special DSA findings and interventional therapy is a new therapeutic method of choice. (authors)
The aim of this thesis is to approach the issue of cancer patients and to present occupational therapy intervention in oncology. The theoretical part of the thesis is an overview of the most important concepts from the field of oncology. It outlines different types of treatments in oncology, including their side effects. There are also the most frequent cancer diagnoses in the Czech Republic and abroad. Furthermore, the work describes the general possibilities of rehabilitation for people wit...
Xia Xiangwen; Liang Huimin; Fang Gansheng; Zhao Long; Huang Rui
Objective: To study the imaging features of nutcracker syndrome (compression of left renal vein), and to assess the value of the interventional therapy for this disease. Methods: The clinical data of 6 cases of nutcracker syndrome undertaken interventional therapy were collected to analyze the clinical features, imaging characteristics and interventional therapeutic value together with comprehensive literatures. Results: The imaging appearance of the 6 cases showed typical left renal vein compression. The average in between angle of superior mesenteric artery(SMA)and abdominal aorta(At)was 20.6 degree ± 4.04 degree in MPR reconstructed imaging of CTA. The blood pressure gradient between proximal and distal compression sites was(6.4 ± 0.36) cmH 2 O. No complications of displacement and defluxion and restenosis occurred after stenting for a year. The subjective symptoms of the 6 patients improved significantly. Conclusion: Endovascular stenting is a safe, mini-traumatic and effective therapy for nutcracker syndrome. (authors)
Forand, Nicholas R; Barnett, Jeffrey G; Strunk, Daniel R; Hindiyeh, Mohammed U; Feinberg, Jason E; Keefe, John R
Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale-Self Report and the Behavioral Activation Scale for Depression-Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges' g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts. Copyright © 2017. Published by Elsevier Ltd.
Cooney, Patricia; Jackman, Catherine; Coyle, David; O'Reilly, Gary
Background Despite the evidence base for computer-assisted cognitive-behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability. Aims To evaluate the utility of a CBT computer game for adults who have an intellectual disability. Method A 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis. Results A significant group × time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU. Conclusions As the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population. © The Royal College of Psychiatrists 2017.
Michail, Maria; Birchwood, Max; Tait, Lynda
Social anxiety is highly prevalent among people with psychosis and linked with significant social disability and poorer prognosis. Although cognitive-behavioural therapy (CBT) has shown to be effective for the treatment of social anxiety in non-psychotic populations, there is a lack of evidence on the clinical effectiveness of CBT for the treatment of social anxiety when this is co-morbid in psychosis. A systematic review to summarise and critically appraise the literature on the effectiveness of CBT interventions for the treatment of social anxiety in psychosis. Two studies were included in the review assessing the effectiveness of group CBT for social anxiety in schizophrenia, both of poor methodological quality. Preliminary findings suggest that group-based CBT is effective in treating symptoms of social anxiety, depression and associated distress in people with schizophrenia. The evidence-base is not robust enough to provide clear implications for practice about the effectiveness of CBT for the treatment of social anxiety in psychosis. Future research should focus on methodologically rigorous randomised controlled trials with embedded process evaluation to assess the effectiveness of CBT interventions in targeting symptoms of social anxiety in psychosis and identify mechanisms of change.
Natalie A. DiPietro
Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need. Type: Idea Paper
Su Xiuqin; Yu Shiping; Zhang Jin; Zhang Caizhen; Yuan Wei; Meng Xiangwen
Objective: To investigate and assess the efficiency and clinical value of interventional therapy for gastrointestinal hemorrhage induced by Dieulafoy disease. Methods: Ten patients definitely diagnosed with Dieulafoy disease suffering from massive acute gastrointestinal hemorrhage received celiac arterial and left gastric arterial angiography, outcoming with 8 positively and 2 negative cases. Among them, 6 were embolized with gelfoam particles and the other two with aneurismal dilatation received gelfoam particles and spring steel coils; and one of the negtive cases was given hypophysin and without intervention to the other. Results: Among the 8 intra-arterial embolized cases, only 1 case rebleeded on the third day after gelfoam embolization, and then treated by surgical operation, and the rest 7 showed no rebleeding. One case with hypophysin treatment rehabilitated after one week. Conclusions: Interventional therapeutics is a safe and effective emergency management for gastrointestinal hemorrhage induced by Dieulafoy disease. (authors)
Esbjørn, Barbara Hoff; Reinholdt-Dunne, Marie Louise; Nielsen, Sara K
Background: Little is known about the effect of case-formulation based cognitive behaviour therapy (CBT) for anxious children. Aim: The present study explores the feasibility of case-formulation driven CBT for anxious children. Parents were involved in treatment as either co-facilitators (involved...... CBT was established by comparing the completion rate and the percentage of children free of anxiety after treatment, with manualized treatments reported in existing meta-analyses. Children aged 7-12 years and their parents participated (n = 54). Families were assessed at pre- and posttreatment...... approach to CBT may be a feasible option when selecting treatment for anxious children; however, further studies must be conducted before firm conclusions can be drawn....
Full Text Available Foreign Language Anxiety (FLA can be a crippling condition for many students, preventing them from taking an active part in the classroom, and also retarding their L2 use in wider communicative situations. Providing learners with the tools to overcome anxiety on an individual basis is an area which needs further investigation. Cognitive Behaviour Therapy (CBT is a widespread counselling practice used to treat anxieties. It shares similarities with some techniques employed in Advising in Language Learning (ALL for helping students with language goals, and it is worthwhile investigating and raising awareness of how it can be used for FLA. The article describes major characteristics of FLA and also CBT, and then describes four functions which CBT and ALL share: goal-setting, guided discovery, Socratic questioning and use of reflection. Preliminary research also demonstrates how some of the practices associated with CBT could be applied by Learning Advisors to help students to overcome FLA.
Rakovshik, Sarah G; McManus, Freda; Vazquez-Montes, Maria; Muse, Kate; Ougrin, Dennis
To investigate the effect of Internet-based training (IBT), with and without supervision, on therapists' (N = 61) cognitive-behavioral therapy (CBT) skills in routine clinical practice. Participants were randomized into 3 conditions: (1) Internet-based training with use of a consultation worksheet (IBT-CW); (2) Internet-based training with CBT supervision via Skype (IBT-S); and (3) "delayed-training" controls (DTs), who did not receive the training until all data collection was completed. The IBT participants received access to training over a period of 3 months. CBT skills were evaluated at pre-, mid- and posttraining/wait using assessor competence ratings of recorded therapy sessions. Hierarchical linear analysis revealed that the IBT-S participants had significantly greater CBT competence at posttraining than did IBT-CW and DT participants at both the mid- and posttraining/wait assessment points. There were no significant differences between IBT-CW and the delayed (no)-training DTs. IBT programs that include supervision may be a scalable and effective method of disseminating CBT into routine clinical practice, particularly for populations without ready access to more-traditional "live" methods of training. There was no evidence for a significant effect of IBT without supervision over a nontraining control, suggesting that merely providing access to IBT programs may not be an effective method of disseminating CBT to routine clinical practice. (c) 2016 APA, all rights reserved).
Occupational therapy interventions for autism spectrum disorder (ASD) require a sound evidence-base. In the context of emerging evidence on coaching interventions in paediatric occupational therapy practice, a review of the occupational therapy literature was conducted to investigate the use of coaching interventions for children and adolescents…
Long, Anna C.; Palermo, Tonya M.
Objectives This study evaluates the usability and feasibility of a Web-based intervention (Web-MAP) to deliver cognitive behavioral therapy (CBT) to adolescents with chronic pain and their parents. Methods The Web site was evaluated in two stages. In stage one, recovered adolescents and parents (n = 5 dyads), who had completed office-based CBT through a pediatric pain management clinic, completed ratings of Web site content, usability, appearance, and theme. In stage two, treatment-seeking ad...
Sukhodolsky, Denis G; Smith, Stephanie D; McCauley, Spencer A; Ibrahim, Karim; Piasecka, Justyna B
Anger, irritability, and aggression are among the most common reasons for child mental health referrals. This review is focused on two forms of behavioral interventions for these behavioral problems: Parent management training (PMT) and cognitive-behavioral therapy (CBT). First, we provide an overview of anger/irritability and aggression as the treatment targets of behavioral interventions, followed by a discussion of the general principles and techniques of these treatment modalities. Then we discuss our current work concerning the transdiagnostic approach to CBT for anger, irritability, and aggression. PMT is aimed at improving aversive patterns of family interactions that engender children's disruptive behavior. CBT targets deficits in emotion regulation and social problem-solving that are associated with aggressive behavior. Both forms of treatment have received extensive support in randomized controlled trials. Given that anger/irritability and aggressive behavior are common in children with a variety of psychiatric diagnoses, a transdiagnostic approach to CBT for anger and aggression is described in detail. PMT and CBT have been well studied in randomized controlled trials in children with disruptive behavior disorders, and studies of transdiagnostic approaches to CBT for anger and aggression are currently underway. More work is needed to develop treatments for other types of aggressive behavior (e.g., relational aggression) that have been relatively neglected in clinical research. The role of callous-unemotional traits in response to behavioral interventions and treatment of irritability in children with anxiety and mood disorders also warrants further investigation.
Horst, Ferdinand; Den Oudsten, Brenda; Zijlstra, Wobbe; de Jongh, Ad; Lobbestael, Jill; De Vries, Jolanda
Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as life threatening; (2) panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD); and (3) PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT), was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL). Methods: Two-arm (CBT and EMDR) parallel RCT in patients with PD (N = 84). Patients were measured at baseline (T1), directly after the last therapy session (T2), and 3 months after ending therapy (T3). Non-inferiority testing (linear mixed model with intention-to-treat analysis) was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT (N = 42) or EMDR therapy (N = 42). Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), and the Mobility Inventory (MI). The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref), at T3. Results: The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses). Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive. Conclusion: EMDR therapy proved to be as effective as CBT for treating PD patients. Trial Registration: Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134 PMID:28868042
Full Text Available Objective: Cognitive Behavioral Therapy (CBT is an effective intervention for patients with panic disorder (PD. From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR therapy could also be useful in the treatment of PD because: (1 panic attacks can be experienced as life threatening; (2 panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD; and (3 PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT, was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL.Methods: Two-arm (CBT and EMDR parallel RCT in patients with PD (N = 84. Patients were measured at baseline (T1, directly after the last therapy session (T2, and 3 months after ending therapy (T3. Non-inferiority testing (linear mixed model with intention-to-treat analysis was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT (N = 42 or EMDR therapy (N = 42. Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ, the Body Sensations Questionnaire (BSQ, and the Mobility Inventory (MI. The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref, at T3.Results: The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses. Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive.Conclusion: EMDR therapy proved to be as effective as CBT for treating PD patients.Trial Registration: Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134
Labanya Bhattacharya; Bhushan Chaudari; Daniel Saldanha; Preethi Menon
Cognitive behavior therapy (CBT) is one of the most extensively researched psychotherapeutic modalities which is being used either in conjunction with psychotropic drugs or alone in various psychiatric disorders. CBT is a short-term psychotherapeutic approach that is designed to influence dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systematic procedure. Recent advances in CBT suggest that there is a fresh look on a "third wave" CBT that has a greater impact and ...
Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis.
Hudson, Joanna L; Moss-Morris, Rona; Game, David; Carroll, Amy; McCrone, Paul; Hotopf, Matthew; Yardley, Lucy; Chilcot, Joseph
Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis. Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation. A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis
Costa, Leonardo Oliveira Pena; Moseley, Anne M; Sherrington, Catherine; Maher, Christopher G; Herbert, Robert D; Elkins, Mark R
The objective of this study was to identify core journals in physical therapy by identifying those that publish the most randomized controlled trials of physical therapy interventions, provide the highest-quality reports of randomized controlled trials, and have the highest journal impact factors. This study was an audit of a bibliographic database. All trials indexed in the Physiotherapy Evidence Database (PEDro) were analyzed. Journals that had published at least 80 trials were selected. The journals were ranked in 4 ways: number of trials published; mean total PEDro score of the trials published in the journal, regardless of publication year; mean total PEDro score of the trials published in the journal from 2000 to 2009; and 2008 journal impact factor. The top 5 core journals in physical therapy, ranked by the total number of trials published, were Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Spine, British Medical Journal (BMJ), and Chest. When the mean total PEDro score was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, Journal of the American Medical Association (JAMA), Stroke, Spine, and Clinical Rehabilitation. When the mean total PEDro score of the trials published from 2000 to 2009 was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, JAMA, Lancet, BMJ, and Pain. The most highly ranked physical therapy-specific journals were Physical Therapy (ranked eighth on the basis of the number of trials published) and Journal of Physiotherapy (ranked first on the basis of the quality of trials). Finally, when the 2008 impact factor was used for ranking, the top 5 journals were JAMA, Lancet, BMJ, American Journal of Respiratory and Critical Care Medicine, and Thorax. There were no significant relationships among the rankings on the basis of trial quality, number of trials, or journal impact factor. Physical therapists who are trying to keep up-to-date by reading the best
Beck, Alison K; Baker, Amanda; Jones, Steven; Lobban, Fiona; Kay-Lambkin, Frances; Attia, John; Banfield, Michelle
Improving accessible, acceptable recovery-oriented service provision for people with bipolar disorder (BD) is an important priority. Mindfulness and acceptance-based cognitive and behavioural therapies (or 'third -wave' CBT) may prove fruitful due to the considerable overlap between these approaches and key features of personal recovery. Groups also confer therapeutic benefits consistent with personal recovery and may improve recovery-oriented service provision by adding another modality for accessing support. The primary objective of this trial is to explore the feasibility and acceptability of a new recovery-focused group therapy (RfGT) intervention for adults with BD. This is the first published feasibility assessment of a time-limited RfGTrecovery-focused group therapy intervention for BD. This protocol describes an open feasibility study, utilising a pre-treatment design versus post- treatment design and nested qualitative evaluation. Participants will be recruited from the Central Coast region of New South Wales, Australia, from primary care providers, specialist mental health services, non-government organisations and via self-referral. The primary outcomes are feasibility and acceptability as indexed by recruitment, retention, intervention adherence, adverse events (if any) and detailed consumer feedback. Clinical outcomes and process measures will be assessed to inform future research. Primary outcome data will utiliseuse descriptive statistics (eg, summarizingsummarising recruitment, demographics, attendance, attrition and intervention adherence). Secondary outcomes will be assessed using repeated-measures analysis of covariance across all time points (including change, effect size and variability). Ethical approval has been granted by the Northern Sydney Local Health District HREChuman research ethics committee (HREC) (HREC/16/HAWKE/69) and The University of Newcastle HREC (H-2016-0107). The Ffindings will be used to improve the intervention per user
Horst, F.; den Oudsten, B.L.; Zijlstra, W.P.; de Jongh, A.; Lobbestael, J.; de Vries, J.
Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as
Horst, F.; Den Oudsten, B.; Zijlstra, W.; de Jongh, A.; Lobbestael, J.; De Vries, J.
Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as
Salzer, Simone; Cropp, Carola; Streeck-Fischer, Annette
Borderline personality disorder (BPD) should be understood as a disorder of development (Streeck-Fischer 2008, 2013) that has its first manifestation in late childhood and adolescence. There are only few treatment studies of adolescents meeting the diagnostic criteria of borderline personality disorder, although early interventions for these patients are urgently needed (see Chanen & McCutcheon 2013). We examined the effectiveness of an inpatient psychodynamic therapy (PDT). Twenty-eight adolescents fulfilling the DSM-IV diagnostic criteria of borderline personality disorder were treated with psychodynamic therapy. The mean duration of treatment was 29.87 weeks (SD = 15.88). Outcomes were remission rates, GAF, GSI, SDQ, IIP and BPI scores. Assessments were made at admission and after treatment. Pre-post comparisons and comparisons with normative data were conducted. At the end of treatment 39.29% of the patients were remitted. We found significant improvements for the GAF, GSI, SDQ, IIP (all p0.001) and the BPI (p = 0.006). These clinically relevant improvements demonstrate the effectiveness of psychodynamic therapy in adolescents with borderline personality disorder and stress the usefulness of an early intervention for these patients.
Zhong Liang; Qin Zenghui
Objective: To discuss the management and feasibility of sacral block anesthesia in pediatric interventional therapy. Methods: A total of 80 pediatric patients were randomly and equally divided into two groups. Patients in group A received sacral block anesthesia together with basic anesthesia with propofol, while patients in group B received intravenous anesthesia with propofol. Small amount of ketamine as maintaining dose was used in both groups when needed. Results: The interventional management was successfully completed in all patients. A marked decrease in blood pressure occurred in three patients of group A receiving sacral block anesthesia. In group B receiving intravenous anesthesia, a decrease of SpO 2 to below 90 percent was seen in 8 cases, and obvious bradycardia developed in 12 cases. All these patients were treated with intravenous medication or by reducing the dose of propofol. Additional small dose of ketamine was needed in 4 patients during the procedure. Conclusion: Sacral block anesthesia combined with intravenous anesthesia is one of the effective anesthesia management schemes for pediatric interventional therapy. (authors)
Naeem, Farooq; Habib, Nazish; Gul, Mirrat; Khalid, Mehwish; Saeed, Sofiya; Farooq, Saeed; Munshi, Tariq; Gobbi, Mary; Husain, Nusrat; Ayub, Muhammad; Kingdon, David
Cognitive Behaviour Therapy (CBT) has an established evidence base and is recommended by the national organizations in United Kingdom and the United States. CBT remains under utilized in low and middle income countries. CBT was developed in the west and it has been suggested that it is underpinned by western values. It therefore follows that to make CBT accessible for non western clients, it needs adapting into a given culture. Our aim was to develop guidelines for adapting CBT for psychosis in Pakistan by incorporating the views of the patients, their carers and mental health professionals. We conducted a series of qualitative studies in Pakistan to adapt CBT for psychosis (a total of 92 interviews). The data were analyzed by systematic content and question analysis. Analysis started by identifying emerging themes and categories. Themes emerging from the analyses of interviews by each interviewer were compared and contrasted with others interviewers constantly. Triangulation of themes and concepts was undertaken to further compare and contrast the data from the different participating groups. The results of these studies highlighted the barriers in therapy as well as strengths while working with this patient group. Patients and their carers in Pakistan use a bio-psycho-spiritual-social model of illness. They seek help from various sources. Therapists make minor adjustments in therapy. The findings from this study will help therapists working with this client group using CBT for psychosis in Pakistan. These results need to be tested through controlled trials.
Esbitt, Sabrina A; Batchelder, Abigail W; Tanenbaum, Molly L; Shreck, Erica; Gonzalez, Jeffrey S
Depression and illness-specific distress are more common among adults with Type 1 diabetes (T1DM) than the general population and have been associated with poorer control of blood glucose and increased risk for serious diabetes-related complications. Treatment nonadherence has also been associated with depressive symptoms and diabetes-related distress, and has repeatedly been suggested as an important modifiable behavioral pathway linking depression and diabetes outcomes. The present study reports on the feasibility and acceptability of a pilot intervention using group-based cognitive-behavioral therapy to improve treatment adherence among adults with T1DM and elevated levels of diabetes-related distress or depressive symptoms. We describe the components of the intervention and utilize qualitative data along with descriptive outcome data. Our findings suggest that participation in the group was acceptable and associated with reductions in depressive symptoms and diabetes-specific distress. Challenges to feasibility and future directions are discussed.
Huegli, R.W.; Jacob, A.L.; Steinbrich, W.
Spinal affections belong to the most widespread sources of back pain. Beside medical history and clinical examination, the radiological investigation plays an important rote in the clinical workup especially with the modern Cross sectional imaging methods such as computed and magnetic resonance tomography. After exclusion of a malignant disease usually a conservative therapeutic approach is the first line treatment option. If the conservative treatment approach falls a minimalinvasive image guided diagnostic or therapeutic infiltration may be considered. Thereby the interventional radiologist should be a member of the team which decides the clinical strategy. This article describes epidemiology and pathophysiology, common pre-interventional diagnostic strategies, drugs, indications, possible complications and the impact of diagnostic and therapeutic minimally invasive image guided techniques in low back pain. In this context facet joint blockade, periradicular and peridural therapy as well as sacroiliac joint blockades are discussed
Cai Fengquan; Yu Xixiang
Objective: To evaluate the clinical value of emergency interventional therapy of stenosis and thrombosis of peripheral arteries. Methods: 26 patients suffered from stenosis and thrombosis of peripheral arteries including, 3 subclavical arteries, 5 iliac arteries, 7 femoral arteries, 4 popliteal arteries, 4 posterior or anterior tibial arteries, 2 graft vessels and 1 instent restenosis were undertaken interventional ATD or urokinase infusion thrombolysis, percutanous transluminal angioplasty (PTA) and stent placement. Results: The stenotic arteries were recanalized after PTA or stent placement and the thrombosis vanished after thrombolysis with distal flowes improved or resumed. Clinical symptom was ameliorated. No more complication occurred except one patient with alimentary hemorrhage after thrombolysis. The patients were followed up from 1 to 20 months with all the involved arteries keeping in constant patency without any amputation. Conclusions: Emergency thrombolysis by machine or drug along with PTA or stent placement can effectively cure the stenosis or thrombosis of peripheral artery with recanalization and no amputation. (authors)
Setsu, R; Asano, K; Numata, N; Tanaka, M; Ibuki, H; Yamamoto, T; Uragami, R; Matsumoto, J; Hirano, Y; Iyo, M; Shimizu, E; Nakazato, M
Guided self-help treatments based on cognitive behavioral therapy (CBT-GSH) are regarded as a first-line effective treatment for bulimia nervosa (BN). With limited application for CBT-GSH in Japanese clinical settings, we conducted a single arm pilot study in order to confirm the acceptability and availability of CBT-GSH in Japan. 25 women with BN received 16-20 sessions of face-to-face CBT-GSH. Primary outcomes were the completion rate of intervention and abstinence rates from objective bingeing and purging as assessed by the Eating Disorder Examination. Secondary outcomes were other self-report measurements of the frequency of bingeing and purging, and characteristic psychopathologies of eating disorders. Assessments were conducted before CBT as baseline as well as after CBT. 92% (23/25) of the participants completed the CBT sessions. After CBT-GSH, 40% (10/25) of the participants (intention-to-treat) achieved symptom abstinence. The mean binge and purge episodes during the previous 28 days improved from 21.88 to 10.96 (50% reduction) and from 22.44 to 10.88 (52% reduction), each (before CBT-GSH to after CBT-GSH), and the within-group effect sizes were medium (Cohen's d = 0.67, 0.65, each). Our study provided a preliminary evidence about the feasibility of CBT-GSH in Japanese clinical settings for the future. Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 10, 2013 (registration ID: UMIN000011120).
Osborne, Unda L; McComish, Judith Fry
Psychotherapeutic treatment of people with borderline personality disorder (BPD) is one of the greatest challenges confronting mental health professionals today. Clients with BPD are often difficult for nurses to work with, perhaps due to a lack of understanding of the underlying dynamics of the disorder. This article describes effective treatment strategies for BPD with a central focus on dialectical behavioral therapy (DBT). In typical mental health settings, nurses can effectively implement interventions using the concepts of DBT to help people with BPD build effective coping strategies and skillful behavioral responses for improved quality of life.
Barge, Jaideep U.; Lopera, Jorge E. [University of Texas Health Science Center, San Antonio (United States)
Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.
Kathryn A. Boschen
Full Text Available Background. Traditional unimodal interventions may be insufficient for treating complex pain, as they do not address cognitive and behavioural contributors to pain. Cognitive Behavioural Therapy (CBT and physical exercise (PE are empirically supported treatments that can reduce pain and improve quality of life. Objectives. To examine the outcomes of a pain self-management outpatient program based on CBT and PE at a rehabilitation hospital in Toronto, Ontario. Methods. The pain management group (PMG consisted of 20 sessions over 10 weeks. The intervention consisted of four components: education, cognitive behavioural skills, exercise, and self-management strategies. Outcome measures included the sensory, affective, and intensity of pain experience, depression, anxiety, pain disability, active and passive coping style, and general health functioning. Results. From 2002 to 2011, 36 PMGs were run. In total, 311 patients entered the program and 214 completed it. Paired t-tests showed significant pre- to posttreatment improvements in all outcomes measured. Patient outcomes did not differ according to the number or type of diagnoses. Both before and after treatment, women reported more active coping than men. Discussion. The PMGs improved pain self-management for patients with complex pain. Future research should use a randomized controlled design to better understand the outcomes of PMGs.
Lin, Janice; Kelleher, Caitlin L; Engsberg, Jack R
Stroke is one of the leading causes of serious long-term disability. However, home exercise programs given at rehabilitation often lack in motivational aspects. The purposes of this pilot study were (1) create individualized virtual reality (VR) games and (2) determine the effectiveness of VR games for improving movement in upper extremities in a 6-week home therapy intervention for persons with stroke. Participants were two individuals with upper extremity hemiparesis following a stroke. VR games were created using the Looking Glass programming language and modified based on personal interests, goals, and abilities. Participants were asked to play 1 hour each day for 6 weeks. Assessments measured upper extremity movement (range of motion and Action Research Arm Test [ARAT]) and performance in functional skills (Canadian Occupational Performance Measure [COPM] and Motor Activity Log [MAL]). Three VR games were created by a supervised occupational therapist student. The participants played approximately four to six times a week and performed over 100 repetitions of movements each day. Participants showed improvement in upper extremity movement and participation in functional tasks based on results from the COPM, ARAT, and MAL. Further development in the programming environment is needed to be plausible in a rehabilitation setting. Suggestions include graded-level support and continuation of creating a natural programming language, which will increase the ability to use the program in a rehabilitation setting. However, the VR games were shown to be effective as a home therapy intervention for persons with stroke. VR has the potential to advance therapy services by creating a more motivating home-based therapy service.
Bryant, Richard A
The potentially debilitating effect of posttraumatic stress disorder (PTSD) has created much interest in early intervention strategies that can reduce PTSD. This review critiques the evidence for psychological debriefing approaches and alternate early intervention strategies. The review critiques the randomized controlled trials of psychological debriefing, and early provision of cognitive behavior therapy. The latter approach involves therapy attention on acutely traumatized individuals who are high risk for PTSD development, and particularly in people with acute stress disorder (ASD). Psychological debriefing does not prevent PTSD. Cognitive behaviour therapy strategies have proven efficacy in reducing subsequent PTSD in ASD populations. Despite the promising evidence for early provision of CBT, many people do not benefit from CBT. This review concludes with consideration of major challenges facing early intervention approaches in the context of terrorist attacks and mass disasters.
Dissanayaka, Nadeeka N W; Pye, Deidre; Mitchell, Leander K; Byrne, Gerard J; O'Sullivan, John D; Marsh, Rodney; Pachana, Nancy A
Anxiety negatively impacts the quality of life of Parkinson's disease (PD) patients and caregivers. Despite high prevalence, there is a paucity of trials investigating effective treatments for anxiety in PD. This uncontrolled study investigated the use of a manualized and tailored Cognitive Behavior Therapy (CBT) for anxiety in PD. Participants completed 6 weekly CBT sessions. Pre-, post- and follow-up (3 and 6 months) assessments were made. Change in outcomes were analysed using t-tests and Reliability Change Index. Of 17 PD patients who agreed to CBT, 12 completed the intervention. This study showed a significant reduction in Hamilton Anxiety Rating Scale scores in PD immediately post CBT (t(11) = 3.59, p < .01), maintained at 3-month (t(8) = 2.83, p = .02) and 6-month (t(7) = 2.07, p = .04) follow-up. A reduction in caregiver burden (t(11) = 2.68, p = .03) was observed post intervention. Improvements in motor disability (t(11) = 2.41, p = .04) and cognitive scores (t(11) = -2.92, p = .01) were also observed post intervention and at follow-up. Tailored CBT can be used to treat anxiety in PD. This study provides preliminary evidence suggesting that tailored CBT reduces anxiety in PD with persisting benefits, and lowers caregiver burden.
Kwon, Jung Hye; Lee, Jeong Jae
Purpose To examine the efficacy of cognitive-behavioral therapy (CBT) for the prevention of postpartum depression (PPD) in "at risk" women. Materials and Methods We recruited 927 pregnant women in 6 obstetric and gynecology clinics and screened them using Beck Depression Inventory (BDI). Ninety-nine of the screened women who had significantly high scores in BDI (a score above 16) were selected for the study. They were contacted through by telephone, and 27 who had consented to participate in the study were interviewed via SCID-IV-I. Twenty-seven eligible women were randomly assigned to the CBT intervention (n = 15) and control condition (n = 12). All participants were required to complete written questionnaires, assessing demographic characteristics, depressive symptoms, negative thoughts, dyadic communication satisfaction, and global marital satisfaction prior to treatment and approximately 1 month postpartum. The 15 women in the CBT condition received 9 bi-weekly 1-hour individual CBT sessions, targeting and modifying negative patterns of thinking and behaviors occurring in the context of the dyadic relationship. Results The analysis of covariance (ANCOVA) showed that there were significant differences in all postpartum measures between the 2 groups, indicating that our antenatal intervention with CBT was effective in reducing depressive symptoms and improving marital satisfaction, which lasted until the postpartum period. Conclusion Our pilot study has provided preliminary empirical evidence that antenatal CBT intervention can be an effective preventive treatment for PPD. Further study in this direction was suggested. PMID:18729297
Zhai Renyou; Dai Dingke; Wang Jianfeng; Yu Ping; Wei Baojie
Objective: To analyze the method and short term efficacy of interventional therapy for hilar biliary obstructive jaundice. Methods: 100 consecutive patients with perihilar biliary obstruction admitted before May 2004 were treated with percutaneous transhepatic biliary drainage (PTBD) or placement of metallic stents. Among them, 39 patients were found with bile duct cancer, 6 with adenocarcinoma of gallbladder, 22 with metastatic carcinoma, 15 with primary liver carcinoma and 18 with bile duct strait after liver transplantation. Serum total bilirubin before operation and 3-7 days, 8-14 days after procedure were analysed by t test. Results: 79 patients with PTBD (including simple external drainage and combined internal and external drainage), and 21 patients with stents placement (including 31 stents of 4 different kinds) were all carried out successfully. There were significant differences in serum total bilirubin before and 3-7 days, 8-14 days after the procedure, P<0.05 vs P<0.01. Conclusion: Interventional therapy is simple, safe, and effective for hilar biliary obstruction, the latter showed more significance than the former with short term satisfaction. (authors)
Jiang Zaibo; Shan Hong; Guan Shouhai; Ma Zhuang; Huang Mingsheng; Li Zhengran; Zhu Kangshun; Chen Hanwei; Xiao Jibo; Mu Yongsheng
Objective: To study the methods and clinical effect of transuterinal artery interventional therapy of fallopian tubal pregnancy. Methods: The authors cured 34 cases of fallopian tubal pregnancy by interventional methods. In the procedure, 4.1 - 5.0 F catheters were used for performing super selective angiography in uterine artery and then infusing Methotrexate 50-100 mg. Finally gelfoam particles or stripes were used to embolise uterine artery. Before and after the procedure, patients showed changes of clinical symptom, physical signs. Value of urine β-hCG and size of pregnancy cyst were studied. Results: 31 cases were succeeded. The successful rate was 91%. 37 fallopian tubal arteries were displayed in 40 uterine arterial angiographies. The stain of ovary was shown done in 21 cases, the appearance rate was 68%. The stain of pregnant cyst was in six cases, the appearance rate was 18%. Conclusion: It is safe and efficient in performing transuterine artery chemo-embolization for therapy of fallopian tubal pregnancy. It could prevent and control fatal bleeding induced by pregnancy cyst rupture
Meta-analyses consistently demonstrate that cognitive behaviour therapy (CBT) provides effective evidence-based treatment for children and adolescents with emotional and behaviour problems. Also consistent across meta-analyses is the observation that CBT treatment effects are often medium in size. This observation has instigated a search for factors that could help explain the limited treatment effects and that could be focused upon to enhance CBT treatment outcomes. The current qualitative review focuses on the parent-child attachment relationship as one factor that could be relevant to enhance CBT treatment effects. This review first acknowledges reasons why CBT has historically not been attracted to attachment theory and its postulates. Second, recent evidence is examined to evaluate whether attachment can be approached from a cognitive schema perspective. Subsequently, research is described showing how restoring attachment relationships could result in large treatment effects. Finally, this evidence is integrated in a model of attachment assessment and intervention that might be compatible with CBT. In sum, this review suggests that restoring trust in insecure parent-child attachment relationships can be integrated within CBT and could contribute to its treatment outcomes.
Nagata, Shinobu; Seki, Yoichi; Shibuya, Takayuki; Yokoo, Mizue; Murata, Tomokazu; Hiramatsu, Yoichi; Yamada, Fuminori; Ibuki, Hanae; Minamitani, Noriko; Yoshinaga, Naoki; Kusunoki, Muga; Inada, Yasushi; Kawasoe, Nobuko; Adachi, Soichiro; Oshiro, Keiko; Matsuzawa, Daisuke; Hirano, Yoshiyuki; Yoshimura, Kensuke; Nakazato, Michiko; Iyo, Masaomi; Nakagawa, Akiko; Shimizu, Eiji
Mental defeat and cognitive flexibility have been studied as explanatory factors for depression and posttraumatic stress disorder. This study examined mental defeat and cognitive flexibility scores in patients with panic disorder (PD) before and after cognitive behavioral therapy (CBT), and compared them to those of a gender- and age-matched healthy control group. Patients with PD (n = 15) received 16 weekly individual CBT sessions, and the control group (n = 35) received no treatment. Patients completed the Mental Defeat Scale and the Cognitive Flexibility Scale before the intervention, following eight CBT sessions, and following 16 CBT sessions, while the control group did so only prior to receiving CBT (baseline). The patients' pre-CBT Mental Defeat and Cognitive Flexibility Scale scores were significantly higher on the Mental Defeat Scale and lower on the Cognitive Flexibility Scale than those of the control group participants were. In addition, the average Mental Defeat Scale scores of the patients decreased significantly, from 22.2 to 12.4, while their average Cognitive Flexibility Scale scores increased significantly, from 42.8 to 49.5. These results suggest that CBT can reduce mental defeat and increase cognitive flexibility in patients with PD Trial registration The study was registered retrospectively in the national UMIN Clinical Trials Registry on June 10, 2016 (registration ID: UMIN000022693).
Le, Long Khanh-Dao; Hay, Phillipa; Wade, Tracey; Touyz, Stephen; Mihalopoulos, Cathrine
This study was to model the cost-effectiveness of specialist-delivered cognitive behavioral therapy for bulimia nervosa (CBT-BN) compared to no intervention within the Australian context. An illness-death model was developed to estimate the cost per disability-adjusted life-year (DALY) averted of CBT-BN over 2 years from the healthcare perspective. Target population was adults aged 18-65 years with BN. Results are reported as incremental cost-effectiveness ratios (ICER) in 2013 Australian dollars per DALY averted. Uncertainty and sensitivity analyses were conducted to test the robustness of results. Primary analysis indicated that CBT-BN was associated with greater DALY averted (0.10 DALY per person) and higher costs ($1,435 per person) than no intervention, resulting the mean ICER of $14,451 per DALY averted (95% uncertainty interval [UI]: $8,762 to $35,650). Uncertainty analysis indicated CBT-BN is 99% likely to be cost-effective at a threshold of $50,000 per DALY averted. Including the patients' time and travel costs resulted in the mean ICER of $18,858 per DALY averted (95% UI: $11,235 to $46,026). Sensitivity analysis indicated the intervention was not cost-effective if over 80% people discontinued treatment. Other analyses including a reduced time horizon, increased remission rates, and 4-month effect size of CBT-BN increases the ICERs but these ICERs remained well below under a threshold of $50,000 per DALY averted. This study has demonstrated that CBT-BN for adults with BN is a cost-effective treatment intervention. Further research is required to investigate the practicability of CBT-ED and the cost-effectiveness of other formats of CBT-BN delivery. © 2017 Wiley Periodicals, Inc.
Lopez, Pablo Luis; Torrente, Fernando Manuel; Ciapponi, Agustín; Lischinsky, Alicia Graciela; Cetkovich-Bakmas, Marcelo; Rojas, Juan Ignacio; Romano, Marina; Manes, Facundo F
Attention deficit hyperactivity disorder (ADHD) is a developmental condition characterised by symptoms of inattention, hyperactivity and impulsivity, along with deficits in executive function, emotional regulation and motivation. The persistence of ADHD in adulthood is a serious clinical problem.ADHD significantly affects social interactions, study and employment performance.Previous studies suggest that cognitive-behavioural therapy (CBT) could be effective in treating adults with ADHD, especially when combined with pharmacological treatment. CBT aims to change the thoughts and behaviours that reinforce harmful effects of the disorder by teaching people techniques to control the core symptoms. CBT also aims to help people cope with emotions, such as anxiety and depression, and to improve self-esteem. To assess the effects of cognitive-behavioural-based therapy for ADHD in adults. In June 2017, we searched CENTRAL, MEDLINE, Embase, seven other databases and three trials registries. We also checked reference lists, handsearched congress abstracts, and contacted experts and researchers in the field. Randomised controlled trials (RCTs) evaluating any form of CBT for adults with ADHD, either as a monotherapy or in conjunction with another treatment, versus one of the following: unspecific control conditions (comprising supportive psychotherapies, no treatment or waiting list) or other specific interventions. We used the standard methodological procedures suggested by Cochrane. We included 14 RCTs (700 participants), 13 of which were conducted in the northern hemisphere and 1 in Australia.Primary outcomes: ADHD symptomsCBT versus unspecific control conditions (supportive psychotherapies, waiting list or no treatment)- CBT versus supportive psychotherapies: CBT was more effective than supportive therapy for improving clinician-reported ADHD symptoms (1 study, 81 participants; low-quality evidence) but not for self-reported ADHD symptoms (SMD -0.16, 95% CI -0.52 to 0
Brothers, Brittany M.; Yang, Hae-Chung; Strunk, Daniel R.; Andersen, Barbara L.
Objective: In this Phase II trial, we evaluated a novel psychological treatment for depressed patients coping with the stresses of cancer. Effectiveness of a combined biobehavioral intervention (BBI) and cognitive behavior therapy (CBT) was studied. Method: Participants were 36 cancer survivors (mean age = 49 years; 88% Caucasian; 92% female)…
Mouthaan, Joanne; Sijbrandij, Marit; de Vries, Giel-Jan; Reitsma, Johannes B.; van de Schoot, Rens; Goslings, J. Carel; Luitse, Jan S. K.; Bakker, Fred C.; Gersons, Berthold P. R.; Olff, Miranda
Background: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. Objective: To determine
Mouthaan, J.; Sijbrandij, M.; de Vries, G.J.; Reitsma, J.B.; van de Schoot, R.; Goslings, J.C.; Luitse, J.S.K.; Bakker, F.C.; Gersons, B.P.R.; Olff, M.
Background: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. Objective: To determine
Tatiana Barbieri Bombarda
Full Text Available Considering the importance of records in the professional practice of occupational therapy, it is necessary to instill a more insightful look at the effectiveness of practitioners’ notes, as well as encourage the development of research–oriented documentary practice. The preparation of records arises from the need to have information from the service as a means of guidance and oversight of the service provided and on the adopted technical responsibility, as well as from the fact that the notes are a valuable data providing resource for research. The present study sought to identify and characterize occupational therapists in the state of Sao Paulo who work in inclusive education and how the records of their interventional practices are performed. A structured questionnaire as a tool available on the website for specific predetermined time was used as the study instrument, and the obtained data were analyzed using descriptive statistics. Participants were 55 occupational therapists working in the inclusive education process registered in the 3rd region of the Regional Council of Physical Therapy and Occupational Therapy. The results demonstrated that free narrative was the most commonly used registration model and that information related to the process of custody of notes was fragmented. These data showed weakness in the systematization of records, which is believed to result in improvement of the profession, a factor that demonstrates the necessity and temporality of the scientific production on this issue.
Wang, Lu-Lu; Dong, Xiao-Qiu; Shao, Xiao-Hui; Wang, Si-Ming
The aim of this study was to determine the effectiveness of ultrasound-guided interventional therapy in the treatment of postoperative recurrent chocolate cysts. The 198 patients enrolled in this study were divided into three groups. In group 1, the saline washing group, the cavity of the cyst was washed thoroughly with warm saline. In group 2, the ethanol short-time retention group, after washing with saline, the cyst was injected with 95% ethanol with a volume of half of the fluid aspirated from the cyst. Ten minutes later, the rest of the ethanol was aspirated. In group 3, the ethanol retention group, the procedures were the same as with the ethanol short-time retention group, except that 95% of the ethanol was retained in the cyst. An ultrasound examination was performed in the third, sixth and 12th months after therapy. The chocolate cyst cure rate was significantly higher in the ethanol retention group (96%, 66/69) than in the ethanol short-time retention group (82%, 56/68) and no case was cured in the first group (saline washing). We conclude that ultrasound-guided injection and 95% ethanol retention are an effective therapy for the treatment of postoperative recurrent chocolate cysts. Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
Zhu Mingde; Zhang Zijing; Ji Hongsheng; Ge Chenlin; Hao Gang; Wei Kongming; Yuan Yuhou; Zhao Xiuping
Objective: To investigate the interventional therapy and its curative effect for progressing stage gastric cancer. Methods: two hundred and twelve patients with progressing stage gastric cancer were treated with arterial perfusion and arterial embolization. Gastric cardia cancer was treated through the left gastric artery and the left inferior phrenic artery or splenic artery. Cancers of lesser and greater gastric curvature was treated either through the left and right gastric arteries or common hepatic artery or through gastroduodenal artery, right gastroomental artery or splenic artery. Gastric antrum cancers were perfused through gastroduodenal artery or after the middle segmental embolization of right gastroomental artery. Results: One hundred and ninety three cases undergone interventional management were followed up. The CR + PR of gastric cardia cancer was 53.13%; gastric body cancer 44.44%; gastric antrum cancer 10%; recurrent cancer and remnant gastric cancer 0. There was no significant difference in outcome between gastric cardia cancer and gastric body cancer (P>0.05) but significant differences were shown both between gastric cardia cancer and gastric antrum cancer, and between gastric body cancer and gastric antrum cancer (P<0.05), with 1 year and 2 years survival rates of 81% and 56% respectively. Conclusion: The interventional therapeutic effect of progressing stage gastric cancers is different due to the different sites of the lesions in the gastric tissue. The curative effect of gastric cardia cancer and gastric body cancer is better than that of gastric antrum cancer, recurrent cancer and remnant gastric cancer. (authors)
Lustyk, M Kathleen B; Gerrish, Winslow G; Shaver, Shelley; Keys, Shaunie L
We systematically reviewed empirical studies that investigated the use of cognitive-behavioral therapy (CBT) for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Our multi-database search identified seven published empirical reports. Three were identified as randomized controlled trials (RCTs). The methods utilized to investigate therapeutic efficacy of CBT in these studies varied widely from case reports to RCTs with pharmacotherapy comparison groups. Initially we provide a brief overview of CBT and justifications for its potential use to treat PMS/PMDD. Next, we provide critical evaluations of the analyses used in each study focusing on the detection of intervention effects assessed by statistically significant time by group interactions. When possible we calculate effect sizes to elucidate the clinical significance of results. Our review revealed a dearth of evidence providing statistically significant CBT intervention effects. Issues such as overall time investment, latency to treatment effects, and complementary and combined therapies are considered. We present a theoretical argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this area. In conclusion, to produce the necessary evidence-base support for PMS/PMDD given the limited empirical evidence reported here, researchers are called on to produce methodologically rigorous investigations of psychosocial interventions for PMS/PMDD.
Thase, Michael E; Wright, Jesse H; Eells, Tracy D; Barrett, Marna S; Wisniewski, Stephen R; Balasubramani, G K; McCrone, Paul; Brown, Gregory K
The authors evaluated the efficacy and durability of a therapist-supported method for computer-assisted cognitive-behavioral therapy (CCBT) in comparison to standard cognitive-behavioral therapy (CBT). A total of 154 medication-free patients with major depressive disorder seeking treatment at two university clinics were randomly assigned to either 16 weeks of standard CBT (up to 20 sessions of 50 minutes each) or CCBT using the "Good Days Ahead" program. The amount of therapist time in CCBT was planned to be about one-third that in CBT. Outcomes were assessed by independent raters and self-report at baseline, at weeks 8 and 16, and at posttreatment months 3 and 6. The primary test of efficacy was noninferiority on the Hamilton Depression Rating Scale at week 16. Approximately 80% of the participants completed the 16-week protocol (79% in the CBT group and 82% in the CCBT group). CCBT met a priori criteria for noninferiority to conventional CBT at week 16. The groups did not differ significantly on any measure of psychopathology. Remission rates were similar for the two groups (intent-to-treat rates, 41.6% for the CBT group and 42.9% for the CCBT group). Both groups maintained improvements throughout the follow-up. The study findings indicate that a method of CCBT that blends Internet-delivered skill-building modules with about 5 hours of therapeutic contact was noninferior to a conventional course of CBT that provided over 8 additional hours of therapist contact. Future studies should focus on dissemination and optimizing therapist support methods to maximize the public health significance of CCBT.
Kennard, Betsy D; Emslie, Graham J; Mayes, Taryn L; Nakonezny, Paul A; Jones, Jessica M; Foxwell, Aleksandra A; King, Jessica
The authors evaluated a sequential treatment strategy of fluoxetine and relapse-prevention cognitive-behavioral therapy (CBT) to determine effects on remission and relapse in youths with major depressive disorder. Youths 8-17 years of age with major depression were treated openly with fluoxetine for 6 weeks. Those with an adequate response (defined as a reduction of 50% or more on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomly assigned to receive continued medication management alone or continued medication management plus CBT for an additional 6 months. The CBT was modified to address residual symptoms and was supplemented by well-being therapy. Primary outcome measures were time to remission (with remission defined as a CDRS-R score of 28 or less) and rate of relapse (with relapse defined as either a CDRS-R score of 40 or more with a history of 2 weeks of symptom worsening, or clinical deterioration). Of the 200 participants enrolled in acute-phase treatment, 144 were assigned to continuation treatment with medication management alone (N=69) or medication management plus CBT (N=75). During the 30-week continuation treatment period, time to remission did not differ significantly between treatment groups (hazard ratio=1.26, 95% CI=0.87, 1.82). However, the medication management plus CBT group had a significantly lower risk of relapse than the medication management only group (hazard ratio=0.31, 95% CI=0.13, 0.75). The estimated probability of relapse by week 30 was lower with medication management plus CBT than with medication management only (9% compared with 26.5%). Continuation-phase relapse-prevention CBT was effective in reducing the risk of relapse but not in accelerating time to remission in children and adolescents with major depressive disorder.
Johnson, Leigh G; Rohan, Kelly J
...), group cognitive-behavioral therapy (CBT), or combination therapy (CBT+LT). Atypical and typical symptoms were assessed using subscales of the Structured Interview Guide for the Hamilton Rating Scale for Depression - SAD Version (SIGH-SAD...
Jones, Allan; Clausen, Loa
OBJECTIVE: The aim of the study was to evaluate the efficacy of a brief group cognitive behavior therapy (CBT) program in treating a large cohort of patients diagnosed with bulimia nervosa. METHOD: Treatment outcome defined as reductions in bulimia related behavioral symptoms and bulimia related...... distress was examined in 205 consecutive new patients enrolled in an eight-session group CBT program. RESULTS: Significant reductions in eating disorder pathology were found on all measures of bulimia related behavioral symptoms, as well as on all measures of bulimia related distress. DISCUSSION......: There is strong evidence for the efficacy of brief group CBT in treating patients with bulimia nervosa....
Kinderman, Peter; Hagan, Paul; King, Sophie; Bowman, James; Chahal, Jasprit; Gan, Li; McKnight, Rebecca; Waldon, Charlotte; Smith, Matthew; Gilbertson, John; Tai, Sara
The widespread use of smartphones makes effective therapies such as cognitive-behavioural therapy (CBT) potentially accessible to large numbers of people. This paper reports the usage data of the first trial of Catch It, a new CBT smartphone app. Uptake and usage rates, fidelity of user responses to CBT principles, and impact on reported negative and positive moods were assessed. A relatively modest proportion of people chose to download the app. Once used, the app tended to be used more than once, and 84% of the user-generated content was consistent with the basic concepts of CBT. There were statistically significant reductions in negative mood intensity and increases in positive mood intensity. Smartphone apps have potential beneficial effects in mental health through the application of basic CBT principles. More research with randomised controlled trial designs should be conducted. None. © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Brown, Wilson J; Dewey, Daniel; Bunnell, Brian E; Boyd, Stephen J; Wilkerson, Allison K; Mitchell, Melissa A; Bruce, Steven E
Forms of cognitive and behavioral therapies (CBTs), including prolonged exposure and cognitive processing therapy, have been empirically validated as efficacious treatments for posttraumatic stress disorder (PTSD). However, the assumption that PTSD develops from dysregulated fear circuitry possesses limitations that detract from the potential efficacy of CBT approaches. An analysis of these limitations may provide insight into improvements to the CBT approach to PTSD, beginning with an examination of negative affect as an essential component to the conceptualization of PTSD and a barrier to the implementation of CBT for PTSD. As such, the literature regarding the impact of negative affect on aspects of cognition (i.e., attention, processing, memory, and emotion regulation) necessary for the successful application of CBT was systematically reviewed. Several literature databases were explored (e.g., PsychINFO and PubMed), resulting in 25 articles that met criteria for inclusion. Results of the review indicated that high negative affect generally disrupts cognitive processes, resulting in a narrowed focus on stimuli of a negative valence, increased rumination of negative autobiographical memories, inflexible preservation of initial information, difficulty considering counterfactuals, reliance on emotional reasoning, and misinterpretation of neutral or ambiguous events as negative, among others. With the aim to improve treatment efficacy of CBT for PTSD, suggestions to incorporate negative affect into research and clinical contexts are discussed.
Fernie, Bruce A; Murphy, Gabrielle; Wells, Adrian; Nikčević, Ana V; Spada, Marcantonio M
Studies have reported that Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are effective treatments for Chronic Fatigue Syndrome (CFS). One hundred and seventy-one patients undertook a course of either CBT (n = 116) or GET (n = 55) and were assessed on a variety of self-report measures at pre- and posttreatment and follow-up. In this paper we present analyses on treatment outcomes for CBT and GET in routine clinical practice and evaluate whether changes on subscales of the Metacognitions Questionnaire-30 (MCQ-30) predict fatigue severity independently of changes in other covariates, and across the two treatment modalities. Both CBT and GET were equally effective at decreasing fatigue, anxiety, and depression, and at increasing physical functioning. Changes on the subscales of the MCQ-30 were also found to have a significant effect on fatigue severity independently of changes in other covariates and across treatment modalities. The findings from the current study suggest that CFS treatment protocols for CBT and GET, based on those from the PACE trial, achieve similar to poorer outcomes in routine clinical practice as in a RCT.
Janse, Anthonie; Worm-Smeitink, Margreet; Bussel-Lagarde, José; Bleijenberg, Gijs; Nikolaus, Stephanie; Knoop, Hans
Cognitive behavioural therapy (CBT) is an effective treatment for fatigue and disabilities in patients with chronic fatigue syndrome (CFS). However, treatment capacity is limited. Providing web-based CBT and tailoring the amount of contact with the therapist to the individual needs of the patient may increase the efficiency of the intervention. Web-based CBT for adolescents with CFS has proven to be effective in reducing fatigue and increasing school attendance. In the proposed study the efficacy of a web-based CBT intervention for adult patients with CFS will be explored. Two different formats of web-based CBT will be tested. In the first format named protocol driven feedback, patients report on their progress and receive feedback from a therapist according to a preset schedule. In the second format named support on demand, feedback and support of the therapist is only given when patients ask for it. The primary objective of the study is to determine the efficacy of a web-based CBT intervention on fatigue severity. A randomized clinical trial will be conducted. Two-hundred-forty adults who have been diagnosed with CFS according to the US Centers for Disease Control and Prevention (CDC) consensus criteria will be recruited and randomized to one of three conditions: web-based CBT with protocol driven feedback, web-based CBT with support on demand, or wait list. Feedback will be delivered by therapists specialized in CBT for CFS. Each of the web-based CBT interventions will be compared to a wait list condition with respect to its effect on the primary outcome measure; fatigue severity. Secondary outcome measures are level of disability, physical functioning, psychological distress, and the proportion of patients with clinical significant improvement in fatigue severity. Outcomes will be assessed at baseline and six months post randomization. The web-based CBT formats will be compared with respect to the time therapists need to deliver the intervention. As far as we
van Apeldoorn, F.J.; Timmerman, M.E.; Mersch, P.P.A.; Hout, W.J.P.J.; Visser, S.; van Dyck, R.; den Boer, J.A.
Objective: To establish the long-term effectiveness of 3 treatments for DSM-IV panic disorder with or without agoraphobia: cognitive-behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both (CBT + SSRI). As a secondary objective, the
Salari, Elham; Shahrivar, Zahra; Mahmoudi-Gharaei, Javad; Shirazi, Elham; Sepasi, Mitra
Parents play an important role in development and continuation of anxiety disorders in children. Yet the evidence on parent contribution in cognitive behavioral therapy (CBT) for childhood anxiety is limited. This open randomized trial examined the effectiveness of a parent-directed group CBT to manage children with anxiety disorders. Parents of 42 children aged 6-12 with primary anxiety disorders were allocated to a six, two-hour weekly intervention and a wait-list (WL) control. The Revised Children's Manifest Anxiety, Children's Depression Inventory, Strengths and Difficulties Questionnaire-Home Version, Depression-Anxiety-Stress Scale, Children Global Assessment Scale, and Global Relational Assessment of Functioning were used to assess children's and parents' functioning and emotional symptoms. Parents completed consumer satisfaction questionnaire. Parents in the CBT group reported significant improvement in their depressive symptoms (p=0.006) and the family functioning (p=0.04), as well as reduction in children's emotional symptoms (p=0.007). Clinician rating of children's functioning showed significant improvement in the CBT group(p=0.001). There was no significant difference in children rating of their anxiety within groups from pre- to post-intervention. Parents were satisfied mostly with the intervention. A brief parent-only CBT based intervention can be effective in the management of childhood anxiety.
The percentage of individuals with dementia worldwide is increasing with the continued trend toward global trend overall. As options for the medical treatment of dementia remain limited, combined, non-pharmacological interventions are necessary to maintain and slow the degeneration of functional capabilities. Additionally, there is a need to help caregivers develop better patterns of care and methods to reduce the burden of care. Therefore, occupational therapists play an important role in the dementia care team. This article introduces how occupational therapists help dementia patient maintain their functional capabilities and delay degeneration and help caregivers reduce their burden of care. Both activities are based on the concept of occupational therapy, which includes three important components: people, activities, and the environment.
Ji Hongjian; Chen Liping; Wang Hui; Cheng Yongde
To review the recent literature relating to non-vascular interventional therapy of respiratory diseases. Metal airway stent insertion can immediately relieve tracheobronchial obstruction and improve pulmonary function. However, as there is a high occurrence of the restenosis after stent insertion, it should be very careful to use metal stenting to treat the benign airway obstruction. Compared with traditional lung volume reduction surgery in treating severe emphysema, bronchoscopic lung volume reduction appears to be effective, safe and less invasive, although its clinical usefullness need to be further proved. Endoscopic occlusion of bronchial fistula represents an effective alternative to surgical treatment. Percutaneous lung biopsy under ultrasound or CT guidance has been applied successfully in the management of both benign and malignant lesions. (authors)
Cao Xusheng; Gu Tongxiao; Liu Huisheng; Zhang Junfeng; Huang Jinyou; Hu Xiumin
Objective: To search an approach to treat tubal pregnancy in a safe and economic way. Methods: 20 cases of tubal pregnancy were studied. Under fluoroscopic guidance, a 3F catheter was introduced to the site of tubal gestation through the uterine cavity, and methotrexate 30 mg in 10 ml saline was injected. Results: On the 5th day after operation, the level of serum hCG began to decline reaching the normal value on the 21 st-28 th day. The gestation sac was absorbed after 2-2.5 months. In 6 cases the fallopian tube was re-canalized after 3 months. Conclusion: Interventional therapy is a valuable and practical method for tubal pregnancy
Full Text Available Chronic pain is a complex physiological and psychological phenomenon. Implicit learning mechanisms contribute to the development of chronic pain and to persistent changes in the central nervous system. We hypothesized that these central abnormalities can be remedied with Cognitive Behavioral Therapy (CBT. Specifically, since regions of the anterior Default Mode Network (DMN are centrally involved in emotional regulation via connections with limbic regions, such as the amygdala, remediation of maladaptive behavioral and cognitive patterns as a result of CBT for chronic pain would manifest itself as a change in the intrinsic functional connectivity (iFC between these prefrontal and limbic regions. Resting-state functional neuroimaging was performed in patients with chronic pain before and after 11-week CBT (n = 19, as well as a matched (ages 19–59, both sexes active control group of patients who received educational materials (n = 19. Participants were randomized prior to the intervention. To investigate the differential impact of treatment on intrinsic functional connectivity (iFC, we compared pre–post differences in iFC between groups. In addition, we performed exploratory whole brain analyses of changes in fractional amplitude of low frequency fluctuations (fALFF. The course of CBT led to significant improvements in clinical measures of pain and self-efficacy for coping with chronic pain. Significant group differences in pre–post changes in both iFC and fALFF were correlated with clinical outcomes. Compared to control patients, iFC between the anterior DMN and the amygdala/periaqueductal gray decreased following CBT, whereas iFC between the basal ganglia network and the right secondary somatosensory cortex increased following CBT. CBT patients also had increased post-therapy fALFF in the bilateral posterior cingulate and the cerebellum. By delineating neuroplasticity associated with CBT-related improvements, these results add to
Coffey, Scott F; Banducci, Anne N; Vinci, Christine
Cognitive behavior therapy (CBT) is a time-limited, goal-oriented psychotherapy that has been extensively researched and has benefits in a number of psychiatric disorders, including anxiety, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, autism, obsessive-compulsive and tic disorders, personality disorders, eating disorders, and insomnia. CBT uses targeted strategies to help patients adopt more adaptive patterns of thinking and behaving, which leads to positive changes in emotions and decreased functional impairments. Strategies include identifying and challenging problematic thoughts and beliefs, scheduling pleasant activities to increase environmental reinforcement, and extended exposure to unpleasant thoughts, situations, or physiologic sensations to decrease avoidance and arousal associated with anxiety-eliciting stimuli. CBT can be helpful in the treatment of posttraumatic stress disorder by emphasizing safety, trust, control, esteem, and intimacy. Prolonged exposure therapy is a CBT technique that includes a variety of strategies, such as repeated recounting of the trauma and exposure to feared real-world situations. For attention-deficit/hyperactivity disorder, CBT focuses on establishing structures and routines, and clear rules and expectations within the home and classroom. Early intensive behavioral interventions should be initiated in children with autism before three years of age; therapy consists of 12 to 40 hours of intensive treatment per week, for at least one year. In many disorders, CBT can be used alone or in combination with medications. However, CBT requires a significant commitment from patients. Family physicians are well suited to provide collaborative care for patients with psychiatric disorders, in concert with cognitive behavior therapists.
Jensen, Tine K; Holt, Tonje; Ormhaug, Silje M
Trauma-focused cognitive behavioral therapy (TF-CBT) is the treatment of choice for traumatized youth, however, follow-up studies are scarce, and treatment effects for co-occurring depression show mixed findings. The aims of this study were to examine whether treatment effects of TF-CBT are maintained at 18 month follow-up and whether degree of co-occurring depression influences treatment effects. As rapid improvement in psychological functioning is warranted for youth, we also investigated whether the symptom trajectory was different for TF-CBT compared to therapy as usual (TAU). The sample consisted of 156 youth (M age = 15.05, 79.50% girls) randomly assigned to TF-CBT or TAU. The youth were assessed for posttraumatic stress symptoms (PTSS), depression, anxiety and general mental health symptoms. Mixed effects analyses followed the symptom courses over 5 time points. Youth receiving TF-CBT maintained their symptom improvement at 18 months follow-up with scores below clinical cut-of on all symptom measures. The most depressed youth had also a significant decline in symptoms that were maintained at follow-up. Symptom trajectories differed as the TF-CBT group reported a more rapid symptom reduction compared to the TAU condition. In the TAU condition, participants received 1.5 times the number of treatment sessions compared to the TF-CBT participants. After 18 months the groups were significantly different on general mental health symptoms only. In conclusion, youth receiving TF-CBT experienced more efficient improvement in trauma related symptoms than youth receiving TAU and these improvements were maintained after 18 months. Also youth experiencing serious co-occurring depression benefitted from TF-CBT.
Burns Barbara J
Full Text Available Abstract Background Behavioral health services for children and adolescents in the U.S. are lacking in accessibility, availability and quality. Evidence-based interventions for emotional and behavioral disorders can improve quality, yet few studies have systematically examined their implementation in routine care settings. Methods Using quantitative and qualitative data, we evaluated a multi-faceted implementation strategy to implement cognitive-behavioral therapy (CBT for depressed adolescents into two publicly-funded mental healthcare centers. Extent of implementation during the study's duration and variables influencing implementation were explored. Results Of the 35 clinicians eligible to participate, 25 (71% were randomized into intervention (n = 11 or usual care (n = 14. Nine intervention clinicians completed the CBT training. Sixteen adolescents were enrolled in CBT with six of the intervention clinicians; half of these received at least six CBT manually-based sessions. Multiple barriers to CBT adoption and sustained use were identified by clinicians in qualitative interviews. Conclusion Strategies to implement evidence-based interventions into routine clinical settings should include multi-method, pre-implementation assessments of the clinical environment and address multiple barriers to initial uptake as well as long-term sustainability.
Doerfler, R Eric; Goodfellow, Linda
No study has tested the effectiveness of individualized cognitive behavioral therapy (CBT) interventions to reduce persistent nausea, pain, anxiety, and fatigue in patients on continuous antiretroviral therapy (ART). Our objective was to determine if CBT could reduce nausea, pain, anxiety, and fatigue in patients with HIV on ART. Men ages 40 to 56 years on ART (n = 18) at a suburban HIV clinic were randomly assigned to a control group or the CBT intervention. Usual adherence education and side-effect management were provided to both groups. Symptoms, health perception, medication adherence, and side-effect-reducing medication use were measured at four time points over 3 months. Participants in the intervention group rated usual fatigue and worst fatigue at 60 days, and nausea duration at 90 days significantly lower than controls (p < .05). Brief CBT training may reduce fatigue and nausea in patients with HIV undergoing ART. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Reynen, K.; Henssge, R.
The current importance of the interventional therapy of coronary artery disease may be deduced from the exponential increase in procedures performed in Germany in the last decade - at least 125,840 in 1996. Today, by improved catheter and balloon materials as well as by growing experience of the cardiologists, even complex lesions may be treated. Limitations of balloon angioplasty include acute vessel closure and restenosis - newer angioplasty devices like directional or rotational atherectomy or excimer-laser angioplasty did not overcome these limitations; only by coronary stenting, acute vessel closure could be managed and the likelihood of restenosis - at least in particular groups of patients - could be reduced. For a few years, intracoronary brachytherapy of the segments dilated with beta- or gamma-emitters has been seeking to reduce restenosis rate; the department of cardiology of the Dresden Cardiovascular Institute is participating in such a multicentre study using the beta-emitter 188 renium. Further main topics of our department represent primary angioplasty in patients with acute myocardial infarction and invasive diagnostic or interventional procedures by the transradial approach. (orig.)
Rector, Neil A; Man, Vincent; Lerman, Bethany
Cognitive-behavioural therapy (CBT) is an empirically supported treatment for anxiety disorders. CBT treatments are based on disorder-specific protocols that have been developed to target individual anxiety disorders, despite that anxiety disorders frequently co-occur and are comorbid with depression. Given the high rates of diagnostic comorbidity, substantial overlap in dimensional symptom ratings, and extensive evidence that the mood and anxiety disorders share a common set of psychological and biological vulnerabilities, transdiagnostic CBT protocols have recently been developed to treat the commonalities among the mood and anxiety disorders. We conducted a selective review of empirical developments in the transdiagnostic CBT treatment of anxiety and depression (2008-2013). Preliminary evidence suggests that theoretically based transdiagnostic CBT approaches lead to large treatment effects on the primary anxiety disorder, considerable reduction of diagnostic comorbidity, and some preliminary effects regarding the impact on the putative, shared psychological mechanisms. However, the empirical literature remains tentative owing to relatively small samples, limited direct comparisons with disorder-specific CBT protocols, and the relative absence of the study of disorder-specific compared with shared mechanisms of action in treatment. We conclude with a treatment conceptualization of the new transdiagnostic interventions as complementary, rather than contradictory, to disorder-specific CBT.
Glenn, Daniel; Golinelli, Daniela; Rose, Raphael D; Roy-Byrne, Peter; Stein, Murray B; Sullivan, Greer; Bystritksy, Alexander; Sherbourne, Cathy; Craske, Michelle G
The present study explored treatment dose and patient engagement as predictors of treatment outcome in cognitive behavioral therapy (CBT) for anxiety disorders. Measures of high versus low treatment dose and high versus low patient engagement in CBT were compared as predictors of 12- and 18-month outcomes for patients being treated for anxiety disorders with CBT (with or without concurrent pharmacotherapy) in primary care settings as part of a randomized controlled effectiveness trial of the Coordinated Anxiety Learning and Management (CALM) intervention. Measures of dose (attendance, exposure completion) and engagement in CBT (homework adherence, commitment) were collected throughout treatment, and blinded follow-up phone assessments of outcome measures (12-item Brief Symptom Inventory, Patient Health Questionnaire 8, Sheehan Disability Scale) were completed at 12 and 18 months. Propensity score weighting controlled for baseline differences in demographics and symptom severity between patients with high and low dose and engagement. These analyses included the 439 patients who selected CBT as treatment modality. Completing exposures, having high attendance, and being more adherent to completing homework predicted better outcomes across all measures at 12 and 18 months, and high CBT commitment predicted better outcomes on all measures at 18 months. This study found that higher treatment dose and patient engagement in CBT for anxiety disorders were stable and robust predictors of greater reductions in anxiety symptoms, depression symptoms, and functional disability. PsycINFO Database Record (c) 2013 APA, all rights reserved.
Liber, Juliette M; De Boo, Gerly M; Huizenga, Hilde; Prins, Pier J M
In this randomized controlled trial, we investigated the effectiveness of a school-based targeted intervention program for disruptive behavior. A child-focused cognitive behavioral therapy (CBT) program was introduced at schools in disadvantaged settings and with active teacher support (ATS) versus educational teacher support (ETS) (CBT + ATS vs. CBT + ETS). Screening (n = 1,929) and assessment (n = 224) led to the inclusion of 173 children ages 8-12 years from 17 elementary schools. Most of the children were boys (n = 136, 79%) of low or low-to-middle class socioeconomic status (87%); the sample was ethnically diverse (63% of non-Western origin). Children received CBT + ATS (n = 29) or CBT + ETS (n = 41) or were entered into a waitlist control condition (n = 103) to be treated afterward (CBT + ATS, n = 39, and CBT + ETS, n = 64). Effect sizes (ES), clinical significance (reliable change), and the results of multilevel modeling are reported. Ninety-seven percent of children completed treatment. Teachers and parents reported positive posttreatment effects (mean ES = .31) for CBT compared with the waitlist control condition on disruptive behavior. Multilevel modeling showed similar results. Clinical significance was modest. Changes had remained stable or had increased at 3-months follow-up (mean ES = .39). No consistent effect of teacher condition was found at posttreatment; however, at follow-up, children who received ETS fared significantly better. This study shows that a school-based CBT program is beneficial for difficult-to-reach children with disruptive behavior: The completion rate was remarkably high, ESs (mean ES = .31) matched those of previous studies with targeted intervention, and effects were maintained or had increased at follow-up.
Manassis, Katharina; Lee, Trevor Changgun; Bennett, Kathryn; Zhao, Xiu Yan; Mendlowitz, Sandra; Duda, Stephanie; Saini, Michael; Wilansky, Pamela; Baer, Susan; Barrett, Paula; Bodden, Denise; Cobham, Vanessa E; Dadds, Mark R; Flannery-Schroeder, Ellen; Ginsburg, Golda; Heyne, David; Hudson, Jennifer L; Kendall, Philip C; Liber, Juliette; Masia-Warner, Carrie; Nauta, Maaike H; Rapee, Ronald M; Silverman, Wendy; Siqueland, Lynne; Spence, Susan H; Utens, Elisabeth; Wood, Jeffrey J
Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.
Docteur, Aurélie; Mirabel-Sarron, Christine; Guelfi, Julien-Daniel; Rouillon, Frédéric; Gorwood, Philip
Cognitive and Behavioural Therapy (CBT) is widely used in bipolar disorder, but recent meta-analyses showed that its impact is either of limited effect or not significant for important aspects such as recurrence rate. A possible benefit of CBT could concern cognitive functions, known to be frequently impaired in patients with bipolar disorder. We analysed if the positive impact of 6 months group-CBT was associated with the improvement of a specific cognitive function, namely explicit memory, trying to disentangle if memory bias (i.e. different capacity according to the emotional valence of words to be recalled) was more improved than memory performance (i.e., total number of recalled words). Depressive, manic, anxiety symptoms and explicit memory for emotional words were initially assessed in 68 remitted bipolar I patients. Six months later, with an attrition rate of 16.2%, patients were re-assessed after CBT (N = 42) or as control condition (waiting list, N = 15). The expected impact of CBT was assessed through the improvement in the Dysfunctional Attitudes Scale. After CBT, an increase was observed for the number of neutral, positive and total words recalled, whereas the number of negative words recalled decreased. This increase was still significant when the improvement of dysfunctional attitudes and mood symptoms are taken into account. The small sample of control patients. CBT was effective, as it improved dysfunctional attitudes and reduced remaining symptoms, but also, and independently, it improved explicit memory performance while reducing memory bias in favour of negative words. Copyright © 2012 Elsevier Ltd. All rights reserved.
van Steensel, F.J.A.; Bögels, S.M.
Objective: The effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders in children with autism spectrum disorders (ASD) was examined, and compared with children without ASD. Method: Children with ASD and comorbid anxiety disorders (n = 79, 58 boys; Mage = 11.76) and children with
Esbjørn, Barbara Hoff; Breinholst, Sonja; Reinholdt-Dunne, Marie Louise
Esbjørn, B. H., Breinholst, S., Reinholdt-Dunne, M. L., & Leth, I. (2011). The effect of parental involvement in CBT of anxious children: Preliminary results from a RCT study. Poster accepted for the Association for Behavioral and Cognitive Therapies, Toronto, Canada....
Schlup, Barbara; Farrell, Lara; Barrett, Paula
This waitlist-controlled study investigates the impact of a group-based cognitive-behavioral therapy with family involvement (CBT-F) on observed mother and child behaviors in children with obsessive-compulsive disorder (OCD). Forty-four children and adolescents with OCD and their mothers were observed during family discussions before and after…
Bockting, Claudi L.H.
A crucial part of the treatment of depression is the prevention of relapse and recurrence. Psychological interventions, especially cognitive behavior therapy (CBT) are helpful in preventing relapse and recurrence in depression. The effectivity of four types of relapse prevention cognitive behavior
Yeo, Lay See; Choi, Pui Meng
The present study investigated the effectiveness of a cognitive-behavioural therapy (CBT) programme delivered by a school psychologist for children with behavioural difficulties in Singapore elementary school classrooms. It examined the impact of a 12-session, psychoeducational group intervention in helping misbehaving pupils to control their…
Objective: The objectives of the current study were to ascertain feasibility and acceptability of directly delivering a cognitive-behavioral therapy (CBT) group intervention for inattentive children in a school setting, to examine the reliability of the RATE-C Questionnaires that accompany the program, and to determine whether they can be used to…
Kearny, Regina; Pawlukewicz, Justine; Guardino, Mary
Because anxiety is the most common mental health disorder diagnosed in children, early intervention is crucial for fundamental coping. Although cognitive-behavioral therapy (CBT) is the preferred treatment method for this affective disorder, instruction for children needs to be specific for them to successfully acquire and implement essential CBT…
Vaclavik, Daniella; Buitron, Victor; Rey, Yasmin; Marin, Carla E; Silverman, Wendy K; Pettit, Jeremy W
Cognitive behavioral therapies (CBTs) are efficacious treatments for anxiety disorders in Latino youth. However, there is a gap in knowledge about moderators of CBT outcomes in Latino youth. This study addresses this gap by examining parental acculturation as a moderator of youth anxiety outcomes in a randomized controlled trial of parent-involved CBT (CBT/P) and peer-involved group CBT (GCBT) in 139 Latino youth (ages 6 to 16 years; mean age = 9.68 years). Comparable youth anxiety reduction effects were found for CBT/P and GCBT. Parental acculturation to majority US culture, but not identification with country of origin, significantly moderated youth anxiety outcomes: at low levels of parental acculturation to majority US culture, youth posttreatment anxiety scores were lower in GCBT than CBT/P; at high levels of parental acculturation to majority US culture, youth posttreatment anxiety scores were lower in CBT/P than GCBT. These findings provide further evidence for the efficacy of CBTs for anxiety disorders in Latino youth and also provide guidance for moving toward personalization of CBTs' selection depending on parental acculturation levels.
Lund, Hannah G; Rybarczyk, Bruce D; Perrin, Paul B; Leszczyszyn, David; Stepanski, Edward
To examine the effect of cognitive-behavioral therapy for insomnia (CBT-I) on the underreporting of sleep relative to objective measurement, a common occurrence among individuals with insomnia. Pre-treatment and post-treatment self-report measures of sleep were compared with those obtained from home-based polysomnography (PSG) in 60 adults (mean age = 69.17; 42 women) with comorbid insomnia. The self-report data were published previously in a randomized controlled trial demonstrating the efficacy of CBT-I compared with a placebo treatment. Self-report measures significantly underestimated sleep at pre-treatment and CBT-I led to a correction in this discrepancy. There were no significant changes in PSG after CBT-I. Path analysis showed that an increase in an objective proxy measure of sleep quality (i.e., decreased stage N1 sleep) after CBT-I was significantly related to improvements in self-report of sleep, with full mediation by reductions in discrepancy. This is the first CBT-I outcome study to analyze discrepancy changes and demonstrate that these changes account for a significant portion of self-report outcome. In addition, improved sleep quality as measured by a decrease in percentage of stage N1 sleep following treatment may be one mechanism that explains why sleep estimation is more accurate following CBT-I. © 2012 Wiley Periodicals, Inc.
Dorsey, Julie; Bradshaw, Michelle
Lower-extremity (LE) musculoskeletal disorders (MSDs) can have a major impact on the ability to carry out daily activities. The effectiveness of interventions must be examined to enable occupational therapy practitioners to deliver the most appropriate services. This systematic review examined the literature published between 1995 and July 2014 that investigated the effectiveness of occupational therapy interventions for LE MSDs. Forty-three articles met the criteria and were reviewed. Occupational therapy interventions varied on the basis of population subgroup: hip fracture, LE joint replacement, LE amputation or limb loss, and nonsurgical osteoarthritis and pain. The results indicate an overall strong role for occupational therapy in treating clients with LE MSDs. Activity pacing is an effective intervention for nonsurgical LE MSDs, and multidisciplinary rehabilitation is effective for LE joint replacement and amputation. Further research on specific occupational therapy interventions in this important area is needed. Copyright © 2017 by the American Occupational Therapy Association, Inc.
Vedel, Ellen; Emmelkamp, Paul M G; Schippers, Gerard M
Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol consumption and enhancing marital functioning, but no study has directly tested the comparative effectiveness of stand-alone BCT versus an individually focused cognitive-behavioral therapy (CBT) in a clinical community sample. The present study is a randomized clinical trial evaluating the effectiveness of stand-alone BCT (n = 30) compared to individual CBT (n = 34) in the treatment of alcohol use disorders in community treatment centers in Dutch male and female alcoholics and their partners. Results show both BCT and CBT to be effective in changing drinking behavior after treatment. BCT was not found to be superior to CBT. Marital satisfaction of the spouse increased significantly in the BCT condition but not in the CBT condition, the differences being significant at the post-test. Patients' self-efficacy to withstand alcohol-related high-risk situations increased significantly in both treatment conditions, but more so in CBT than in BCT after treatment. Treatment involvement of the spouse did not increase retention. Regular practitioners in community treatment centers can effectively deliver both treatments. Stand-alone BCT is as effective as CBT in terms of reduced drinking and to some extent more effective in terms of enhancing relationship satisfaction. However, BCT is a more costly intervention, given that treatment sessions lasted almost twice as long as individual CBT sessions. Copyright 2008 S. Karger AG, Basel.
Walczak, Monika Anna; Esbjørn, Barbara Hoff; Breinholst, Sonja
Children’s and parents’ attachment patterns have been linked with the presence of pediatric anxiety disorders. The present study examined the role of attachment in predicting cognitive behavior therapy (CBT) treatment outcomes. A total of 69 children aged 7–13 years were assessed using a semi......-structured interview, and treated with CBT. Differences between responders and nonresponders with regard to pretreatment characteristics were explored, and the predictive power of factors significantly different between groups was assessed using binominal logistic regression. Responders and nonresponders did...
Huegli, R.W.; Jacob, A.L.; Steinbrich, W. [Universitaetsspital Basel (Switzerland). Interventionelle Radiologie
Spinal affections belong to the most widespread sources of back pain. Beside medical history and clinical examination, the radiological investigation plays an important rote in the clinical workup especially with the modern Cross sectional imaging methods such as computed and magnetic resonance tomography. After exclusion of a malignant disease usually a conservative therapeutic approach is the first line treatment option. If the conservative treatment approach falls a minimalinvasive image guided diagnostic or therapeutic infiltration may be considered. Thereby the interventional radiologist should be a member of the team which decides the clinical strategy. This article describes epidemiology and pathophysiology, common pre-interventional diagnostic strategies, drugs, indications, possible complications and the impact of diagnostic and therapeutic minimally invasive image guided techniques in low back pain. In this context facet joint blockade, periradicular and peridural therapy as well as sacroiliac joint blockades are discussed.
Ellis, Jason G; Cushing, Toby; Germain, Anne
Despite considerable evidence supporting cognitive behavioral therapy for insomnia (CBT-I) for chronic insomnia, it remains untested within the context of acute insomnia. This study examined the efficacy of a single session of CBT-I, with an accompanying self-help pamphlet, for individuals with acute insomnia. A pragmatic parallel group randomized controlled trial. Community. Forty adults (mean age 32.9 ± 13.72 y) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defined insomnia disorder, except a self-reported duration of less than 3 mo (i.e., acute insomnia), who reported no previous exposure to CBT-I and were not currently taking medication for sleep. A single 60- to 70-min session of CBT-I (n = 20), with an accompanying self-help pamphlet, or wait list control group (n = 20). All subjects were offered a full individual course of CBT-I on completion of the study, regardless of group allocation. Subjects completed sleep diaries and the Insomnia Severity Index (ISI) pretreatment and 1 mo following treatment. There were no between-group differences on baseline ISI scores or subjective sleep continuity. The intervention group reported significantly lower ISI scores than controls (t(38) 2.24, P insomnia caseness (i.e., ≥ 10), 60% of those in the CBT-I group had remitted by 1 mo compared to 15% of those in the control group. This single session of cognitive behavioral therapy for insomnia (CBT-I) is sufficiently efficacious for a significant proportion of those with acute insomnia. The results are discussed in terms of integrating this brief form of CBT-I into the "stepped care" model of insomnia. Testing the efficacy of an early intervention for acute insomnia (SRCTN05891695) http://www.controlled-trials.com/ISRCTN05891695. © 2015 Associated Professional Sleep Societies, LLC.
In 1997, researches at the University of Amsterdam developed one of the first psychotherapeutic applications of the World Wide Web. The implemented a standardized cognitive behavioural treatment (CBT) of post-traumatic stress symptoms in a website, and used this site to treat clients over the
Eidelman, Polina; Talbot, Lisa; Ivers, Hans; Bélanger, Lynda; Morin, Charles M; Harvey, Allison G
As part of a larger randomized controlled trial, 188 participants were randomized to behavior therapy (BT), cognitive therapy (CT), or cognitive-behavioral therapy (CBT) for insomnia. The aims of this study were threefold: (a) to determine whether change in dysfunctional beliefs about sleep was related to change in sleep, insomnia symptoms, and impairment following treatment; (b) to determine whether BT, CT, and CBT differ in their effects on dysfunctional beliefs; and (c) to determine whether the treatments differ in their effects on particular kinds of dysfunctional beliefs. Beliefs, sleep, insomnia symptoms, and sleep-related psychosocial impairment were assessed at pretreatment, posttreatment, and 6- and 12-month follow-up. Greater change in dysfunctional beliefs occurring over the course of BT, CT, or CBT was associated with greater improvement in insomnia symptoms and impairment at posttreatment and both follow-ups. All groups experienced a significant decrease in dysfunctional beliefs during treatment, which were sustained through 6- and 12-month follow-up. Compared with the BT group, a greater proportion of participants in the CT and/or CBT groups endorsed dysfunctional beliefs below a level considered clinically significant at posttreatment and 12-month follow-up. The results demonstrate the importance of targeting dysfunctional beliefs in insomnia treatment, suggest that beliefs may be significantly modified with BT alone, and indicate that cognitive interventions may be particularly powerful in enhancing belief change. Copyright © 2016. Published by Elsevier Ltd.
Addington, Jean; Epstein, Irvin; Liu, Lu; French, Paul; Boydell, Katherine M; Zipursky, Robert B
There has been increasing interest in early detection during the prodromal phase of a psychotic disorder. To date a few treatment studies have been published with some promising results for both pharmacological treatments, using second generation antipsychotics, and psychological interventions, mainly cognitive behavioral therapy. The purpose of this study was to determine first if cognitive behavioral therapy (CBT) was more effective in reducing the rates of conversion compared to a supportive therapy and secondly whether those who received CBT had improved symptoms compared to those who received supportive therapy. Fifty-one individuals at clinical high risk of developing psychosis were randomized to CBT or a supportive therapy for up to 6 months. The sample was assessed at 6, 12 and 18 months post baseline on attenuated positive symptoms, negative symptoms, depression, anxiety and social functioning. Conversions to psychosis only occurred in the group who received supportive therapy although the difference was not significant. Both groups improved in attenuated positive symptoms, depression and anxiety and neither improved in social functioning and negative symptoms. There were no differences between the two treatment groups. However, the improvement in attenuated positive symptoms was more rapid for the CBT group. There are limitations of this trial and potential explanations for the lack of differences. However, both the results of this study and the possible explanations have significant implications for early detection and intervention in the pre-psychotic phase and for designing future treatments. Copyright © 2010 Elsevier B.V. All rights reserved.
Gradisar, Michael; Dohnt, Hayley; Gardner, Greg; Paine, Sarah; Starkey, Karina; Menne, Annemarie; Slater, Amy; Wright, Helen; Hudson, Jennifer L.; Weaver, Edward; Trenowden, Sophie
Objective: To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD). Design: Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only. Setting: Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia. Patients: 49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs WL: N = 17). Interventions: CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene. Measurements and Results: DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed. Clinical Trial Information: Australia – New Zealand Trials Registry Number: ACTRN12610001041044. Citation: Gradisar M; Dohnt H; Gardner G; Paine S; Starkey
Trockel, Mickey; Karlin, Bradley E.; Taylor, C. Barr; Brown, Gregory K.; Manber, Rachel
Objective: To examine the effects of cognitive behavioral therapy for insomnia (CBT-I) on suicidal ideation among Veterans with insomnia. Design: Longitudinal data collected in the course of an uncontrolled evaluation of a large-scale CBT-I training program. Setting: Outpatient and residential treatment facilities. Participants: Four hundred five Veterans presenting for treatment of insomnia. Interventions: Cognitive behavioral therapy for insomnia. Measurement and Results: At baseline, 32% of patients, compared with 21% at final assessment, endorsed some level of suicidal ideation [χ2(df = 1) = 125; P suicidal ideation. The effect of change in insomnia severity on change in depression severity was also significant. After controlling for change in depression severity and other variables in the model, the effect of change in insomnia severity on change in suicidal ideation remained significant. Conclusion: This evaluation of the largest dissemination of cognitive behavioral therapy for insomnia (CBT-I) in the United States found a clinically meaningful reduction in suicidal ideation among Veterans receiving CBT-I. The mechanisms by which effective treatment of insomnia with CBT-I reduces suicide risk are unknown and warrant investigation. The current results may have significant public health implications for preventing suicide among Veterans. Citation: Trockel M, Karlin BE, Taylor CB, Brown GK, Manber R. Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. SLEEP 2015;38(2):259–265. PMID:25515115
Crits-Christoph, Paul; Gibbons, Mary Beth Connolly; Temes, Christina M.; Elkin, Irene; Gallop, Robert
Objective: The purpose of the current investigation was to examine the interpersonal accuracy of interventions in cognitive therapy and interpersonal therapy as a predictor of the outcome of treatment for patients with major depressive disorder. Method: The interpersonal accuracy of interventions was rated using transcripts of treatment sessions…
Noelle R Leonard
Full Text Available We investigated the impact of cognitive behavioral therapy and mindfulness training (CBT/MT on attentional task performance in incarcerated adolescents. Attention is a cognitive system necessary for managing cognitive demands and regulating emotions. Yet persistent and intensive demands, such as those experienced during high-stress intervals like incarceration and the events leading to incarceration, may deplete attention resulting in cognitive failures, emotional disturbances, and impulsive behavior. We hypothesized that CBT/MT may mitigate these deleterious effects of high stress and protect against degradation in attention over the high-stress interval of incarceration. Using a group randomized controlled trial design, we randomly assigned dormitories of incarcerated youth, ages 16 to 18, to a CBT/MT intervention (youth n = 147 or an active control intervention (youth n = 117. Both arms received approximately 750 minutes of intervention in a small-group setting over a 3-5 week period. Youth in the CBT/MT arm also logged the amount of out-of-session time spent practicing MT exercises. The Attention Network Test was used to index attentional task performance at baseline and 4 months post-baseline. Overall, task performance degraded over time in all participants. The magnitude of performance degradation was significantly less in the CBT/MT vs. control arm. Further, within the CBT/MT arm, performance degraded over time in those with no outside-of-class practice time, but remained stable over time in those who practiced mindfulness exercises outside of the session meetings. Thus, these findings suggest that sufficient CBT/MT practice may protect against functional attentional impairments associated with high-stress intervals. Keywords: adolescent development, incarcerated adolescents, detained adolescents, stress, attention, mindfulness meditation.
Talbot, Lisa S.; Maguen, Shira; Metzler, Thomas J.; Schmitz, Martha; McCaslin, Shannon E.; Richards, Anne; Perlis, Michael L.; Posner, Donn A.; Weiss, Brandon; Ruoff, Leslie; Varbel, Jonathan; Neylan, Thomas C.
Study Objectives: Examine whether cognitive behavioral therapy for insomnia (CBT-I) improves sleep in posttraumatic stress disorder (PTSD) as well as nightmares, nonsleep PTSD symptoms, depression symptoms, and psychosocial functioning. Design: Randomized controlled trial with two arms: CBT-I and monitor-only waitlist control. Setting: Department of Veterans Affairs (VA) Medical Center. Participants: Forty-five adults (31 females: [mean age 37 y (22-59 y)] with PTSD meeting research diagnostic criteria for insomnia, randomly assigned to CBT-I (n = 29; 22 females) or monitor-only waitlist control (n = 16; nine females). Interventions: Eight-session weekly individual CBT-I delivered by a licensed clinical psychologist or a board-certified psychiatrist. Measurements and Results: Measures included continuous monitoring of sleep with diary and actigraphy; prepolysomnography and postpolysomnography and Clinician-Administered PTSD Scale (CAPS); and pre, mid, and post self-report questionnaires, with follow-up of CBT-I participants 6 mo later. CBT-I was superior to the waitlist control condition in all sleep diary outcomes and in polysomnography-measured total sleep time. Compared to waitlist participants, CBT-I participants reported improved subjective sleep (41% full remission versus 0%), disruptive nocturnal behaviors (based on the Pittsburgh Sleep Quality Index-Addendum), and overall work and interpersonal functioning. These effects were maintained at 6-mo follow-up. Both CBT-I and waitlist control participants reported reductions in PTSD symptoms and CAPS-measured nightmares. Conclusions: Cognitive behavioral therapy for insomnia (CBT-I) improved sleep in individuals with posttraumatic stress disorder, with durable gains at 6 mo. Overall psychosocial functioning improved following CBT-I. The initial evidence regarding CBT-I and nightmares is promising but further research is needed. Results suggest that a comprehensive approach to treatment of posttraumatic stress
Kobak, Kenneth A; Mundt, James C; Kennard, Betsy
Rapid advances in information technology and telecommunications have resulted in a dramatic increase in the use of mobile devices and the internet to enhance and facilitate access to treatment. Cognitive behavior therapy (CBT) is an empirically based treatment that is well suited for enhancement by new technologies, particularly with youth. To facilitate the dissemination of this evidence-based treatment, we developed a technology-enhanced CBT intervention for the treatment of adolescent depression consisting of (1) online therapist training (2) in-session use of tablets for teaching clients CBT concepts and skills, and (3) text messaging for between session homework reminders and self-monitoring. Eighteen licensed clinicians (social workers n = 7, psychologists n = 9) were randomized to have their patients receive either the intervention (CBT) or treatment as usual (TAU). Each clinician treated four adolescents for 12 weeks. Clinicians in the CBT arm completed an online tutorial on CBT treatment of adolescent depression, then received an iPad with access to patient education materials for teaching CBT concepts to patients during sessions. Individualized text messages were integrated into treatment for homework reminders, support, and outcomes measurement. Outcome measures included a 49-item multiple choice test for tutorial effectiveness; the system usability scale (SUS) for user satisfaction; quick inventory of depressive symptomatology-adolescent version (QIDS-A-Pat); and clinician and patient ratings on the therapeutic alliance scale for adolescents (TASA). A significant increase in knowledge of CBT concepts was found after completing the tutorial, t(8) = 7.02, p higher in the CBT arm t(131) = 4.03, p = 0.001. A significant reduction in depression was found in both groups [t(34) = 8.453, p technology-enhanced CBT intervention as a means of improving CBT treatment of adolescent depression and may help address the critical shortage of therapists
Tang Jun; Shang Jianqiang; Chen Jie; Li Fengxin; Liu Yanjun
Objective: To determine the methods and results of treating traumatic pseudoaneurysms in siphon segment of internal carotid artery (ICA)by interventional therapy. Methods: Twelve cases of traumatic pseudoaneurysms in siphon segment of internal carotid artery were treated. The collateral circulation of Willis circle was observed after DSA. Different methods of treatment were applied according to the collateral circulation of Willis circle. Ten cases were treated by occlusion of ICA completely, 1 case was embolized by guglielmi detachable coil (GDC) only. Results: Nine of 12 treated by occlusion of ICA were cured. In the 3 cases who had poor collateral of Willis circle, one was cured by GDC embolization alone; one died 48 hours later after ICA occlusion though his consciousness and the activity of extremities were normal during the temporary balloon test occlusion (BTO) of ICA. One died during the training to improve the collateral of the Willis circle. Conclusion: ICA embolization is feasible for treatment of traumatic pseudoaneurysms in siphon segment of internal carotid artery after evaluating the collateral circulation of Willis circle. (authors)
Arnfred, Sidse M.; Aharoni, Ruth; Hvenegaard, Morten
Background: Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the “The Unified Protocol for Transdiagnostic Treatment of Emotional...... of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors...... included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment...
Terides, Matthew D; Dear, Blake F; Fogliati, Vincent J; Gandy, Milena; Karin, Eyal; Jones, Michael P; Titov, Nickolai
Cognitive-behavioural therapy (CBT) is an effective treatment for clinical and subclinical symptoms of depression and general anxiety, and increases life satisfaction. Patients' usage of CBT skills is a core aspect of treatment but there is insufficient empirical evidence suggesting that skills usage behaviours are a mechanism of clinical change. This study investigated if an internet-delivered CBT (iCBT) intervention increased the frequency of CBT skills usage behaviours and if this statistically mediated reductions in symptoms and increased life satisfaction. A two-group randomised controlled trial was conducted comparing internet-delivered CBT (n = 65) with a waitlist control group (n = 75). Participants were individuals experiencing clinically significant symptoms of depression or general anxiety. Mixed-linear models analyses revealed that the treatment group reported a significantly higher frequency of skills usage, lower symptoms, and higher life satisfaction by the end of treatment compared with the control group. Results from bootstrapping mediation analyses revealed that the increased skills usage behaviours statistically mediated symptom reductions and increased life satisfaction. Although skills usage and symptom outcomes were assessed concurrently, these findings support the notion that iCBT increases the frequency of skills usage behaviours and suggest that this may be an important mechanism of change.
Bragard, Isabelle; Etienne, Anne-Marie; Faymonville, Marie-Elisabeth; Coucke, Philippe; Lifrange, Eric; Schroeder, Hélène; Wagener, Aurélie; Dupuis, Gilles; Jerusalem, Guy
The authors asked breast cancer (BC) patients to participate in 1 of 3 mind-body interventions (cognitive-behavioral therapy (CBT), yoga, or self-hypnosis) to explore their feasibility, ease of compliance, and impact on the participants' distress, quality of life (QoL), sleep, and mental adjustment. Ninety-nine patients completed an intervention (CBT: n = 10; yoga: n = 21; and self-hypnosis: n = 68). Results showed high feasibility and high compliance. After the interventions, there was no significant effect in the CBT group but significant positive effects on distress in the yoga and self-hypnosis groups, and, also, on QoL, sleep, and mental adjustment in the self-hypnosis group. In conclusion, mind-body interventions can decrease distress in BC patients, but RCTs are needed to confirm these findings.
Cassin, Stephanie E.; Wnuk, Susan; Du, Chau; Jackson, Timothy; Hawa, Raed; Parikh, Sagar V.
Objective This study aimed to determine the feasibility and preliminary efficacy of a post-operative telephone-based cognitive behavioral therapy intervention (Tele-CBT) in improving eating pathology and psychosocial functioning. Methods Six-month post-operative bariatric surgery patients (n = 19) received six sessions of Tele-CBT. Study outcome variables included binge eating (BES), emotional eating (EES), depressive symptoms (PHQ-9), and anxiety symptoms (GAD-7). Results Retention was 73.7 % post-intervention. Tele-CBT resulted in significant reductions in mean difference scores on BES, EES-Total, EES-Anxiety, EES-Anger, PHQ9, and GAD7. Tele-CBT patients experienced a mean weight loss of 8.62 ± 15.02 kg between 6-months post-surgery (pre-Tele-CBT) and 12-months post-surgery. Conclusions These preliminary results suggest that post-surgery Tele-CBT is feasible and can improve post-surgery symptoms of psychopathology in this uncontrolled study, supporting the need for a randomized controlled trial. PMID:27491293
Morean, Meghan E; Kong, Grace; Camenga, Deepa R; Cavallo, Dana A; Carroll, Kathleen M; Pittman, Brian; Krishnan-Sarin, Suchitra
Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward. We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence. CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation. CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers. Copyright © 2014 Elsevier Ltd. All rights reserved.
Granero, R; Fernández-Aranda, F; Mestre-Bach, G; Steward, T; Baño, M; Agüera, Z; Mallorquí-Bagué, N; Aymamí, N; Gómez-Peña, M; Sancho, M; Sánchez, I; Menchón, J M; Martín-Romera, V; Jiménez-Murcia, S
Compulsive buying behavior (CBB) is receiving increasing consideration in both consumer and psychiatric-epidemiological research, yet empirical evidence on treatment interventions is scarce and mostly from small homogeneous clinical samples. To estimate the short-term effectiveness of a standardized, individual cognitive behavioral therapy intervention (CBT) in a sample of n=97 treatment-seeking patients diagnosed with CBB, and to identify the most relevant predictors of therapy outcome. The intervention consisted of 12 individual CBT weekly sessions, lasting approximately 45minutes each. Data on patients' personality traits, psychopathology, sociodemographic factors, and compulsive buying behavior were used in our analysis. The risk (cumulative incidence) of poor adherence to the CBT program was 27.8%. The presence of relapses during the CBT program was 47.4% and the dropout rate was 46.4%. Significant predictors of poor therapy adherence were being male, high levels of depression and obsessive-compulsive symptoms, low anxiety levels, high persistence, high harm avoidance and low self-transcendence. Cognitive behavioral models show promise in treating CBB, however future interventions for CBB should be designed via a multidimensional approach in which patients' sex, comorbid symptom levels and the personality-trait profiles play a central role. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Martinez Devesa, P; Waddell, A; Perera, R; Theodoulou, M
Tinnitus is an auditory perception that can be described as the experience of sound, in the ear or in the head, in the absence of external acoustic stimulation (not usually audible to anyone else). At present no specific therapy for tinnitus is acknowledged to be satisfactory in all patients. Cognitive behavioural therapy (CBT) uses relaxation, cognitive restructuring of the thoughts and exposure to exacerbating situations in order to promote habituation and may benefit tinnitus patients, as may the treatment of associated psychological conditions. To assess whether cognitive behavioural therapy is effective in the management of patients suffering from tinnitus. Our search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE and EMBASE. The last search date was June 2006. Randomised controlled trials in which patients with unilateral or bilateral tinnitus as main symptom received cognitive behavioural treatment. One review author (PMD) assessed every report identified by the search strategy. The four review authors assessed the methodological quality, applied inclusion/exclusion criteria and extracted data. Six trials comprising 285 participants were included. 1. subjective tinnitus loudness. CBT compared to a waiting list control group: we found no significant difference (Standardised Mean Difference (SMD) 0.06 (95% CI -0.25 to 0.37)). CBT compared to another intervention (Yoga, Education, Minimal Contact - Education and Education): we found no significant difference (SMD 0.1 (95% CI -0.22 to 0.42)).2. a) Depression. CBT compared to a waiting list control group: we found no significant difference in either group (SMD 0.29 (95%CI -0.04 to 0.63)). CBT compared to another intervention (Yoga, Education and Minimal Contact - Education): we found no significant difference (SMD 0.01 (95% CI -0.43 to 0.45)). b) Quality of life: CBT compared to a waiting list control
Jones, Karyn Dayle
Group play therapy is a common treatment modality for children who have been sexually abused. Sexually abused preschoolers exhibit different group play therapy behaviors than do nonabused children. Group workers need to be aware of these differences and know the appropriate group interventions. This article describes group play therapy with…
Petersson, Gunnar; Nystrom, Maria
The question of competence in providing music therapy has rarely been the focus of interest in empirical research, as most music therapy research aims at measuring outcomes. Therefore, the aim of this study is to analyse and describe musicians' learning processes when they study music therapy as a caring intervention. An initial presumption is…
McGillivray, J. A.; Evert, H. T.
We examined the efficacy of cognitive behavioural therapy (CBT) delivered in groups on the reduction of symptoms of depression, anxiety and stress in young people on the autism spectrum. Utilising a quasi-experimental design, comparisons were made between individuals allocated to a group intervention program and individuals allocated to a…
Full Text Available Abstract Background Psychological therapies especially Cognitive Behaviour Therapy (CBT are used widely in the West to help patients with psychiatric problems. Cognitive Behaviour Therapy has an established evidence base for the treatment of different emotional disorders. In spite of these developments in the developed world, patients in most developing countries hardly benefit from non pharmacological interventions. Although a significant number of psychologists are trained in Pakistan each year, psychological interventions play only a minor role in treatment plans in Pakistan. We conducted interviews with psychologists in Pakistan, to explore their experiences and their views on "providing CBT in Pakistan". These interviews were conducted as part of a project whose focus was to try to develop culturally-sensitive CBT in Pakistan. Methods In depth semi structured interviews were conducted with 5 psychologists working in psychiatry departments in Lahore, Pakistan. Results All the psychologists reported that psychotherapies, including CBT, need adjustments for use in Pakistan, although they were not able to elicit on these in details. Four major themes were discovered, hurdles in therapy, therapy related issues, involvement of the family and modification in therapy. The biggest hurdles in therapy were described to be service and resource issues. Conclusions For CBT to be acceptable, accessible and effective in Non Western cultures numerous adjustments need to be made, taking into consideration; factors related to service structure and delivery, patient's knowledge and beliefs about health and the therapy itself. Interviews with the psychologists in these countries can give us insights which can guide development of therapy and manuals to support its delivery.
Sportel, B Esther; de Hullu, Eva; de Jong, Peter J; Nauta, Maaike H
Social anxiety is a common mental disorder among adolescents and is associated with detrimental long term outcomes. Therefore, this study investigated the efficacy of two possible early interventions for adolescent social anxiety and test anxiety. An internet-based cognitive bias modification (CBM; n = 86) was compared to a school-based cognitive behavioral group training (CBT; n = 84) and a control group (n = 70) in reducing symptoms of social and test anxiety in high socially and/or test anxious adolescents aged 13-15 years. Participants (n = 240) were randomized at school level over the three conditions. CBM consisted of a 20-session at home internet-delivered training; CBT was a 10-session at school group training with homework assignments; the control group received no training. Participants were assessed before and after the intervention and at 6 and 12 month follow-up. At 6 month follow-up CBT resulted in lower social anxiety than the control condition, while for CBM, this effect was only trend-significant. At 12 month follow-up this initial benefit was no longer present. Test anxiety decreased more in the CBT condition relative to the control condition in both short and long term. Interestingly, in the long term, participants in the CBM condition improved more with regard to automatic threat-related associations than both other conditions. The results indicate that the interventions resulted in a faster decline of social anxiety symptoms, whereas the eventual end point of social anxiety was not affected. Test anxiety was influenced in the long term by the CBT intervention, and CBM lead to increased positive automatic threat-related associations. TrialRegister.nl NTR965.
Gumley, Andrew; Karatzias, Athanasios; Power, Kevin; Reilly, James; McNay, Lisa; O'Grady, Margaret
The study aimed to test two hypotheses. Firstly, that participants who relapsed during the 12-month follow-up period of our randomized controlled trial, would show increased negative beliefs about their illness and reduced self-esteem, in comparison to the non-relapsed participants. Secondly, that cognitive behavioural therapy (CBT) for early signs of relapse would result in a reduction in negative beliefs about psychosis and an improvement in self-esteem at 12 months. A total of 144 participants with schizophrenia or a related disorder were randomized to receive either treatment as usual (TAU; N=72) or CBT (N=72). Participants completed the Personal Beliefs about Illness Questionnaire (PBIQ; Birchwood, Mason, MacMillan, & Healy, 1993) and the Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965) at entry, 3 months, 6 months, and 12 months. At 12 months, relapsers showed greater increase in scores for PBIQ entrapment compared with non-relapsers. In addition, after controlling for baseline covariates (treatment group and PBIQ self versus illness), relapsers also showed greater increase in scores for PBIQ self versus illness at 12 months. Furthermore, in comparison to treatment as usual, participants who received CBT showed greater improvement in PBIQ loss and in Rosenberg self-esteem. The study provides evidence that relapse is associated with the development of negative appraisals of entrapment and self-blame (self vs. illness). In addition, this is the first study to show that CBT reduces negative appraisals of loss arising from psychosis and improvements in self-esteem. Implications for future research and treatment are discussed.
Liber, J.M.; de Boo, G.M.; Huizenga, H.; Prins, P.J.M.
Objective: In this randomized controlled trial, we investigated the effectiveness of a school-based targeted intervention program for disruptive behavior. A child-focused cognitive behavioral therapy (CBT) program was introduced at schools in disadvantaged settings and with active teacher support
Liber, J.M.; de Boo, G.M.; Huizenga, H.; Prins, P.J.M.
Objective: In this randomized controlled trial, we investigated the effectiveness of a school-based targeted intervention program for disruptive behavior. A child-focused cognitive behavioral therapy (CBT) program was introduced at schools in disadvantaged settings and with active teacher support
Christensen, Helen; Farrer, Louise; Batterham, Philip J.; Mackinnon, Andrew; Griffiths, Kathleen M.; Donker, Tara
OBJECTIVES: The effect of web-based interventions for depression on suicide ideation in callers to helplines is not known. The aim of this study was to determine if web-based Cognitive Behaviour Therapy (CBT) with and without telephone support is effective in reducing suicide ideation in callers to
Christensen, Helen; Farrer, Louise; Batterham, Philip J.; Mackinnon, Andrew; Griffiths, Kathleen M.; Donker, Tara
Objectives: The effect of web-based interventions for depression on suicide ideation in callers to helplines is not known. The aim of this study was to determine if web-based Cognitive Behaviour Therapy (CBT) with and without telephone support is effective in reducing suicide ideation in callers to
Ramsawh, Holly J; Bomyea, Jessica; Stein, Murray B; Cissell, Shadha H; Lang, Ariel J
Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.
Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis
Hudson, JL; Moss-Morris, R; Game, D; Carroll, A; McCrone, P; Hotopf, M; Yardley, L; Chilcot, J
Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced ...
Effectiveness of cognitive behavioral therapy integrated with systematic desensitization, cognitive behavioral therapy combined with eye movement desensitization and reprocessing therapy, and cognitive behavioral therapy combined with virtual reality exposure therapy methods in the treatment of flight anxiety: a randomized trial.
Triscari, Maria Teresa; Faraci, Palmira; Catalisano, Dario; D'Angelo, Valerio; Urso, Viviana
The purpose of the research was to compare the effectiveness of the following treatment methods for fear of flying: cognitive behavioral therapy (CBT) integrated with systematic desensitization, CBT combined with eye movement desensitization and reprocessing therapy, and CBT combined with virtual reality exposure therapy. Overall, our findings have proven the efficacy of all interventions in reducing fear of flying in a pre- to post-treatment comparison. All groups showed a decrease in flight anxiety, suggesting the efficiency of all three treatments in reducing self-report measures of fear of flying. In particular, our results indicated significant improvements for the treated patients using all the treatment programs, as shown not only by test scores but also by participation in the post-treatment flight. Nevertheless, outcome measures maintained a significant effect at a 1-year follow-up. In conclusion, combining CBT with both the application of eye movement desensitization and reprocessing treatment and the virtual stimuli used to expose patients with aerophobia seemed as efficient as traditional cognitive behavioral treatments integrated with systematic desensitization.
Full Text Available Smoking cessation programs are widely implemented to assist smokers in the process of quitting smoking. Cognitive Behavioural Therapy (CBT is a psychological approach that is increasingly used in smoking cessation programs. CBT has also been implemented for smoking cessation programs and has been successful in helping smokers to quit. Another advantage of CBT is that it can be combined with different tools and technologies and hence made to deliver effective health intervention programs. The recent advancements in smartphone technologies have been widely explored to develop smoking cessation apps as tools to assist with quitting smoking. However, most existing smartphone apps lack follow-up and adherence to clinical guidelines for treatment. To date, there are no studies which have explored implementing CBT modules into smoking cessation apps. Therefore, there is a need for implementing behavioural change mechanisms in smoking cessation apps to help smokers quit effectively. In this study, we propose a new approach that combines mobile health technology and CBT methods to provide an effective smoking cessation program. The ubiquitous presence of smartphones and the various communication benefits they provide are utilized by our proposed system to provide a CBT paradigm into smoking cessation app systems and hence enhance their success potential. Currently, the proposed system is at the implementation stage, which is soon to be followed by a clinical trial to study the impact of this system on smoking cessation.
Herbert, Vanessa; Kyle, Simon D; Pratt, Daniel
Individuals with insomnia report difficulties pertaining to their cognitive functioning. Cognitive behavioural therapy for insomnia (CBT-I) is associated with robust, long-term improvements in sleep parameters, however less is known about the impact of CBT-I on the daytime correlates of the disorder. A systematic review and narrative synthesis was conducted in order to summarise and evaluate the evidence regarding the impact of CBT-I on cognitive functioning. Reference databases were searched and studies were included if they assessed cognitive performance as an outcome of CBT-I, using either self-report questionnaires or cognitive tests. Eighteen studies met inclusion criteria, comprising 923 individuals with insomnia symptoms. The standardised mean difference was calculated at post-intervention and follow-up. We found preliminary evidence for small to moderate effects of CBT-I on subjective measures of cognitive functioning. Few of the effects were statistically significant, likely due to small sample sizes and limited statistical power. There is a lack of evidence with regards to the impact of CBT-I on objective cognitive performance, primarily due to the small number of studies that administered an objective measure (n = 4). We conclude that adequately powered randomised controlled trials, utilising both subjective and objective measures of cognitive functioning are required. Copyright © 2017 Elsevier Ltd. All rights reserved.
Södersten, P; Bergh, C; Leon, M; Brodin, U; Zandian, M
We examine the science and evidence supporting cognitive behavior therapy (CBT) for the treatment of bulimia nervosa and other eating disorders. Recent trials focusing on the abnormal cognitive and emotional aspects of bulimia have reported a remission rate of about 45%, and a relapse rate of about 30% within one year. However, an early CBT trial that emphasized the normalization of eating behavior had a better outcome than treatment that focused on cognitive intervention. In support of this finding, another treatment, that restores a normal eating behavior using mealtime feedback, has an estimated remission rate of about 75% and a relapse rate of about 10% over five years. Moreover, when eating behavior was normalized, cognitive and emotional abnormalities were resolved at remission without cognitive therapy. The critical aspect of the CBT treatment of bulimia nervosa therefore may actually have been the normalization of eating behavior. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Garvik, Margit; Idsoe, Thormod; Bru, Edvin
The present study aimed to investigate changes in school functioning, including motivation, intentions to quit school and social relations in school, following an early group based CBT intervention implemented for depressed adolescents. The "Adolescent Coping with Depression Course" (ACDC) is such an early group intervention. The primary…
Houghton, Stephen; Alsalmi, Nadiyah; Tan, Carol; Taylor, Myra; Durkin, Kevin
To evaluate an 8-week cognitive behavior therapy (CBT) treatment specifically designed for adolescents with ADHD and comorbid anxiety. Using a multiple baseline design, nine adolescents (13 years to 16 years 9 months) received a weekly CBT, which focused on four identified anxiety-arousing times. Participants self-recorded their levels of anxiety for each of the four times during baseline, intervention, and a maintenance phase. Anxiety was also assessed using the Multidimensional Anxiety Scale for Children (MASC). Paired samples t tests supported the success of the intervention. Interrupted time-series data for each participant revealed varying rates of success across the four times, however. The MASC data revealed significant reductions in Physical Symptoms of Anxiety, Social Anxiety, Separation Anxiety, Harm Avoidance, and Total Anxiety. The data demonstrate the efficacy of a CBT program for the treatment of comorbid anxiety in adolescents with ADHD.
Depression is an extremely common mental health disorder, with prevalence rates rising. Low-intensity interventions are frequently used to help meet the demand for treatment. Bibliotherapy, for example, is often prescribed via books on prescription schemes (for example 'Reading Well' in England) to those with mild to moderate symptomology. Bibliotherapy can effectively reduce symptoms of depression (Naylor et al., 2010). However, the majority of self-help books are based on cognitive behavioural therapy (CBT), which may not be suitable for all patients. Research supports the use of positive psychology interventions for the reduction of depression symptoms (Bolier et al., 2013) and as such self-help books from this perspective should be empirically tested. This study aimed to test the efficacy of 'Positive Psychology for Overcoming Depression' (Akhtar, 2012), a self-help book for depression that is based on the principles of positive psychology, in comparison with a CBT self-help book that is currently prescribed in England as part of the Reading Well books on prescription scheme. Participants (n = 115) who were not receiving treatment, but had symptoms of depression, read the positive psychology or the CBT self-help book for 8 weeks. Depression and well-being were measured at baseline, post-test and 1-month follow-up. Results suggest that both groups experienced a reduction in depression and an increase in well-being, with no differences noted between the two books. Future directions are discussed in terms of dissemination, to those with mild to moderate symptoms of depression, via books on prescription schemes.
Gao Xinghan; Zhu Zhenfang; Lv Fanzhen; Yan Dejun; Su Baomin
Objective: To study the indication, the procedure, the necessity and feasibility of the percutaneous interventional therapy of lung abscess and pyothorax under the CT guidance. Methods: The group included 18 patients who received percutaneous interventional therapy of lung abscess and pyothorax. Results: 13 patients were cured by a single procedure, 3 patients received twice intervention. Triple therapies were done in 2 patients. 2 cases out of 18 were eventually diagnosed as peripheral lung cancer. The body temperature and the WBC count returned to normal range after the procedures. 16 patients completely recovered in 1-5 weeks after the therapies. Conclusion: The interventional therapy under CT guidance not only helps the diagnosis and differential diagnosis of chronic or acute lung abscess and pyothorax, but also shortens the course of treatment and avoids the open surgery. It is a safe, simple and convenient method
Acarturk, Z Ceren; Abuhamdeh, Sami; Jalal, Baland; Unaldı, Nurdan; Alyanak, Behiye; Cetinkaya, Mustafa; Gulen, Birgul; Hinton, Devon
The most common mental health problems among adolescents are anxiety and mood disorders. While disorder-specific cognitive behavior therapy (CBT) is effective for each of these conditions, the comorbidity between anxiety and mood disorders indicates a need for the development of evidence-based transdiagnostic treatments. To examine the efficacy of culturally adapted transdiagnostic CBT (CA-CBT) in reducing symptoms of anxiety and depression in treatment-resistant Turkish adolescents, 13 adolescent participants with anxiety or mood disorders who were treatment resistant received 10 sessions of CA-CBT in group format. The main outcome measures were the Screen for Childhood Child Anxiety Related Disorders (SCARED), Beck Depression Inventory (BDI), and the Turkish Symptom and Syndrome Addendum (TSSA), which were assessed at baseline, posttreatment, and at 2-month follow-up. At posttreatment, there were large effect sizes for all measures: depression scores (BDI, d = .9), anxiety scores (SCARED, d = 1.1), and the Turkish Symptom and Syndrome Addendum (TSSA, d = 1.6). Moreover, at 2-month follow-up, depression and anxiety symptoms were either maintained or continued to improve such that from pretreatment to follow-up the effect sizes were as follows: depression scores (BDI, d = 1.4), anxiety scores (SCARED, d = 1.7), and the Turkish Symptom and Syndrome Addendum (TSSA, d = 2.4). In addition, there were no dropouts across treatment. This open trial suggests that CA-CBT is effective in reducing anxiety and depression symptoms and that the treatment is well accepted. A full randomized controlled trial to verify the effectiveness of transdiagnostic CA-CBT in similar populations is needed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Kava, Christine M.; Akiba, Christopher F.; Lucid, Leah; Dorsey, Shannon
Objective This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known how about western-developed EBTs are delivered in a culturally responsive manner. Method Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data. Results Lay counselors described the importance of being responsive to TF-CBT participants’ customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs. Conclusion The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. PMID:27414470
van Steensel, F J A; Bögels, S M
The effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders in children with autism spectrum disorders (ASD) was examined, and compared with children without ASD. Children with ASD and comorbid anxiety disorders (n = 79, 58 boys; Mage = 11.76) and children with anxiety disorders (n = 95, 46 boys; Mage = 12.85), and their parents, participated. All families were referred to 1 of 7 mental health care centers and received the same CBT. Anxiety, quality of life, ASD-like behaviors, and emotional-behavioral problems were measured at waitlist (ASD-group only, n = 17), pretest, posttest, and 3 months, 1 year, and 2 years after CBT. CBT was more effective than waitlist for treating anxiety disorders (d = -1.45) and anxiety symptoms (d = -0.48) in children with ASD. At 2 years follow-up, 61% of the children with and 64% without ASD were free of their primary anxiety disorder (percentages not significantly different). The decrease in severity of anxiety disorders after CBT (d values ranging between -1.05 and -1.46) was not different for children with and without ASD. Improvements were less in children with ASD for (only) 2 out of 7 continuous outcomes measures: anxiety symptoms (d values ranging between -0.68 and -0.94 vs. d values ranging between -0.98 and -1.25) and quality of life (d values ranging between 0.39 and 0.56 vs. d values ranging between 0.77 and 0.98). CBT for anxiety disorders is effective for children with ASD, also in the long-term. Treatment gains may be somewhat less compared with children without ASD. (c) 2015 APA, all rights reserved).
Hu Di; Zeng Jinjin; Wang Jianfeng; Zhai Renyou
Objective: This research is one of the sub-researches of 'The comparative study of the standards of interventional therapies and the evaluation of the long-term and middle-term effects for common malignant tumors', which is one of the National Key Technologies R and D Program in the eleventh five-year plan. Based on the project,the authors need to establish an international standard in order to set up the national tumor interventional therapy database and registration system. Methods: By using the computing programs of downloading software, self-management and automatic integration, the program was written by the JAVA words. Results: The database and registration system for the national tumor interventional therapy was successfully set up, and it could complete both the simple and complex inquiries. The software worked well through the initial debugging. Conclusion: The national tumor interventional therapy database and registration system can not only precisely tell the popularizing rate of the interventional therapy nationwide, compare the results of different methods, provide the latest news concerning the interventional therapy, subsequently promote the academic exchanges between hospitals, but also help us get the information about the distribution of the interventional physicians, the consuming quantity and variety of the interventional materials, so the medical costs can be reduced. (authors)
Hamblen, Jessica L; Norris, Fran H; Symon, Kerry A; Bow, Thomas E
Cognitive-behavioral therapy for postdisaster distress (CBT-PD) is a transdiagnostic intervention that has been used following major disasters such as the 9/11 terrorist attacks and Hurricane Katrina. In this study, we report findings from a community-based treatment program that offered CBT-PD to individuals who experienced Hurricane Sandy. Eight trained community therapists delivered CBT-PD to 342 adults who had been exposed to Hurricane Sandy. Participants were assessed at referral, pretreatment, intermediate treatment, posttreatment and 5-month follow-up. The overall prepost effect size was 1.41, indicating large improvement pre to posttreatment. Gains were maintained at follow-up. Timing of the intervention did not affect outcome. Participants who received the intervention early (i.e., 10 to 15 months after Sandy) had the same improvement as those who received it later (i.e., 21 to 26 months after Sandy). Similarly, there was no difference in outcome between individuals with severe as compared with moderate distress at pretreatment. Results suggest that CBT-PD is appropriate for a range of individuals with moderate to severe distress and that it has benefit both early on as well as two years postdisaster. Findings add to growing literature that CBT-PD should be considered as one important component of a larger disaster response system. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Law, Emily F; Beals-Erickson, Sarah E; Fisher, Emma; Lang, Emily A; Palermo, Tonya M
Internet-delivered treatment has the potential to expand access to evidence-based cognitive-behavioral therapy (CBT) for pediatric headache, and has demonstrated efficacy in small trials for some youth with headache. We used a mixed methods approach to identify effective components of CBT for this population. In Study 1, component profile analysis identified common interventions delivered in published RCTs of effective CBT protocols for pediatric headache delivered face-to-face or via the Internet. We identified a core set of three treatment components that were common across face-to-face and Internet protocols: 1) headache education, 2) relaxation training, and 3) cognitive interventions. Biofeedback was identified as an additional core treatment component delivered in face-to-face protocols only. In Study 2, we conducted qualitative interviews to describe the perspectives of youth with headache and their parents on successful components of an Internet CBT intervention. Eleven themes emerged from the qualitative data analysis, which broadly focused on patient experiences using the treatment components and suggestions for new treatment components. In the Discussion, these mixed methods findings are integrated to inform the adaptation of an Internet CBT protocol for youth with headache.
Su Hongying; Xiao Liang; Zhong Hongshan; Xu Ke; Zheng Yanbo; Lu Zaiming
Objective: To summarize the different types, clinical manifestation, treatment and prognosis of pulmonary embolism after interventional therapy in order to promote the diagnosis and treatment for the severe complication. Methods: The cases of pulmonary embolism complications after interventional therapy were collected from three hospitals between 1998 and 2005. The patients were divided into two types of iodized oil and thrombus pulmonary embolism according to the different types of the embolus. The experience of the clinical manifestation, diagnosis and treatment were summarized. Results: Ten patients with pulmonary embolism complication after interventional therapy were collected, including five with thrombus pulmonary embolism and four with iodized oil pulmonary embolism. All 5 cases of the thrombus pulmonary embolism suffered burst dyspnea and apsychia, two died and the others recovered or turned better. Aggravating dyspnea without shock occurred in the five iodized oil pulmonary embolism cases, 1 to 3 days after interventional therapy. The symptoms disappeared 15 to 50 days after combined therapy including majorly oxygen supply therapy. Conclusion: Pulmonary embolism is an emergent and severe complication after interventional therapy including acute thrombus pulmonary embolism without deep vein thrombosis which can be effectively treated be effectively treated with maintaining effective circulation and thrombolysis; and iodized oil pulmonary embolism with slow onsets could disappear within 1 month after combined therapy with mainly oxygen supplying therapy. The diagnosis and antidiastole mainly rely on enhancement of CT scan. (authors)
Lee, Young Mi; Yeun, Young Ran
Several intervention studies have suggested that foot massage and cognitive behavioral therapy (CBT) are beneficial for reducing the stress response. However, no randomized control trials have been conducted to examine these effects in middle-aged women, who are more commonly exposed to stress relative to others. This study aimed to examine the effects of combined self-administered foot massage and CBT on the psychophysiological stress response in Korean middle-aged women. Randomized controlled trial. Subjects were recruited from the social welfare center in Sahmcheok, Kangwondo, Korea. The subjects performed some of the massage at the center and some at home, and CBT was performed at the center. Fifty-three women aged 45-64 years were randomly assigned to Group A (intervention, n = 31) or B (usual care, n = 30). Combined self-administered foot massage and CBT. Depression, anxiety, stress, blood pressure, heart rate, blood glucose (BG), and oxygen saturation were measured at baseline and 3-week follow-up. Mean depression scores (p = 0.021), stress scores (p = 0.009), systolic blood pressure (SBP) (p = 0.035), and BG levels (p = 0.007) had decreased significantly subsequent to the intervention. Combined self-administered foot massage and CBT led to reductions in depression, stress, SBP, and BG levels. Therefore, the intervention could be an effective means of reducing the stress response in middle-aged women.
Leurent Baptiste E
Full Text Available Abstract Background Whilst evidence suggests cognitive behaviour therapy (CBT may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT, a talking control (TC and treatment as usual (TAU, delivered in a primary care setting, for older people with depression. Methods Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. Results Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p Conclusions CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. Trial Registration isrctn.org Identifier: ISRCTN18271323
van den Akker, Lizanne E; Beckerman, Heleen; Collette, Emma H; Twisk, Jos Wr; Bleijenberg, Gijs; Dekker, Joost; Knoop, Hans; de Groot, Vincent
Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS-related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between-group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: -6.7 (95% confidence interval (CI) = -10.7; -2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = -3.6; 4.4)). No clinically relevant effects were found on societal participation. Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.
Dryman, M Taylor; McTeague, Lisa M; Olino, Thomas M; Heimberg, Richard G
Internet-delivered cognitive-behavioral therapy (ICBT) has been established as both efficacious and effective in reducing symptoms of social anxiety. However, most research has been conducted in controlled settings, and little is known regarding the utility of such programs in an open-access format. The present study examined the use, adherence, and effectiveness of Joyable, an open-access, Internet-delivered, coach-supported CBT-based intervention for social anxiety. Participants were 3,384 registered users (Mage [SD] = 29.82 [7.89]; 54% male) that created an account between 2014 and 2016. Characteristics of use, factors related to attrition and adherence, and within-group outcomes were examined. The primary outcome measure was the Social Phobia Inventory. On average, participants remained in the program for 81.02 days (SD = 60.50), during which they completed 12.14 activities (SD = 11.09) and 1.53 exposures (SD = 3.18). About half (57%) had contact with a coach. Full adherence to the program was achieved by 16% of participants, a rate higher than previously published open-access studies of ICBT. Social anxiety symptoms were significantly reduced for participants that engaged in the program, with medium within-group effects from baseline through the cognitive restructuring module (d = 0.63-0.76) and large effects from baseline through the exposure module (d = 1.40-1.83). Response rates were high (72%). Exposures and coach contact were significant predictors of retention and outcome. This open-access online CBT-based program is effective in reducing social anxiety symptoms and has the potential to extend Internet-based mental health services to socially anxious individuals unwilling or unable to seek face-to-face evidence-based therapy. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Internet-administered cognitive behavior therapy is a promising new way to deliver psychological treatment. There are an increasing number of controlled trials in various fields such as anxiety disorders, mood disorders and health conditions such as headache and insomnia. Among the advantages for the field of cognitive behavior therapy is the dissemination of the treatment, being able to access treatment from a distance, and possibilities to tailor the interventions. To date, studies in which large effects have been obtained have included patient support from a clinician. Recent trials suggest that this support may come from non-clinicians and that therapist effects are minimal. Since studies also suggest that internet-delivered cognitive behavior therapy can be equally effective as face-to-face cognitive behavior therapy, this is a finding that may have implications for CBT practitioners. However, there are other aspects to consider for implementation, as while clinicians may hold positive attitudes towards internet-delivered CBT a recent study suggested that patients are more skeptical and may prefer face-to-face treatment. In the present work, I argue that internet-delivered CBT may help to increase adherence to treatment protocols, that training can be facilitated by means of internet support, and that research on internet interventions can lead to new insights regarding what happens in regular CBT. Moreover, I conclude that internet-delivered CBT works best when support is provided, leaving an important role for clinicians who can incorporate internet treatment in their services. However, I also warn against disseminating internet-delivered CBT to patients for whom it is not suitable, and that clinical skills may suffer if clinicians are trained and practice mainly using the internet. PMID:21138574
Full Text Available Abstract Internet-administered cognitive behavior therapy is a promising new way to deliver psychological treatment. There are an increasing number of controlled trials in various fields such as anxiety disorders, mood disorders and health conditions such as headache and insomnia. Among the advantages for the field of cognitive behavior therapy is the dissemination of the treatment, being able to access treatment from a distance, and possibilities to tailor the interventions. To date, studies in which large effects have been obtained have included patient support from a clinician. Recent trials suggest that this support may come from non-clinicians and that therapist effects are minimal. Since studies also suggest that internet-delivered cognitive behavior therapy can be equally effective as face-to-face cognitive behavior therapy, this is a finding that may have implications for CBT practitioners. However, there are other aspects to consider for implementation, as while clinicians may hold positive attitudes towards internet-delivered CBT a recent study suggested that patients are more skeptical and may prefer face-to-face treatment. In the present work, I argue that internet-delivered CBT may help to increase adherence to treatment protocols, that training can be facilitated by means of internet support, and that research on internet interventions can lead to new insights regarding what happens in regular CBT. Moreover, I conclude that internet-delivered CBT works best when support is provided, leaving an important role for clinicians who can incorporate internet treatment in their services. However, I also warn against disseminating internet-delivered CBT to patients for whom it is not suitable, and that clinical skills may suffer if clinicians are trained and practice mainly using the internet.
Himelhoch, Seth; Medoff, Deborah; Maxfield, Jennifer; Dihmes, Sarah; Dixon, Lisa; Robinson, Charles; Potts, Wendy; Mohr, David C
This pilot randomized controlled trial evaluated a previously developed manualized telephone based cognitive behavioral therapy (T-CBT) intervention compared to face-to-face (f2f) therapy among low-income, urban dwelling HIV infected depressed individuals. The primary outcome was the reduction of depressive symptoms as measured by the Hamliton rating scale for depression scale. The secondary outcome was adherence to HAART as measured by random telephone based pill counts. Outcome measures were collected by trained research assistants masked to treatment allocation. Analysis was based on intention-to-treat. Thirty-four participants met eligibility criteria and were randomly assigned to receive T-CBT (n = 16) or f2f (n = 18). There was no statistically significant difference in depression treatment outcomes comparing f2f to T-CBT. Within group evaluation demonstrated that both the T-CBT and the f2f psychotherapy groups resulted in significant reductions in depressive symptoms. Those who received the T-CBT were significantly more likely to maintain their adherence to antiretroviral medication compared to the f2f treatment. None of the participants discontinued treatment due to adverse events. T-CBT can be delivered to low-income, urban dwelling HIV infected depressed individuals resulting in significant reductions in depression symptoms and improved adherence to antiretroviral medication. Clinical Trial.gov identifier: NCT01055158.
Reschke-Hernández, Alaine E
The purpose of this paper is to provide a systematic review of the history of music therapy research and treatment of children with autism. Understanding such history is important in order to improve clinical efficacy and inform future research. This paper includes a history of autism diagnosis, reviews strengths and limitations of music therapy practice with children with autism from 1940-2009, and suggests direction for future music therapy research and clinical practice with this population. Literature was limited to the English language and obtained with the following search terms: autism, autistic, (early) infantile autism, child, therapeutic music, musical therapy, and music therapy. Table of contents from music therapy journals were searched, and reference lists from obtained articles were perused for additional articles. This historical review focused primarily on journal articles, however, books and book chapters that appeared to hold particular historical significance were also included.
Wilson, Courtney J.; Cottone, R. Rocco
A comprehensive review of the literature on clinical work with African American youth with cognitive behavior therapy (CBT) is presented. The strengths and limitations of CBT in relation to this population are outlined. Although CBT shows promise in helping, research on the efficacy and effectiveness of CBT in this group is lacking. (Contains 3…
Priscilla G. Wittkopf
Full Text Available Summary The consequences of chronic pain and associated disabilities to the patient and to the health care system are well known. Medication is often the first treatment of choice for chronic pain, although side effects and high costs restrict long-term use. Inexpensive, safe and easy to self-administer non-pharmacological therapies, such as mirror therapy, are recommended as adjuncts to pain treatment. The purpose of this review is to describe the principles of use of mirror therapy so it can be incorporated into a health care delivery. The physiological rationale of mirror therapy for the management of pain and the evidence of clinical efficacy based on recent systematic reviews are also discussed. Mirror therapy, whereby a mirror is placed in a position so that the patient can view a reflection of a body part, has been used to treat phantom limb pain, complex regional pain syndrome, neuropathy and low back pain. Research evidence suggests that a course of treatment (four weeks of mirror therapy may reduce chronic pain. Contraindications and side effects are few. The mechanism of action of mirror therapy remains uncertain, with reintegration of motor and sensory systems, restored body image and control over fear-avoidance likely to influence outcome. The evidence for clinical efficacy of mirror therapy is encouraging, but not yet definitive. Nevertheless, mirror therapy is inexpensive, safe and easy for the patient to self-administer.
Friðgeirsdóttir, Guðlaug; Jóhannsson, Gunnar; Ellertsson, Steindór; Björnsdóttir, Erla
Insomnia is a common health problem with serious mental and physical consequences as well as increased economical costs. The use of hypnotics in Iceland is immense in spite of cognitive behavioral therapy for insomnia (CBT-I) being recommended as the first choice treatment of chronic insomnia. To meet the needs of more individuals suffering from insomnia, online CBT-I was established at betrisvefn.is. The objective of this research was to evaluate the effectiveness of this internet-based CBT-I. One hundred seventy-five users (mean age 46 y (18-79 y)) started a 6 week online intervention for insomnia. The drop-out rate was 29%, leaving a final sample of 125 users. The intervention is based on well-established face-to-face CBT-I. Sleep diaries were used to determine changes in sleep efficiency, sleep onset latency and wake after sleep onset. Treatment effects were assesed after 6 weeks of treatment and at the 6 week follow-up. Significant improvement was found in all main sleep variables except for 5% decrease in total sleep time (TST). Effects were sustained at 6 week follow-up and TST increased. The use of hypnotics decreased significantly. This form of treatment seems to suit its users very well and over 94% would recommend the treatment. Internet interventions for insomnia seem to have good potential. CBT-I will hopefully be offered as the first line treatment for chronic insomnia in Iceland instead of hypnotics as the availability of the CBT-I is growing. Thus, the burden on health care clinics might reduce along with the hypnotics use and the considerable costs of insomnia.
Watts, Sarah; Mackenzie, Anna; Thomas, Cherian; Griskaitis, Al; Mewton, Louise; Williams, Alishia; Andrews, Gavin
This paper reports the results of a pilot randomized controlled trial comparing the delivery modality (mobile phone/tablet or fixed computer) of a cognitive behavioural therapy intervention for the treatment of depression. The aim was to establish whether a previously validated computerized program (The Sadness Program) remained efficacious when delivered via a mobile application. 35 participants were recruited with Major Depression (80% female) and randomly allocated to access the program using a mobile app (on either a mobile phone or iPad) or a computer. Participants completed 6 lessons, weekly homework assignments, and received weekly email contact from a clinical psychologist or psychiatrist until completion of lesson 2. After lesson 2 email contact was only provided in response to participant request, or in response to a deterioration in psychological distress scores. The primary outcome measure was the Patient Health Questionnaire 9 (PHQ-9). Of the 35 participants recruited, 68.6% completed 6 lessons and 65.7% completed the 3-months follow up. Attrition was handled using mixed-model repeated-measures ANOVA. Both the Mobile and Computer Groups were associated with statistically significantly benefits in the PHQ-9 at post-test. At 3 months follow up, the reduction seen for both groups remained significant. These results provide evidence to indicate that delivering a CBT program using a mobile application, can result in clinically significant improvements in outcomes for patients with depression. Australian New Zealand Clinical Trials Registry ACTRN 12611001257954.
Hogue, Aaron; Dauber, Sarah; Stambaugh, Leyla Faw; Cecero, John J.; Liddle, Howard A.
The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive-behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and…
Ritterband, Lee M; Cox, Daniel J; Walker, Lynn S; Kovatchev, Boris; McKnight, Lela; Patel, Kushal; Borowitz, Stephen; Sutphen, James
This study evaluated the benefits of enhanced toilet training delivered through the Internet for children with encopresis. Twenty-four children with encopresis were randomly assigned to the Internet intervention group (Web) or no Internet intervention group (No-Web). All participants continued to receive routine care from their primary care physician. The Web participants demonstrated greater improvements in terms of reduced fecal soiling, increased defecation in the toilet, and increased unprompted trips to the toilet (ps<.02). Both groups demonstrated similar improvements in knowledge and toileting behaviors. Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.
Lamb, Kalina M; Nogg, Kelsey A; Safren, Steven A; Blashill, Aaron J
Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence. Participants assigned to CBT-BISC reported statistically significant reductions in body image disturbance post-intervention, which subsequently predicted changes in ART adherence from post-intervention to long term follow-up (b = 20.01, SE = 9.11, t = 2.19, p = 0.028). One pathway in which CBT-BISC positively impacts ART adherence is through reductions in body image disturbance. Body image disturbance represents one, of likely several, mechanism that prospectively predicts ART adherence among sexual minority men living with HIV.
Wilson, Brian L., Ed.
This completely revised 2nd edition edited by Brian L. Wilson, addresses both theoretical issues and practical applications of music therapy in educational settings. 17 chapters written by a variety of authors, each dealing with a different setting or issue. A valuable resource for demonstrating the efficacy of music therapy to school…
Clemmensen, Peter; Dridi, Nadia Paarup; Holmvang, Lene
For several years, clopidogrel plus aspirin has been the dual antiplatelet therapy (DAPT) of choice for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with stent implantation. More recently, prasugrel and ticagrelor have demonstrated greater effica...
Full Text Available Interventional therapy has become the first choice of non-surgical treatment for hepatocellular carcinoma (HCC due to its advantages such as little trauma and marked local effect. However, the clinical efficiency is less than expected. One of the possibilities is the resistance of cancer cells to anti-cancer drugs. Increasing attention has been paid to the combination of traditional Chinese medicine (TCM and interventional therapy in HCC treatment. This paper reviews the progress in TCM combined with interventional therapy for HCC at animal experiment and clinical study levels in recent ten years. It is pointed out that the combination therapy with TCM and intervention for HCC has a unique advantage.
Wei Lin; Liu Shiguang
Objective: To discuss the perioperative nursing care of patients who is going to receive interventional therapy for hepatic artery stenosis after liver transplantation and to provide useful reference for reducing surgery-related complication and for improving the prognosis of patients. Methods: Based on the patient's condition and operative requirement,we provided effective nursing care for 20 patients who were admitted to receive the interventional therapy for hepatic artery stenosis after liver transplantation. The nursing care included preoperative preparation,postoperative nursing and medical guidance at the time of discharge. Results: Interventional therapy was successfully performed in all 20 cases, and no hemorrhagic tendency or acute thrombosis occurred. Marked symptomatic improvement was obtained in all patients. Conclusion: The interventional therapy is an effective treatment for hepatic artery stenosis after liver transplantation. Intensive perioperative nursing care can well prevent the occurrence of surgery-related complications and can surely improve the therapeutic results. (authors)
Pereira, Ana Isabel; Muris, Peter; Mendonça, Denisa; Barros, Luisa; Goes, Ana Rita; Marques, Teresa
The present study explored the role of parents' in-session and out-session involvement in CBT for anxious children. Fifty 8- to 12-year-old children with a principal DSM-IV anxiety disorder participated in a group CBT program. Parental involvement in the therapy was assessed by the clinician and the children and parents completed a standardized anxiety scale as the main therapy outcome measure, at pre- and post-intervention. In addition, the parents completed questionnaires to evaluate a number of possible correlates of parental involvement, namely, child's anxiety symptoms intensity and interference, parental beliefs about anxiety, expectancies regarding the efficacy of the intervention, and parental anxiety. The results indicated that the parents were moderately involved in the therapy and that socio-economic status and parental beliefs about anxiety were significant correlates of parental involvement. Finally, partial support was found for the idea that parents' involvement in the therapy might have a positive impact on therapy outcome.
Patrícia Paes Araujo Fialho
Full Text Available OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.
Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive-compulsive disorder: the Obsessive-Compulsive Treatment Efficacy randomised controlled Trial (OCTET).
Lovell, Karina; Bower, Peter; Gellatly, Judith; Byford, Sarah; Bee, Penny; McMillan, Dean; Arundel, Catherine; Gilbody, Simon; Gega, Lina; Hardy, Gillian; Reynolds, Shirley; Barkham, Michael; Mottram, Patricia; Lidbetter, Nicola; Pedley, Rebecca; Molle, Jo; Peckham, Emily; Knopp-Hoffer, Jasmin; Price, Owen; Connell, Janice; Heslin, Margaret; Foley, Christopher; Plummer, Faye; Roberts, Christopher
BACKGROUND The Obsessive-Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive-compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive-behavioural therapy (CBT) treatment intensity formats. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive-behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions. DESIGN A three-arm, multicentre, randomised controlled trial. SETTING Improving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts. PARTICIPANTS Patients aged ≥ 18 years meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale-Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English. INTERVENTIONS Participants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT. MAIN OUTCOME MEASURES The primary outcome was OCD symptoms using the Yale-Brown Obsessive Compulsive Scale - Observer Rated. RESULTS Patients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data
Ammerman, Robert T; Peugh, James L; Teeters, Angelique R; Putnam, Frank W; Van Ginkel, Judith B
Child maltreatment contributes to depression in adults. Evidence indicates that such experiences are associated with poorer outcomes in treatment. Mothers in home visiting programs display high rates of depression and child maltreatment histories. In-Home Cognitive Behavioral Therapy (IH-CBT) was developed to treat maternal depression in home visiting. The purpose of this study was to examine the moderating effects of child maltreatment history on depression, social functioning, and parenting in mothers participating in a clinical trial of IH-CBT. Ninety-three depressed mothers in home visiting between 2 and 10 months postpartum were randomly assigned to IH-CBT (n = 47) plus home visiting or standard home visiting (SHV; n = 46). Mothers were identified via screening and then confirmation of major depressive disorder diagnosis. Measures of child maltreatment history, depression, social functioning, and parenting were administered at pre-treatment, post-treatment, and 3-month follow-up. Results indicated high rates of maltreatment in both conditions relative to the general population. Mixed model analyses found a number of main effects in which experiences of different types of trauma were associated with poorer functioning regardless of treatment condition. Evidence of a moderating effect of maltreatment on treatment outcomes was found for physical abuse and parenting and emotional abuse and social network size. Future research should focus on increasing the effectiveness of IH-CBT with depressed mothers who have experienced child maltreatment. © The Author(s) 2014.
Berga, Sarah L; Marcus, Marsha D; Loucks, Tammy L; Hlastala, Stefanie; Ringham, Rebecca; Krohn, Marijane A
To determine whether cognitive behavior therapy (CBT) targeted to problematic attitudes common among women with functional hypothalamic amenorrhea would restore ovarian function. Randomized, prospective, controlled intervention. Clinical research center in an academic medical institution. Sixteen women participated who had functional hypothalamic amenorrhea; were of normal body weight; and did not report psychiatric conditions, eating disorders, or excessive exercise. Subjects were randomized to CBT or observation for 20 weeks. Serum levels of E(2) and P and vaginal bleeding were monitored. Of eight women treated with CBT, six resumed ovulating, one had partial recovery of ovarian function without evidence of ovulation, and one did not display return of ovarian function. Of those randomized to observation, one resumed ovulating, one had partial return of ovarian function, and six did not recover. Thus, CBT resulted in a higher rate of ovarian activity (87.5%) than did observation (25.0%), chi(2) = 7.14. A cognitive behavioral intervention designed to minimize problematic attitudes linked to hypothalamic allostasis was more likely to result in resumption of ovarian activity than observation. The prompt ovarian response to CBT suggests that a tailored behavioral intervention offers an efficacious treatment option that also avoids the pitfalls of pharmacological modalities.
Muhlenhaupt, Mary; Pizur-Barnekow, Kris; Schefkind, Sandra; Chandler, Barbara; Harvison, Neil
Occupational therapy provides a unique contribution in early intervention programs for families and their children from birth to 3 years old who are at risk for, or who have, identified disabilities. This article describes occupational therapy's distinct value and presents the profession's perspective on services to enhance families' caregiving…
Battes, Linda C; Pedersen, Susanne S.; Oemrawsingh, Rohit M
Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose-response relationship between...... beta blocker dose and depressive symptoms....
Battes, L.C.; Pedersen, S.S.; Oemrawsingh, R.M.; van Geuns, R.-J.M.; Al Amri, I.; Regar, E.; de Jaegere, P.T.; Serruys, P.W.; van Domburg, R.T.
Background Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose–response
Effectiveness of cognitive behavioral therapy integrated with systematic desensitization, cognitive behavioral therapy combined with eye movement desensitization and reprocessing therapy, and cognitive behavioral therapy combined with virtual reality exposure therapy methods in the treatment of flight anxiety: a randomized trial
Full Text Available Maria Teresa Triscari,1 Palmira Faraci,2 Dario Catalisano,3 Valerio D’Angelo,1 Viviana Urso1 1Laboratory for Psychosomatic Disorders, Local Health Trust, Palermo, Italy; 2Faculty of Human and Social Sciences, University of Enna “Kore”, Enna, Italy; 3Italian Flight Safety Committee, Aeroporto di Fiumicino, Fiumicino (RM, Italy Abstract: The purpose of the research was to compare the effectiveness of the following treatment methods for fear of flying: cognitive behavioral therapy (CBT integrated with systematic desensitization, CBT combined with eye movement desensitization and reprocessing therapy, and CBT combined with virtual reality exposure therapy. Overall, our findings have proven the efficacy of all interventions in reducing fear of flying in a pre- to post-treatment comparison. All groups showed a decrease in flight anxiety, suggesting the efficiency of all three treatments in reducing self-report measures of fear of flying. In particular, our results indicated significant improvements for the treated patients using all the treatment programs, as shown not only by test scores but also by participation in the post-treatment flight. Nevertheless, outcome measures maintained a significant effect at a 1-year follow-up. In conclusion, combining CBT with both the application of eye movement desensitization and reprocessing treatment and the virtual stimuli used to expose patients with aerophobia seemed as efficient as traditional cognitive behavioral treatments integrated with systematic desensitization. Keywords: flight anxiety, fear of flying, aerophobia, cognitive behavioral therapy, EMDR, VRET
Salcedo, Stephanie; Gold, Alexandra K; Sheikh, Sana; Marcus, Peter H; Nierenberg, Andrew A; Deckersbach, Thilo; Sylvia, Louisa G
Bipolar disorder requires psychiatric medications, but even guideline-concordant treatment fails to bring many patients to remission or keep them euthymic. To address this gap, researchers have developed adjunctive psychotherapies. The purpose of this paper is to critically review the evidence for the efficacy of manualized psychosocial interventions for bipolar disorder. We conducted a search of the literature to examine recent (2007-present), randomized controlled studies of the following psychotherapy interventions for bipolar disorder: psychoeducation (PE), cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and family therapies such as family focused therapy (FFT). All of the psychotherapy interventions appear to be effective in reducing depressive symptoms. Psychoeducation and CBT are associated with increased time to mood episode relapse or recurrence. MBCT has demonstrated a particular effectiveness in improving depressive and anxiety symptoms. Online psychotherapy interventions, programs combining one or more psychotherapy interventions, and targeted interventions centering on particular symptoms have been the focus of recent, randomized controlled studies in bipolar disorder. Psychotherapy interventions for the treatment of bipolar disorder have substantial evidence for efficacy. The next challenge will to disseminate these psychotherapies into the community. Copyright © 2016 Elsevier B.V. All rights reserved.
Social anxiety disorder (SAD) is a highly prevalent and chronic disorder that causes considerable psychosocial impairment. This article reviews recent changes in the definition of SAD in DSM-5 and summarizes the current evidence for effective cognitive-behavioral treatments in adults, children, and adolescents. Current data suggests that cognitive-behavioral therapy (CBT) is efficacious in the treatment of this condition. Among different CBT approaches, individual cognitive therapy may be associated with the largest effect sizes. In this review, interventions targeting dysfunctional cognitive processes that contribute to the effective treatment of SAD are discussed. Some recent findings from neuroimaging research and studies on the augmentation of CBT using neuroenhancers indicate that changes in emotion regulation as well as fear extinction are important psychological mediators of positive outcome. Furthermore, internet-delivered CBT is a promising field of technological innovation that may improve access to effective treatments. Despite the availability of effective treatments, treatment-resistant SAD remains a common problem in clinical practice that requires more research efforts. Finally, potential areas for further development of CBT as well as its dissemination in health care are summarized.
Billington, Josie; Farrington, Grace; Lampropoulou, Sofia; Lingwood, Jamie; Jones, Andrew; Ledson, James; McDonnell, Kate; Duirs, Nicky; Humphreys, Anne-Louise
The case for psychosocial interventions in relation to chronic pain, one of the most common health issues in contemporary healthcare, is well-established as a means of managing the emotional and psychological difficulties experienced by sufferers. Using mixed methods, this study compared a standard therapy for chronic pain, cognitive behavioural therapy (CBT), with a specific literature-based intervention, shared reading (SR) developed by national charity, The Reader. A 5-week CBT group and a 22-week SR group for patients with chronic pain ran in parallel, with CBT group members joining the SR group after the completion of CBT. In addition to self-report measures of positive and negative affect before and after each experience of the intervention, the 10 participants kept twice-daily (12-hourly) pain and emotion diaries. Qualitative data were gathered via literary-linguistic analysis of audio/video-recordings and transcriptions of the CBT and SR sessions and video-assisted individual qualitative interviews with participants. Qualitative evidence indicates SR's potential as an alternative or long-term follow-up or adjunct to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by patients with chronic pain. In addition, quantitative analysis, albeit of limited pilot data, indicated possible improvements in mood/pain for up to 2 days following SR. Both findings lay the basis for future research involving a larger sample size. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
van den Akker, Lizanne Eva; Beckerman, Heleen; Collette, Emma Hubertine; Eijssen, Isaline Catharine Josephine Maria; Dekker, Joost; de Groot, Vincent
Fatigue is a frequently occurring symptom of multiple sclerosis (MS) that limits social participation. To systematically determine the short and long-term effects of cognitive behavioral therapy (CBT) for the treatment of MS-related fatigue. Pubmed, Cochrane, EMBASE, Psychology and Behavioral Sciences Collection, ERIC, PsychINFO, Cinahl, PsycARTICLES, and relevant trial registers were searched up to February 2016. In addition, references from retrieved articles were examined. Studies were included if participants had MS, fatigue was a primary outcome measure, the intervention was CBT, and the design was a randomized controlled trial. The search was performed by two independent reviewers, three CBT experts determined whether interventions were CBT. Data on patient and study characteristics and fatigue were systematically extracted using a standardized data extraction form. Two independent reviewers assessed risk of bias using the Cochrane Collaboration risk of bias tool. In the event of disagreement, a third reviewer was consulted. Of the 994 identified studies, 4 studies were included in the meta-analysis, comprising 193 CBT-treated patients and 210 patients who underwent a control treatment. Meta-analyses of these studies showed that CBT treatment had a positive short-term effect on fatigue (standardized mean difference [SMD]=-0.47; 95% confidence interval [CI]=-0.88; -0.06; I 2 =73%). In addition, three studies showed a long-term positive effect of CBT (SMD=-0.30; CI -0.51; -0.08; I 2 =0%). This review found that the use of CBT for the treatment of fatigue in patients with MS has a moderately positive short-term effect. However, this effect decreases with cessation of treatment. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available BACKGROUND: Access to Cognitive behavioural therapy (CBT for depression is limited. One solution is CBT self-help books. Trial Objectives: To assess the impact of a guided self-help CBT book (GSH-CBT on mood, compared to treatment as usual (TAU. HYPOTHESES: GSH-CBT will have improved mood and knowledge of the causes and treatment of depression compared to the control receiving TAUGuided self-help will be acceptable to patients and staff. METHODS AND FINDINGS: PARTICIPANTS: Adults attending seven general practices in Glasgow, UK with a BDI-II score of ≥14. 141 randomised to GSH-CBT and 140 to TAU. INTERVENTIONS: RCT comparing 'Overcoming Depression: A Five Areas Approach' book plus 3-4 short face to face support appointments totalling up to 2 hours of guided support, compared with general practitioner TAU. PRIMARY OUTCOME: The BDI (II score at 4 months. Numbers analysed: 281 at baseline, 203 at 4 months (primary outcome, 117 at 12 months. OUTCOME: Mean BDI-II scores were lower in the GSH-CBT group at 4 months by 5.3 points (2.6 to 7.9, p<0.001. At 4 and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II in the GSH-CBT arm. The mean support was 2 sessions with 42.7 minutes for session 1, 41.4 minutes for session 2 and 40.2 minutes of support for session 3. Adverse effects/Harms: Significantly less deterioration in mood in GSH-CBT (2.0% compared to 9.8% in the TAU group for BDI-II category change. LIMITATIONS: Weaknesses: Our follow-up rate of 72.2% at 4 months is better than predicted but is poorer at 12 months (41.6%. In the GSH-CBT arm, around 50% of people attended 2 or fewer sessions. 22% failed to take up treatment. CONCLUSIONS: GSH-CBT is substantially more effective than TAU. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN13475030.
Rosso, Isabelle M; Killgore, William D S; Olson, Elizabeth A; Webb, Christian A; Fukunaga, Rena; Auerbach, Randy P; Gogel, Hannah; Buchholz, Jennifer L; Rauch, Scott L
Prior research has shown that the Sadness Program, a technician-assisted Internet-based cognitive behavioral therapy (iCBT) intervention developed in Australia, is effective for treating major depressive disorder (MDD). The current study aimed to expand this work by adapting the protocol for an American population and testing the Sadness Program with an attention control group. In this parallel-group, randomized controlled trial, adult MDD participants (18-45 years) were randomized to a 10-week period of iCBT (n = 37) or monitored attention control (MAC; n = 40). Participants in the iCBT group completed six online therapy lessons, which included access to content summaries and homework assignments. During the 10-week trial, iCBT and MAC participants logged into the web-based system six times to complete self-report symptom scales, and a nonclinician technician contacted participants weekly to provide encouragement and support. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), and the secondary outcomes were the Patient Health Questionnaire-9 and Kessler-10. Intent-to-treat analyses revealed significantly greater reductions in depressive symptoms in iCBT compared with MAC participants, using both the self-report measures and the clinician-rated HRSD (d = -0.80). Importantly, iCBT participants also showed significantly higher rates of clinical response and remission. Exploratory analyses did not support illness severity as a moderator of treatment outcome. The Sadness Program led to significant reductions in depression and distress symptoms. With its potential to be delivered in a scalable, cost-efficient manner, iCBT is a promising strategy to enhance access to effective care. © 2016 Wiley Periodicals, Inc.
Full Text Available Background: Insomnia is a common sleep disorder in patients with breast cancer and studies show a higher frequency than in the general population but it appears to be understudied and the treatment seems to be a neglected problem. There is a growing body of evidence about the efficacy of cognitive behavioral therapy for insomnia (CBT-I in breast cancer survivors. The aim of this review is to examine the best available scientific evidence related to CBT-I and insomnia in patients with breast cancer and to assess the effect of CBT-I on their psychosocial functioning, sleep, quality of life, and mood. Methods: Empirical articles published in peer-reviewed journals from the earliest reports available until August 2015 were considered. The research on PubMed generated 18 papers, three of which did not meet the inclusion criteria. Another paper was retrieved by screening the reference list of the previously selected papers. Results: A total of 16 studies were found that evaluated the effects of CBT-I in breast cancer patients. CBT-I appears to be an effective therapy for insomnia in breast cancer survivors, improving mood, general and physical fatigue and global and cognitive dimensions of quality of life. CBT-I may also reduce menopausal symptoms, such as hot flushes and night sweat problems, frequency of medicated nights, level of depression, and anxiety. Conclusions: CBT-I seems to be an eligible intervention for improving sleep in breast cancer survivors. Improvements concerning insomnia and sleep quality are durable (usually up to 12 months and statistically significant.
Because of advances in surgical technique, radiation therapy, and combined chemotherapy regimens, there has been a dramatic improvement in the survival of children with pediatric malignancies. All treatment modalities are associated with adverse effects that may be manifested months to years after therapy. This article has provided an overview of the physiologic and psychologic adverse effects of antineoplastic therapy and described the multidisciplinary approach used by one institution to identify and initiate appropriate remedial intervention. Nurses can learn to assist in the identification of adverse late effects, provide support to the family, and facilitate appropriate intervention
Kovacs, Maria; Lopez-Duran, Nestor L
For this special issue about child and adolescent depression, the authors were asked to describe contextual emotion regulation therapy as an example of a developmentally informed psychosocial intervention. The article begins with the authors' definition of the elements that should comprise such an intervention. A succinct summary of this contextual emotion regulation therapy is then provided, including its explanatory paradigm of depression, followed by an exposition of how it addresses the various definitional criteria of a developmentally informed intervention. The article concludes with a brief overview of the challenges of implementing a developmentally sensitive psychotherapy for depressed children and adolescents.
Grilo, Carlos M.; Masheb, Robin M.; Wilson, G. Terence; Gueorguieva, Ralitza; White, Marney A.
Objective: Cognitive-behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL).…
Van Apeldoorn, Franske J.; Van Hout, Wiljo J. P. J.; Timmerman, Marieke E.; Mersch, Peter Paul A.; den Boer, Johan A.
Background: Existing literature on panic disorder (PD) yields no data regarding the differential rates of improvement during Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitor (SSRI) or both combined (CBT+SSRI). Method: Patients were randomized to CBT, SSRI or CBT+SSRI which
Curtis, David F
Children with Attention-Deficit/Hyperactivity Disorder (ADHD) present significant problems with behavioral disinhibition that often negatively affect their peer relationships. Although behavior therapies for ADHD have traditionally aimed to help parents and teachers better manage children's ADHD-related behaviors, therapy processes seldom use peer relationships to implement evidence-based behavioral principles. This article introduces Structured Dyadic Behavior Therapy as a milieu for introducing effective behavioral techniques within a socially meaningful context. Establishing collaborative behavioral goals, benchmarking, and redirection strategies are discussed to highlight how in-session dyadic processes can be used to promote more meaningful reinforcement and change for children with ADHD. Implications for improving patient care, access to care, and therapist training are also discussed.
Blanche, Erna Imperatore; Fogelberg, Donald; Diaz, Jesus; Carlson, Mike; Clark, Florence
The manualization of a complex occupational therapy intervention is a crucial step in ensuring treatment fidelity for both clinical application and research purposes. Towards this latter end, intervention manuals are essential for assuring trustworthiness and replicability of randomized controlled trials (RCT’s) that aim to provide evidence of the effectiveness of occupational therapy. In this paper, literature on the process of intervention manualization is reviewed. The prescribed steps are then illustrated through our experience in implementing the University of Southern California/Rancho Los Amigos National Rehabilitation Center’s collaborative Pressure Ulcer Prevention Project (PUPP). In this research program, qualitative research provided the initial foundation for manualization of a multifaceted occupational therapy intervention designed to reduce incidence of medically serious pressure ulcers in people with SCI. PMID:22214116
Zalta, Alyson K; Dowd, Sheila; Rosenfield, David; Smits, Jasper A J; Otto, Michael W; Simon, Naomi M; Meuret, Alicia E; Marques, Luana; Hofmann, Stefan G; Pollack, Mark H
Sleep quality may be an important, yet relatively neglected, predictor of treatment outcome in cognitive-behavioral therapy (CBT) for anxiety disorders. Specifically, poor sleep quality may impair memory consolidation of in-session extinction learning. We therefore examined sleep quality as a predictor of treatment outcome in CBT for social anxiety disorder and the impact of d-cycloserine (DCS) on this relationship. One hundred sixty-nine participants with a primary diagnosis of DSM-IV generalized social anxiety disorder were recruited across three sites. Participants were enrolled in 12 weeks of group CBT. Participants randomly received 50 mg of DCS (n = 87) or pill placebo (n = 82) 1 hr prior to sessions 3-7. Participants completed a baseline measure of self-reported sleep quality and daily diaries recording subjective feelings of being rested upon wakening. Outcome measures including social anxiety symptoms and global severity scores were assessed at each session. Poorer baseline sleep quality was associated with slower improvement and higher posttreatment social anxiety symptom and severity scores. Moreover, patients who felt more "rested" after sleeping the night following a treatment session had lower levels of symptoms and global severity at the next session, controlling for their symptoms and severity scores the previous session. Neither of these effects were moderated by DCS condition. Our findings suggest that poor sleep quality diminishes the effects of CBT for social anxiety disorder and this relation is not attenuated by DCS administration. Therapeutic attention to sleep quality prior to initiation of CBT and during the acute treatment phase may be clinically indicated. © 2013 Wiley Periodicals, Inc.
Full Text Available Nasreen Khatri, Elsa Marziali, Illia Tchernikov, Nancy ShepherdRotman Research Institute, Toronto, ON, CanadaBackground: The primary objective of this pilot study was to demonstrate reliable adherence to a group cognitive behavioral (CBT therapy protocol when delivered using on-line video conferencing as compared with face-to-face delivery of group CBT. A secondary aim was to show comparability of changes in subject depression inventory scores between on-line and face-to-face delivery of group CBT.Methods: We screened 31 individuals, 18 of whom met the criteria for a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnosis of mood and/or anxiety disorder. All qualifying participants had the necessary equipment (computer, webcam, Internet for participation in the study, but could exercise their preference for either the on-line or face-to-face format. Eighteen completed the 13 weekly session intervention program (ten face-to-face; eight video conferencing. We coded adherence to protocol in both intervention formats and generated pre–post changes in scores on the Beck Depression Inventory Second Edition (BDI-II for each participant.Results: Application of the CBT protocol coding system showed reliable adherence to the group CBT intervention protocol in both delivery formats. Similarly, qualitative analysis of the themes in group discussion indicated that both groups addressed similar issues. Pre–post intervention scores for the BDI-II were comparable across the two delivery formats, with 60% of participants in each group showing a positive change in BDI-II severity classification (eg, from moderate to low symptoms.Conclusion: This pilot study demonstrates that group CBT could be delivered in a technology-supported environment (on-line video conferencing and can meet the same professional practice standards and outcomes as face-to-face delivery of the intervention program.Keywords: psychotherapy, gerontology, mood