Article

Cognitive behavioral therapy: Current status and future research directions

February 2015
Psychotherapy Research 25(3)

DOI:10.1080/10503307.2014.1002440

Authors:

Shelley McMain

Centre for Addiction and Mental Health; University of Toronto,

Michelle Gayle Newman

Pennsylvania State University

Robert J. DeRubeis

University of Pennsylvania

Cognitive behaviour therapy (CBT), an umbrella term that includes a diverse group of treatments, is defined by a strong commitment to empiricism. While CBT has a robust empirical base, areas for improvement remain. This article reviews the status of the current empirical base and its limitations, and presents future directions for advancement of the field. Ultimately, studies are needed that will identify the predictors, mediators, and moderators of treatment response in order to increase knowledge on how to personalize interventions for each client and to strengthen the impact of CBT. Efforts to advance the dissemination and implementation of CBT, innovative approaches such as practice-oriented research, and the advantages of incorporating new and existing technologies, are discussed as well.

Evaluating the Efficacy of Web-Based Cognitive Behavioral Therapy for the Treatment of Patients With Bipolar II Disorder and Residual Depressive Symptoms: Protocol for a Randomized Controlled Trial

Article

Full-text available

Apr 2023

Background: Bipolar disorder (BD) is a highly prevalent psychiatric condition that can significantly impact every aspect of a person's life if left untreated. A subtype of BD, Bipolar disorder II (BD-II) is characterized by long depressive episodes and residual depression symptoms, with short-lived hypomanic episodes. Medication and psychotherapy, such as cognitive behavioral therapy (CBT), are the main treatment options for BD-II. CBT specific for BD-II involves the recognition of warning signs, potentially triggering stimuli, and the development of coping skills to increase euthymic periods and improve global functioning. However, access to in-person CBT may be limited by several barriers including low availability, high costs and geographical limitations. Thus, online adaptations of CBT (e-CBT) have become a promising solution to address these treatment barriers Nevertheless, e-CBT for the treatment of BD-II remains understudied. Objective: The proposed study aims to establish the first e-CBT program specific for the treatment of BD-II with residual depressive symptoms. The primary objective of this study will be to determine the effect of e-CBT in managing BD symptomatology. The secondary objective will be to assess the effects of this e-CBT program on quality of life, and resilience. The tertiary objective will involve gathering user feedback using a post-treatment survey to support the continuous improvement and optimization of the proposed program. Methods: Adult participants (n = 170) with a confirmed diagnosis of BD-II experiencing residual depressive symptoms will be randomly assigned to either the e-CBT plus TAU (n = 85) group or the TAU (n = 85) control group. Participants in the control group will be able to participate in the online program after the first 13 weeks. The e-CBT program will consist of 13 weekly online modules designed following a validated CBT framework. Participants will complete module-related homework and receive asynchronous personalized feedback from a therapist. TAU will consist of standard treatment services conducted outside of the current research study. Depression and manic symptoms quality of life and resiliency will be assessed using clinically validated symptomatology questionnaires at baseline, week 6, and week 13. Results: The study received ethics approval in March 2020 and participant recruitment is expected to begin in February 2023 through targeted advertisements and physician referrals. Data collection and analysis are expected to conclude by December 2024. Linear and binomial regression (continuous and categorical outcomes respectively) will be conducted along with qualitative interpretive methods. Conclusions: The findings will be the first on the effectiveness of delivering e-CBT for patients with BD-II with residual depressive symptoms. This approach can provide an innovative method to address barriers to in-person psychotherapy by increasing accessibility and decreasing costs. Clinicaltrial: clinicaltrials.gov (NCT04664257); clinicaltrials.gov/ct2/show/NCT04664257.

Cognitive Interventions in Individuals With Chronic Respiratory Diseases: Protocol for a Systematic Review

Article

Full-text available

Jul 2023

Background: Chronic respiratory diseases (CRDs) may cause reduced oxygen availability to organs and body tissues, leading to an increased risk for ischemic damage, which can result in brain tissue injury. This damage can lead to a myriad of neurological symptoms contributing to cognitive decline. Cognitive interventions may attenuate cognitive deficits in people with CRDs; however, the effects have not yet been systematically summarized in the literature. Objective: The purpose of this systematic review is to assess the effects of cognitive interventions (including cognitive behavioral therapy and transcranial brain stimulation) on cognitive function (primary outcome), HRQL, self-management, symptoms, physical activity, physical function, ability to complete activities of daily living (ADLs), hospital admissions, functional capacity, functional performance, psychological and social outcomes, exacerbations, healthcare utilization, and survival in individuals with CRDs. Methods: This review will be conducted in accordance with the Cochrane handbook for systematic reviews of interventions and reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be performed in MEDLINE, Embase, Emcare, PsycINFO, Scopus, and CINAHL. Articles will be included if they focus on the effects of cognitive interventions on adults with CRDs, are published in peer-reviewed journals, and are written in English, French, or Portuguese. Risk of bias will be evaluated with the Cochrane Risk of Bias 2 tool for randomized controlled trials, and the Risk of Bias in Non-randomized Studies of Interventions tool for nonrandomized studies. Meta-analyses will be performed if at least 2 studies provided sufficient data for a specific outcome. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment will be used to evaluate the overall quality of the evidence. Results: This systematic review was initiated in November 2022 and registered with PROSPERO in February 2023, prior to title and abstract screening. Full-text screening of articles will be completed in June 2023. Data extraction and drafting of the manuscript will occur from July 2023 to August 2023, with expected publication in February 2024. Conclusions: This systematic review will summarize the effects of cognitive interventions on cognitive function in people with CRDs. It will guide health care professionals in selecting evidence-based strategies to enhance cognitive well-being and overall health outcomes for individuals with CRDs. Additionally, it will identify research gaps and highlight areas for future exploration, supporting researchers in advancing knowledge in this field. Trial registration: PROSPERO CRD42023396234; https://tinyurl.com/mwjrfbxv. International registered report identifier (irrid): PRR1-10.2196/48235.

The Efficacy of Mindfulness-Based Cognitive Therapy on Disease Perception, Body Image, and Fear of Cancer Recurrence in Women with Breast Cancer

Article

Full-text available

Jul 2023

Background: Currently, the prevalence of breast cancer and its debilitating consequences are increasing, causing adverse personal, family, and social effects in patients. Therefore, patients with breast cancer should try to reduce the injuries described above through various treatment methods. Objectives: This study aimed to assess the efficacy of mindfulness-based cognitive therapy (MBCT) on disease perception, body image, and fear of cancer recurrence in women with breast cancer. Methods: This applied study was designed based on a pre-test and post-test. The study included 30 participants, 15 test groups (15 people), and 15 control groups (15 people). A test group was used for MBCT, while the other was not exposed to the intervention. Eight 90-minute sessions were held weekly for the test group for two months. The research tools included the Broadbent Illness Perception Questionnaire (BIPQ), Multidimensional Body-Self Relations Questionnaire (MBSRQ), and Fear of Cancer Recurrence Inventory Questionnaire (FCRIQ). Finally, the resulting data were analyzed by SPSS software Version 25. Results: The statistical test of covariance analysis showed that the MBCT method significantly affects disease perception, body image, and fear of disease recurrence in women with breast cancer (P < 0.05). Conclusions: Based on the results, the MBCT method can help manage breast cancer in women. Therefore, breast cancer patients can improve their quality of life and life expectancy by learning this treatment method.

A Randomized Controlled Trial of the Effectiveness of Cognitive Behavior Therapy for Major Depression in Bangladesh

Article

Apr 2023
INT J COGN THER

This was a randomized controlled trial, conducted to determine the effectiveness of CBT for depression delivered by trained therapists with an adapted Bengali CBT (BaCBT) manual, as compared to a control group. A total of 148 patients with a diagnosis of depression and attending psychiatry departments of three hospitals in Dhaka, Bangladesh, were assessed for eligibility, and 107 were randomly allocated to either treatment (n = 54) or a waitlist (n = 53). Assessments of outcome were completed at 3 time points (pre-test, post-test, and 1-month follow-up). The results revealed significant reductions in depression severity, anxiety, perceived stress, and suicidal ideation in the group that received the intervention, but modest to no significant changes in the control group. This is the first report of the results of an adapted CBT program for depression from Bangladesh. Although several limitations of the study are noted, and further studies are needed to generalize these current results, they indicate that CBT is an efficacious treatment option for depression in varied cultures.

BYSTANDERS' EXPERIENCES OF SCHOOL BULLYING FOLLOWING A SELF-DEBASING COGNITIVE DISTORTION RESTRUCTURING INTERVENTION

Thesis

Full-text available

Apr 2020

Segun Emmanuel Adewoye

There is evidence from the literature that the negative emotions and behaviours that bystanders expressed in reactions to witnessing bullying could have stemmed from self-debasing cognitive distortions and errors in thinking patterns which included personalisation, catastrophising, over-generalisation and selective abstraction. For this reason, the purpose of this qualitative descriptive-exploratory study was to explore and describe 10 early adolescent bystanders' experiences of school bullying following a self-debasing cognitive distortion restructuring intervention. Appraisal and cognitive theory were adopted as the overarching theoretical framework. This is because both theories demonstrated how individual thinking patterns could play a primary and significant role in the development and maintenance of emotional and behavioural responses to events witnessed or experienced. A descriptive-exploratory research design was used because it best suited the purpose of the study. The philosophical assumption underpinning this study emanated from an interpretivism paradigm which is a paradigm concerned with understanding the world from the perspective of people‟s experiences thereof. Purposive sampling was used to select 10 participants who were within the age range of 11 to 13 years for the study. Individual interviews were used as formal data collection strategies while a reflective research journal and audio recordings were used as additional data collection methods. The inductive thematic dataanalysis process was followed to analyse all data collected. The data was collected and analysed in two stages. The findings of this study, from the pre-intervention phase, indicated that personalisation evoked self-blame and feelings of guilt; catastrophising amplified anxiety and fear; overgeneralisation induced and exacerbated a negative perception of school safety and selective abstraction led to indirect co-victimisation. The findings that emerged at the first stage informed the common concepts that were addressed in the intervention. The findings of this study from the post-intervention phase revealed specifically that the self-debasing cognitive distortion restructuring intervention modified bystanders‟ experiences of school bullying. There were observable reduction in bystanders‟ negative emotional and behavioural reactions to witnessing bullying as a result of learning to challenge the validity and reality of distortions in their thinking patterns. Therefore, it is recommended that school counsellors and educational psychologists should provide adequate support to victims of bullying by equipping them with cognitive restructuring skills to root out the source of bias in their thought patterns. Key concepts: Bullying, bystanders, self-debasing, cognitive distortions, thinking patterns, emotional and behavioural reactions, bystanders‟ experiences.

Neural Effects of Cognitive Behavioral Therapy in Psychiatric Disorders: A Systematic Review and Activation Likelihood Estimation Meta-Analysis

Article

Full-text available

May 2022

Background Cognitive behavioral therapy (CBT) is a first-line psychotherapeutic treatment that has been recommended for psychiatric disorders. Prior neuroimaging studies have provided preliminary evidence suggesting that CBT can have an impact on the activity of brain regions and functional integration between regions. However, the results are far from conclusive. The present article aimed to detect characteristic changes in brain activation following CBT across psychiatric disorders. Method Web of Science, Cochrane Library, Scopus, and PubMed databases were searched to identify whole-brain functional neuroimaging studies of CBT through 4 August 2021. To be included in the meta-analysis, studies were required to examine functional activation changes between pre-and post-CBT. The included studies were then divided into subgroups according to different task paradigms. Then, an activation likelihood estimation algorithm (ALE) was performed in the different meta-analyses to identify whether brain regions showed consistent effects. Finally, brain regions identified from the meta-analysis were categorized into eight functional networks according to the spatial correlation values between independent components and the template. Results In total, 13 studies met inclusion criteria. Three different meta-analyses were performed separately for total tasks, emotion tasks, and cognition tasks. In the total task ALE meta-analysis, the left precuneus was found to have decreased activation. For the cognition task ALE meta-analysis, left anterior cingulate (ACC) and left middle frontal gyrus (MFG) were found to have decreased activation following CBT. However, the emotion task ALE meta-analysis did not find any specific brain regions showing consistent effects. A review of included studies revealed default mode network (DMN), executive control network (ECN), and salience network (SN) were the most relevant among the eight functional networks. Conclusion The results revealed that the altered activation in the prefrontal cortex and precuneus were key regions related to the effects of CBT. Therefore, CBT may modulate the neural circuitry of emotion regulation. This finding provides recommendations for the rapidly developing literature.

Efektivitas pelatihan mindfulness untuk mengatasi insomnia pada mahasiswa

Article

Full-text available

Jan 2022

The goal of this study tested the effectiveness of Mindfulness training to overcome insomnia in college students.The number of participating subjects amounted to 8 people in the weight category, with four people in each group(experiment and control). Treatment was given to subjects in the experimental group as many as four meetings with11 sessions within one month. For control is given a mindfulness diary to find out the emotional condition and sleep of the subject. The study used the Jakarta Psychiatric Study Group – Insomnia Rating Scale as a pre-test and post-test to measure insomnia levels before and after treatment. The data analysis technique used in the study was the Mann-Whitney U Test. The results showed that the experimental group’s results (Mdn=7) were higher than those of the control group (Mdn=15.8). Mann-Whitney’s test results showed a significant difference in pain scores between the experimental and control groups (N experiment = 4, Control = 4, Z =-2,337; p=0.019). This can be seen in the decrease in insomnia score in the experimental group. Mindfulness training proved to be appropriate for overcoming insomnia in college students.

Progression of intervention-focused research for Gulf War illness

Article

Full-text available

Dec 2019

The Persian Gulf War of 1990 to 1991 involved the deployment of nearly 700,000 American troops to the Middle East. Deployment-related exposures to toxic substances such as pesticides, nerve agents, pyridostigmine bromide (PB), smoke from burning oil wells, and petrochemicals may have contributed to medical illness in as many as 250,000 of those American troops. The cluster of chronic symptoms, now referred to as Gulf War Illness (GWI), has been studied by many researchers over the past two decades. Although over $500 million has been spent on GWI research, to date, no cures or condition-specific treatments have been discovered, and the exact pathophysiology remains elusive. Using the 2007 National Institute of Health (NIH) Roadmap for Medical Research model as a reference framework, we reviewed studies of interventions involving GWI patients to assess the progress of treatment-related GWI research. All GWI clinical trial studies reviewed involved investigations of existing interventions that have shown efficacy in other diseases with analogous symptoms. After reviewing the published and ongoing registered clinical trials for cognitive-behavioral therapy, exercise therapy, acupuncture, coenzyme Q10, mifepristone, and carnosine in GWI patients, we identified only four treatments (cognitive-behavioral therapy, exercise therapy, CoQ10, and mifepristone) that have progressed beyond a phase II trial. We conclude that progress in the scientific study of therapies for GWI has not followed the NIH Roadmap for Medical Research model. Establishment of a standard case definition, prioritized GWI research funding for the characterization of the pathophysiology of the condition, and rapid replication and adaptation of early phase, single site clinical trials could substantially advance research progress and treatment discovery for this condition.

Study Protocol for a Randomized Double Blind, Placebo Controlled Trial Exploring the Effectiveness of a Micronutrient Formula in Improving Symptoms of Anxiety and Depression

Article

Full-text available

Jun 2018

Background: Anxiety and depression are conferring an increasing burden on society. Although treatments exist for both conditions, side effects, and difficulties accessing treatment prevent many people from receiving adequate assistance. Nutritional approaches have demonstrated some success in treating anxiety and depression. We plan to investigate whether a micronutrient formula, Daily Essential Nutrients, improves symptoms of anxiety and depression compared to a placebo in a community recruited sample. Methods: This will be a randomized, double blind placebo controlled study (RCT). Two hundred adults will be assigned to either a placebo or micronutrient group (placebo or Daily Essential Nutrients (DEN)) in a 1:1 ratio. Baseline data will be collected for 2 weeks, followed by 10 weeks of placebo or micronutrient intervention. Psychometrics will be used to measure progress and participant safety will be monitored weekly. Results: The primary outcome measures will be total scores on three measures of symptom severity at 10 weeks. Linear mixed modelling will be used to measure between group differences and effect sizes will be calculated using pooled mean scores and standard deviations over the course of the trial. Conclusions: If effective, micronutrients could provide an alternative treatment, with fewer barriers and adverse events than currently available treatments.

Cognitive behavioral therapy for post-stroke depression: A meta-analysis

Article

Apr 2018
J AFFECT DISORDERS

Background: Cognitive behavioral therapy (CBT) has been widely used for post-stroke depression (PSD), but the findings have been inconsistent. This is a meta-analysis of randomized controlled trials (RCTs) of CBT for PSD. Methods: Both English (PubMed, PsycINFO, Embase) and Chinese (WanFang Database, Chinese National Knowledge Infrastructure and SinoMed) databases were systematically searched. Weighted and standardized mean differences (WMDs/SMDs), and the risk ratio (RR) with their 95% confidence intervals (CIs) were calculated using the random effects model. Results: Altogether 23 studies with 1,972 participants with PSD were included and analyzed. Of the 23 RCTs, 39.1% (9/23) were rated as high quality studies, while 60.9% (14/23) were rated as low quality. CBT showed positive effects on PSD compared to control groups (23 arms, SMD = -0.83, 95% CI: -1.05 to -0.60, P < 0.001). Both CBT alone (7 arms, SMD = -0.76, 95% CI: -1.22 to -0.29, P = 0.001) and CBT with antidepressants (14 arms, SMD = -0.95, 95% CI: -1.20 to -0.71, P < 0.00001) significantly improved depressive symptoms in PSD. CBT had significantly higher remission (6 arms, RR = 1.76, 95% CI: 1.37-2.25, P < 0.00001) and response rates (6 arms, RR = 1.41, 95% CI: 1.22-1.63, P < 0.00001), with improvement in anxiety, neurological functional deficits and activities of daily living. CBT effects were associated with sample size, mean age, proportion of male subjects, baseline depression score, mean CBT duration, mean number of CBT sessions, treatment duration in each session and study quality. Conclusion: Although this meta-analysis found positive effects of CBT on depressive symptoms in PSD, the evidence for CBT is still inconclusive due to the limitations of the included studies. Future high-quality RCTs are needed to confirm the benefits of CBT in PSD.

“I would not want the mechanic to direct me to an engine repair manual”: a qualitative analysis of provider perspectives on low-intensity treatments for patients on waiting lists

Article

Full-text available

Aug 2023
BMC PSYCHIATRY

Background Low-intensity treatments (LITs), such as bibliotherapy or online self-help, have the potential to reach more individuals than traditional face-to-face care by circumventing many of the common barriers to mental health treatment. Despite substantial research evidence supporting their usability and efficacy across several clinical presentations, prior work suggests that mental health providers rarely recommend LITs for patients waiting for treatment. Methods The present study analyzed provider open responses to a prompt asking about perceived barriers, thoughts, and comments related to additional treatment resources for patients on treatment waiting lists. We surveyed 141 practicing mental health providers, 65 of whom responded to an open text box with additional thoughts on using LITs for patients on treatment waiting lists. Responses were qualitatively coded using a thematic coding process. Results Qualitative outcomes yielded 11 codes: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress. Conclusions Results suggest providers are predominantly concerned about the potential of suggesting a LIT that would be ultimately inappropriate for their patient due to a lack of assessment of the patient’s needs. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care.

Blended learning for diagnostic skills: a multicenter cluster randomized non-inferiority trial

Preprint

Full-text available

Jul 2023

Objective: Clinical diagnoses determine if and how therapists treat their patients. As misdiagnoses can have severe adverse effects, disseminating evidence-based diagnostic skills into clinical practice is highly important. Therefore, we developed and evaluated a blended learning course in a multicenter cluster randomized trial. Method: Undergraduate students (N=350) enrolled in eighteen university courses at three universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants' performance in a clinical diagnostic interview after the courses, secondary outcomes were diagnostic knowledge and participants' reactions to the courses. All outcomes were analyzed on the individual participant level using non-inferiority testing. Results: Compared to the synchronous course (74.6% pass rate), participation in the blended learning course (89.0% pass rate) increased the likelihood of successfully passing the behavioral test, OR=2.77 (95% CI [1.55, 5.13]), indicating not only non-inferiority, but superiority of the blended learning course. Furthermore, participants in the blended learning course did not perform worse than participants in the synchronous course on the diagnostic knowledge test and several reaction measures. Conclusions: Blended learning can help to improve the diagnostic skills and knowledge of (future) clinicians and thus make an important contribution to improving mental health care.

Tailored Psychological Interventions to Manage Body Image: An Opinion Study on Breast Cancer Survivors

Article

Full-text available

Feb 2023
Int J Environ Res Publ Health

Objective: Oncological care affects the body strongly, even some years after therapies. Body image, as the mental representation of one's own body, is particularly affected by breast cancer, with a high level of dissatisfaction and negative perception. Literature has shown the effectiveness of various psychological interventions to promote body image in breast cancer survivors, dealing with inner sensations and related emotions and thoughts. The present opinion study presents BI issues and personalized psychological interventions to increase a positive BI in breast cancer survivors. Conclusions: Implementing specific and personalized psychological interventions tailored on BI, the characteristics of oncological journey and emotional and cognitive issues is fundamental. Directions for clinical practice are given.

A mixed-methods approach to understanding the perspectives, experiences, and attitudes of a culturally tailored cognitive behavioral therapy/motivational interviewing intervention for African American patients with type 2 diabetes: a randomized parallel design pilot study

Article

Full-text available

May 2022

Background African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention. Methods Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention. Results Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% ( t (26) = 0.5, p -value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall ( t (26) = 2.6; p -value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants ( t (26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy. Conclusion This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management. Trial registration ClinicalTrials.gov , NCT03562767 . Registered on 19 June 2018

Psychological and Psychopharmacological Interventions in Psychocardiology

Article

Full-text available

Mar 2022

Patients with mental disorders have an increased risk to develop cardiovascular disease (CVD), and CVD are frequently comorbid with especially adjustment, anxiety and depressive disorders. Therefore, clinicians need to be aware of effective and safe psychological and pharmacological treatment strategies for patients with comorbid CVD and mental disorders. Cognitive behavioral therapy and third-wave of cognitive-behavioral therapy are effective for patients with CVD and mental disorders. Internet-based psychological treatments may also be considered. In more severe cases, psychopharmacological drugs are frequently used. Although generally well tolerated and efficacious, drug- and dose-dependent side effects require consideration. Among antidepressants, selective serotonin reuptake inhibitors, selective serotonin and noradrenalin reuptake inhibitors, and newer antidepressants, such as mirtazapine, bupropion, agomelatine, and vortioxetine, can be considered, while tricyclic antidepressants should be avoided due to their cardiac side effects. Mood stabilizers have been associated with arrhythmias, and some first- and second-generation antipsychotics can increase QTc and metabolic side effects, although substantial differences exist between drugs. Benzodiazepines are generally safe in patients with CVD when administered short-term, and may mitigate symptoms of acute coronary syndrome. Laboratory and ECG monitoring is always recommended in psychopharmacological drug-treated patients with CVD. Presence of a heart disease should not exclude patients from necessary interventions, but may require careful risk-benefit evaluations. Effectively and safely addressing mental disorders in patients with CVD helps to improve both conditions. Since CVD increase the risk for mental disorders and vice versa, care providers need to screen for these common comorbidities to comprehensively address the patients’ needs.

Exploring and defining the process of creating an immersive experience aimed at breaking the taboo of schizophrenia, by a creative team with a schizophrenic patient as a team member in partnership with a patient association.

Thesis

Full-text available

Feb 2022

Karim Sellami

The inclusivity of people with schizophrenia on production teams is a hot topic in thevideo game industry. There is little research in this area. Research shows that in general,stigma and stability status of patients are factors that directly and indirectly influence theiremployability. As well as the local dynamism of the job market in the cities where thesepeople reside and the support of their families favor their employment. Family associationssuch as the PromesseS association in France help them to accompany their sick loved ones intheir daily lives. Our study aims to propose a process of co-construction of a video game thatwould promote the inclusiveness of people suffering from schizophrenia in the video gameindustry. We used a review of research on video game production methodologies and theemployability of people with schizophrenia to conduct semi-structured interviews. In thisway, we spoke with four studios about their production methodologies and their practices forthe inclusiveness of people with schizophrenia.We discussed with four families of the PromesseS association about the role theyplayed in the professional integration of their relatives. The results show that the workingconditions of the studios can favour the instability of people suffering from schizophrenia.The feedback from the families underlines the role they play in identifying stress factors andhelping their loved ones to define an adapted work environment. The relationship of trustbetween these families and the health professionals is essential to achieve this. We thuspropose a co-construction process that involves all of these stakeholders to identify inclusivebehaviors of people with schizophrenia in the video game industry. We did not interviewenough studios and families. Additional interviews with psychiatrists in particular would benecessary to complete and validate this proposal

Evaluating an engaging and coach-assisted online cognitive behavioral therapy for depression among adolescent and young adult cancer survivors: A pilot feasibility trial

Article

Full-text available

Jan 2022

Objectives Technology-assisted Cognitive Behavioral Therapy (tCBT) has significant potentials to provide engaging and accessible depression treatment for adolescents and young adults (AYAs) coping with cancer. This study evaluated the feasibility and preliminary efficacy of an engaging and tailorable tCBT – Mind Your Total Health (MYTH) – for AYA cancer survivors’ depression. Methods Seventeen AYAs diagnosed with cancer were randomly assigned to either the intervention (MYTH) or control group. The intervention group (n = 10) received eight weekly 30-35 minutes coach-assisted tCBT (MYTH), while the control group (n = 7) received active control, BeatingtheBlues (BtB). Results Eight out of ten participants in the MYTH group completed at least six out of eight sessions, suggesting strong feasibility (80% completion rate) among AYAs with cancer. Efficacy outcomes indicated that participants in the MYTH group reported significant pre- and post-treatment reduction in depression, t(9) = 5.25, p < 0.001, and anxiety, t(9)=5.07, p < 0.001. Notably, participants in the MYTH group reported significantly lower post-treatment depression than participants in the BtB group, t(15) = 2.40, p < 0.05. The between-group difference reflected a significant between-group treatment effect size, d = 1.12, p < 0.05. Discussion This engaging, tailorable, and coach-assisted tCBT intervention is promising in alleviating depression and anxiety among AYA cancer survivors. Future research needs to include larger sample size and a more diverse patient population.

How a Transdiagnostic Approach can Improve the Treatment of Emotional Disorders: Insights from Clinical Psychology and Neuroimaging

Article

Jan 2022

Multiple psychological treatments for emotional disorders have been developed and implemented, improving the quality of life of individuals. Nevertheless, relapse and poor response to psychotherapy are common. This article argues that a greater understanding of both the psychological and neurobiological mechanisms of change in psychotherapy is essential to improve treatment for emotional disorders. It aims to demonstrate how an understanding of these mechanisms provides a basis for: (i) reconceptualizing some mental disorders; (ii) refining and establishing the evidence for existing therapeutic techniques; and (iii) designing new techniques that precisely target the processes that maintain these disorders. Possible future directions for researchers and practitioners working at the intersection of neuropsychology and clinical psychology are discussed.

Effects of Cognitive Behavioral Therapy on Pain and Sleep in Adults with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Article

Full-text available

Nov 2021
Neural Plast

The objective of this study was to systematically review the literature on the effects of cognitive behavioral therapy (CBT) on insomnia and pain in patients with traumatic brain injury (TBI). PubMed, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched. Outcomes, including pain, sleep quality, and adverse events, were investigated. Differences were expressed using mean differences (MDs) with 95% confidence intervals (CIs). The statistical analysis was performed using STATA 16.0. Twelve trials with 476 TBI patients were included. The included studies did not indicate a positive effect of CBT on pain. Significant improvements were shown for self-reported sleep quality, reported with the Pittsburgh Self-Reported Sleep Quality Index (MD, -2.30; 95% CI, -3.45 to -1.15; P<0.001) and Insomnia Severity Index (MD, -5.12; 95% CI, -9.69 to -0.55; P=0.028). No major adverse events related to CBT were reported. The underpowered evidence suggested that CBT is effective in the management of sleep quality and pain in TBI adults. Future studies with larger samples are recommended to determine significance. This trial is registered with PROSPERO registration number CRD42019147266.

Outcomes of a Blended Care Coaching Program for Clients Presenting With Moderate Levels of Anxiety and Depression: Pragmatic Retrospective Study

Article

Full-text available

Oct 2021

Background Depression and anxiety are leading causes of disability worldwide, but access to quality mental health care is limited by myriad factors. Cognitive-behavioral coaching is rooted in evidence-based principles and has the potential to address some of these unmet care needs. Harnessing technology to facilitate broader dissemination within a blended care model shows additional promise for overcoming barriers to care. Objective The aim of this study is to evaluate the outcomes of a blended care coaching (BCC) program for clients presenting with moderate levels of anxiety and depression in real-world settings. Methods This study examined retrospective data from US-based individuals (N=1496) who presented with moderate levels of depression and anxiety symptoms and who received blended care coaching services. Using a short-term framework, clients met with coaches via a secure video conference platform and also received digital video lessons and exercises. To evaluate the effectiveness of the BCC program, mixed effects modeling was used to examine growth trajectories of anxiety and depression scores over the course of care. ResultsOut of the total sample of 1496 clients, 75.9% (n=1136) demonstrated reliable improvement, and 88.6% (n=1326) recovered based on either the Generalized Anxiety Disorder-7 scale (anxiety) or Patient Health Questionnaire-9 (depression). On average, clients exhibited a significant decline in anxiety and depression symptoms during the initial weeks of coaching, with a continued decline over subsequent weeks at a lower rate. Engaging in a coaching session was associated with lower anxiety (b=–1.04) and depression (b=–0.79) symptoms in the same week, as well as lower anxiety (b=–0.74) and depression (b=–0.91) symptoms the following week (P

Self-Debasing Cognitive Distortions Restructuring Intervention Down Regulate Bystanders Emotional and Behavioural Reactions to Witnessing School Bullying

Article

Full-text available

Sep 2021

Self-debasing cognitive distortion influences a person’s interpretation and increases the likelihood of negative reactions to events. Despite the theoretical support for the significant influence that cognition has in the onset and maintenance of behavioural and emotional reactions to victimisation, little research has been done on proactive cognitive strategy to down regulate negative emotional and behavioural reactions to witnessing bullying. For this reason, a qualitative descriptive-exploratory design was utilised to explore 10 early adolescent bystanders' reactions to school bullying following a self-debasing cognitive distortion restructuring intervention. Findings indicated that there were reductions in bystanders’ negative reactions to witnessing bullying that resulted from challenging the validity and reality of distortions in their thinking patterns. The study recommended that bystanders should be equipped with self-debasing cognitive distortions restructuring skills to root out the source of bias in their thought patterns with a view of down regulating their emotional and behavioural reactions to witnessing bullying.

The efficacy of cognitive behavioral therapy-based interventions on patients with hypertension: A systematic review and meta-analysis

Article

Full-text available

Jul 2021

Recently, the benefits of cognitive behavioral therapy (CBT)-based interventions for patients with hypertension have been recognized, but there has been no systematic review that has comprehensively analyzed the efficacy of CBT on health outcomes in this population. We aimed to explore the therapeutic effect of CBT-based interventions on hypertension patients through a meta-analysis. Relevant randomized controlled trials (RCTs) were obtained by searching electronic databases. The primary outcomes were physiological indicators (blood pressure, blood lipid profile). Secondary outcomes were psychological indicators (anxiety, depression), and the quality of sleep. Stata version 15.0 software was used to analyze the results. A total of 15 RCTs were included. The main analysis revealed that CBT-based interventions reduced systolic pressure: -8.67 (95% CI: -10.67 to -6.67, P=0.000); diastolic pressure: −5.82 (95% CI: -7.82 to -3.81, P=0.000); total cholesterol levels: -0.43 (95% CI: -0.76 to -0.10, P=0.010); depressive symptoms: -3.13 (95% CI: -4.02 to -2.24, P=0.000); anxiety symptoms: -3.63 (95% CI: -4.40 to -2.87, P=0.000); and improved quality of sleep: -2.93 (95% CI: -4.40 to -1.47, P=0.000). Additionally, the results of subgroup analysis indicated that long-term group-based CBT-based interventions were particularly beneficial for blood pressure management in hypertension patients. CBT-based interventions are effective in reducing systolic pressure, diastolic pressure, total cholesterol levels, anxiety symptoms, depressive symptoms, and improving quality of sleep in hypertension patients.

Cultural adaptations of cognitive behaviour therapy for the Orthodox Jewish community: A qualitative study of therapists' perspectives

Article

Jan 2021

Cultural factors are influential in the prevalence, diagnosis and treatment efficacy of mental health conditions. Although the literature has advanced substantially towards the development of cultural adaptations of cognitive behavioural therapy (CBT) for various minority cultural groups, research into cultural adaptations of CBT for the Orthodox Jewish community has been scarce. This qualitative study interviewed five CBT therapists about their experiences working with clients from the London Orthodox Jewish community and uncovered several key practical implications for the clinical practice of CBT with this client group. This study indicates that CBT is a culturally appropriate psychological treatment for this client group that accords with Orthodox Jewish teachings and religious beliefs. CBT therapists are encouraged to become familiar with Orthodox Jewish cultural practices and beliefs and adopt a culturally sensitive approach to treatment. Despite the reduced mental health stigma within the community, this study recommends that CBT therapists normalise mental health conditions and therapy with Orthodox Jewish clients. Due to the close-knit nature of the community, it is suggested that CBT therapists display heightened confidentiality with this client group. To overcome the mistrust of their Orthodox Jewish clients, CBT therapists are advised to display cultural sensitivity and genuine respect for the Orthodox Jewish way of life, in addition to building a strong therapeutic alliance. Further qualitative research exploring different perspectives is necessary to produce evidence-based guidelines for the cultural adaptation of CBT for the Orthodox Jewish community. Key learning aims (1) To explore how CBT therapists work with the religious beliefs and practices of Orthodox Jewish clients. (2) To discover the challenges faced by Orthodox Jewish clients when accessing psychological treatment. (3) To consider the ways in which CBT can be culturally adapted to meet the needs of the Orthodox Jewish community.

Effectiveness of Cognitive Behavioral Therapy on Health Outcomes in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Article

Sep 2020

"The incidence of psychological distress (such as anxiety and depression) is high in COPD patients. CBT has been proved to reduce depression and anxiety and enhance quality of life. This meta-analysis evaluated the effectiveness of cognitive behavioral therapy(CBT) on patients with chronic obstructive pulmonary disease(COPD). The following electronic databases were searched from inception to March 2020: PubMed, EMBase, Cochrane Library, Web of Science, Medline, OVID, CINAHL, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wangfang Database (WF), PsycARTICLES, VIP database. The Scopus and Google scholar database that we did not use. Randomized controlled trials (RCTs) that compared CBT with routine methods of care in COPD were retrieved in electronic databases. The Cochrane Risk of Bias Tool and Review Manager version 5.3 were used for risk of bias assessment and meta-analysis, respectively. Both data synthesis and descriptive analysis were used for outcome assessment. A total of 10 RCTs involving 1173 patients were included. Data synthesis showed that CBT was statistically significant in improving short- and medium-term depression and treatment compliance. Mediumterm anxiety and quality of life were improved among COPD patients receiving CBT, although no significant effect was found for short-term quality of life and anxiety. Descriptive analysis showed that CBT could reduce dyspnea. No clear evidence supports the effectiveness on improving self-efficacy in COPD patients with the use of CBT (P > 0.05). CBT can be a useful strategy to improve the symptoms of depression, dyspnea and treatment compliance in patients with COPD. It can also improve patients’ quality of life and anxiety to some extent, but there is still lack of strong evidence in improving patients’ self-efficacy."

Cost-effectiveness of an indicated preventive intervention for depression in adolescents

Article

Sep 2020

Background Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. Methods A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. Results The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented more cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. Limitations: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. Conclusions GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated. Key messages Indicated preventive interventions for depression are cost-saving and can generate substantial health benefits. Indicated preventive interventions can be adopted as cost-effective preventive strategies for depression.

Effect of pain on depression among nursing home residents: Serial mediation of perceived social support and self‐rated health. A cross‐sectional study

Article

Full-text available

Oct 2020
GERIATR GERONTOL INT

Aim: The aim of this study was to investigate how perceived social support and self-rated health together could mediate the relationship between pain and depression among Chinese nursing home residents with pain. Methods: The study was conducted in 38 nursing homes in 13 cities in China. A convenience sample of 2154 older adults responded to the questionnaire survey. A mediation analysis was performed on the data of 990 participants with pain. The data were collected by a questionnaire consisting of socio-economic and demographic characteristics, the Geriatric Depression Scale-15, the Multidimensional Scale of Perceived Social Support, Self-rated Health Scale and the Numerical Rating Scale of pain. The sample was subdivided by sex. Descriptive analysis, t-tests, chi-squared tests, Mann-Whitney U-tests, Spearman correlation analyses and the bootstrap method were used to analyze data. Results: The prevalence rate of pain and depression among nursing home residents were 46.0% and 20.7% respectively. Pain, perceived social support and self-rated health were all significantly correlated with depression (r = 0.217, P < 0.01; r = -0.216, P < 0.01; r = 0.385, P < 0.01, respectively). Perceived social support and self-rated health independently and in series partly explained the relationship between pain and depression. Conclusions: The results of the study showed that pain was associated with low perceived social support first, and then poor self-rated health, which was in turn related to the development of depression among nursing home residents with pain. For nursing home residents, perceived social support and self-rated health as an internal resource can affect the ability to overcome the suffering of pain and reduce the level of depression. Geriatr Gerontol Int 2020; ••: ••-••.

CBT MobileWork©: User-Centered Development and Testing of a Mobile Mental Health Application for Depression

Article

Full-text available

Apr 2021
COGNITIVE THER RES

Background“Homework assignments,” a critical element of Cognitive Behavioral Therapy (CBT) for depression, are a means of CBT skill generalization and maintenance. Yet, homework adherence is often low. We developed CBT MobileWork,© a smartphone application (app) to promote CBT skills practice “as-needed.”Methods We applied a user-centered design in a laboratory setting with 8 depressed patients and 5 therapists for the initial development and testing. We then completed a real-world evaluation of CBT MobileWork© with 15 depressed patients in CBT and their therapists. This report details the prototype development, presents data evaluating feasibility and usability in the lab and real-world, and presents preliminary findings of associated measures.ResultsOur data indicates that both patients and therapists reported high levels of satisfaction and rated the application highly usable during testing in both controlled laboratory and under real-world conditions. A moderate association between app use and reductions in depression was found.ConclusionsCBT MobileWork© has preliminary feasibility for CBT skills practice and may benefit patients with CBT homework completion.

Cost-effectiveness of an indicated preventive intervention for depression in adolescents: a model to support decision making

Article

Full-text available

Sep 2020
J AFFECT DISORDERS

Background : Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. Methods : A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option in a Swedish setting. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as differences in the proportion of cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. Results : The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented a larger proportion of cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. Limitations : The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. Conclusions : GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated.

Positive Psychology - the basics

Book

Full-text available

May 2020

Rona Hart

This book provides an accessible and balanced introduction to positive psychology scholarship and its applications, incorporating an overview of the development of positive psychology. Positive Psychology: The Basics delineates positive psychology’s journey as a discipline, takes stock of its achievements and provides an updated overview of its core topics, exploring the theory, research and interventions in each. Launched as a rebellious discipline just over two decades ago, positive psychology challenged the emphasis of applied psychology on disease and dysfunction and offered a new, more balanced perspective on human life. From its foundations in the late 20th century to recent “second-wave” theories around the importance of recognizing negative emotions, this compact overview covers the key ideas and principles, from research around emotional wellbeing, optimism and change, to posttraumatic growth and positive relationships. The first jargon-free introduction to the subject, Hart introduces the reader to a range of issues, including self-regulation and flow, character strengths and virtues and positive relationships, concluding with a chapter on how interventions can affect happiness and wellbeing. Positive Psychology: The Basics is an essential resource for students, practitioners, academics and anyone who is interested in understanding the essence of a life well lived.

Efektivitas Cognitive Behavior Therapy (Cbt) Untuk Meningkatkan Kualitas Tidur Penderita Gejala Insomnia Usia Dewasa Awal

Article

Full-text available

Sep 2019

Early adulthood becomes a period which cognitive and physical development functions optimally so that it affect young adult to have new activities and experiences that are vulnerable to an unhealthy lifestyle, such as smoking, alcohol consumption, and excessive caffeine consumption. The more daily activity they have, the higher they become depressed that impacts on irregular sleep patterns, decreased sleep quality, and experience symptoms of insomnia. The purpose of this study was to examine the effectiveness of Cognitive Behavior Therapy (CBT) to improve sleep quality in patients with insomnia symptoms in early adulthood. The study used an experimental research method with one group pre-test post-test experimental design, and took samples of 4 people with age range between 20-25 years. The Pittsburgh Sleep Quality Index (PSQI) was used as measurement tool and furthermore writer used Wilcoxon Signed-Rank Test to analyze the data. The results showed a significant sleep quality difference of 4 subjects prior and after CBT. CBT’s components such as stimulus control, sleep restriction, sleep hygiene education, and cognitive therapy believed to affects sleep quality in this study. Other than that, internal factors like motivation and obedient towards therapy and also external factors like support from fellow subjects or family members become factors which affects changes in subjects’ condition.

Smartphone-Based Interventions for the Treatment of Mental Health Problems - Studies on Feasibility, Treatment Effects, and the Assessment of Common Factors for a Transdiagnostic Approach

Thesis

Jan 2019

Christian Aljoscha Lukas

Mental health problems are common in the general population and are associated with high individual and economic burden. To reduce this burden, psychotherapy research and practice have been increasingly professionalized since the latter half of the 20th century and evidence-based psychotherapeutic treatments have been made widely available. Despite the costly efforts to provide evidence-based psychotherapy on a large scale, a significant number of patients remain untreated or do not respond to available interventions. With the integration of computers into everyday life in the 1990s, research has increasingly focused on computer-based interventions (CBIs) to improve both the provision and the quality of evidence-based treatments for all patients. In the last two decades, numerous studies have demonstrated the effectiveness of CBIs for the treatment of mental health problems. In the 21st century, technology is rapidly progressing, and smartphones have gradually taken the place of personal computers in the general population. As a result, smartphone-based interventions (SBIs) are widely discussed as possible aids for the treatment of mental health problems, and there already exists a plethora of SBIs for various patient groups. However, the majority of available SBIs lack empirical evidence as they have not been evaluated in experimental studies. Hence, there exists considerable uncertainty regarding the benefits and possible treatment effects of SBIs. Moreover, most SBIs lack quality in terms of their interventional content, their use of the smartphone’s technological facilities, and their utilization of strategies that engage the patient to use the SBI regularly. Therefore, this dissertation addresses the development and evaluation of an SBI approach that uses evidence-based strategies, seizes upon the smartphones’ technological features, and applies gamification elements to increase patient engagement. Based on the promising findings for blended interventions that combine traditional face-to-face cognitive-behavioral therapy (CBT) with computerized approach-avoidance modification training (AAMT) in the treatment of alcohol use disorders and depression, the SBI approach introduced in this dissertation makes use of intervention techniques from both CBT and smartphone-based AAMT. In six studies, problem-specific SBIs that apply this combined approach are evaluated for their usability and possible effects in the treatment of various mental health problems. Study 7 presents emotion regulation (ER) as a possible common factor in psychopathology that can be targeted by a single SBI addressing patients suffering from various mental health problems. Study 1 examines the feasibility and explores possible effects of an intervention that combines a brief individual counseling session with two weeks of smartphone-based AAMT. This approach is evaluated in a sample of college students meeting criteria for problematic alcohol use. Findings on both usability and treatment effects provide preliminary evidence that the intervention can significantly reduce dysfunctional beliefs about alcohol, craving of alcohol, and alcohol consumption. Study 2 is a multi-center study that assesses the effect of smartphone-based AAMT combined with a brief individual counseling session for participants with elevated levels of body dissatisfaction. Results show that the intervention significantly reduces body dissatisfaction and symptoms of eating disorders. Study 3 evaluates a blended intervention for the reduction of procrastination. Results from this study provide preliminary evidence that a blended intervention that combines two group counseling sessions with 14 days of smartphone-based AAMT can significantly reduce both general and academic procrastination. In Study 4, the blended intervention is comprised of a brief individual psychoeducation session and smartphone-based AAMT for the training of inter- and intraindividual emotion recognition skills in alexithymic individuals. Results show that the intervention improved computer-assessed emotion recognition skills and demonstrated additional effects over a psychoeducation-only control condition. Studies 5 and 6 evaluate SBIs in samples of individuals reporting heightened levels of depression. While results from Study 5 provide preliminary efficacy for an intervention that combines 14-days of smartphone-based AAMT in combination with a psychoeducation group session, Study 6 examines the effectiveness of a stand-alone SBI targeting depressive symptoms using an automated approach that includes an increased degree of gamification. Results of Study 6 demonstrate that 14 days of training with this stand-alone SBI could significantly reduce depressive symptoms. Study 7 comprises two studies that focus on the cross-sectional assessment of deficits in ER skills with the aim to identify common factors that may be targeted by a single, transdiagnostic SBI. Comparisons between two clinical samples and a sample from the general population indicated that participants that met diagnostic criteria for a mental disorder reported lower ER skills than participants from the general population and that ER skills differed across the clinical subgroups. In conclusion, the present dissertation provides evidence that: (1) the AAMT paradigm can be successfully transferred from computers to smartphone devices as indicated by high acceptance scores, high usability ratings, and the frequent use of the SBIs by participants included in the pilot studies; (2) problem-specific SBIs that incorporate face-to-face CBT techniques with AAMT principles may be efficacious for the reduction of symptoms in the targeted mental health problems; (3) a standalone SBI that applies automated CBT techniques and technologically enriched AAMT variants may effectively reduce symptoms of depression; and that (4) ER skills are promising transdiagnostic processes that may be successfully trained in a single SBI that targets a broad range of mental health problems. Further research using larger, more heterogeneous samples including participants that meet diagnostic criteria for mental disorders is necessary to confirm the findings from this dissertation.

Un modelo transdiagnóstico guiado por el Self: Una visión ampliada de la psicoterapia cognitivo analítica

Article

Full-text available

Jul 2018

Carlos Mirapeix

Abordamos en este artículo una comprensión de los modelos transdiagnósticos guiados por el self y mediados por una formulación de caso de orientación transdiagnóstica, que intenta sintetizar los mecanismos transdiagnósticos de vulnerabilidad y de acción. Los conceptos actuales sobre el self permiten describir con mayor precisión patrones que permiten operativizar algunos de sus componentes y así poder avanzar en una futura metodología de evaluación con una mayor validez empírica. La implementación de tratamientos transdiagnósticos irán desde la mayor estructuración del tipo de técnicas que pueden utilizarse para modificar determinados mecanismos, siendo necesario e inevitable encajarlos con lo auténticamente individual de los pacientes que tratamos, su identidad, su self y por ende sus patrones de relación interpersonales.

The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: A meta-analysis of randomized controlled trials

Article

Oct 2018
J AFFECT DISORDERS

Background This systematic review and meta-analysis aimed to update and give an overview of the evidence from published literature that focused on the efficacy of cognitive behaviour therapy (CBT) in the management of somatoform disorders and medically unexplained physical symptoms (MUPS). Methods A comprehensive literature search was carried out through an electronic search of various databases on randomized controlled trials (RCTs). Primary outcome was the severity of somatic symptoms. Secondary outcomes were also measured based on severity of anxiety symptoms, severity of depressive symptoms, social functioning, physical functioning, doctor visits and the compliance with CBT, as well as follow-up visits. Effects were summarized by a random effects model using mean differences or odds ratio with 95% confidence intervals (CIs). Results A total of 15 RCTs comprising 1671 patients with somatoform disorders or MUPS were enrolled in our systematic review and meta-analysis. The main analysis revealed that CBT could alleviate somatic symptoms: -1.31 (95% CI: -2.23 to -0.39, p = 0.005); anxiety symptoms: -1.89 (95% CI: -2.91 to -0.86; p < 0.001); depressive symptoms: -1.93 (95% CI: -3.56 to -0.31; p = 0.020); improve physical functioning: 4.19 (95% CI: 1.90 to 6.49; p < 0.001). The efficacy of CBT on alleviating somatic symptoms, anxiety and depressive symptoms were sustained on follow-up. CBT may not be effective in reducing the number of doctor visits: -1.23 (95% CI: -2.97 to 0.51; p = 0.166); and improving social functioning: 3.27 (95% CI: -0.08 to 6.63; p = 0.056). The results of subgroup analysis indicated that CBT was particularly beneficial when the duration of session was more than 50 minutes to reduce the severity of somatic symptoms from pre to post treatment time, when it was group based and applied affective and developed good interpersonal strategy during the treatment. Longer duration and frequency such as more than 10 sessions and 12 weeks treatments had significant effect on reduction of the comorbid symptoms including depression and anxiety, but they may underpin low level of compliance of CBT based treatments. Conclusions: CBT is effective for the treatment of somatoform disorders and MUPS by reducing physical symptoms, psychological distress and disability.

Network changes associated with transdiagnostic depressive symptom improvement following cognitive behavioral therapy in MDD and PTSD

Article

Full-text available

Dec 2018

Despite widespread use of cognitive behavioral therapy (CBT) in clinical practice, its mechanisms with respect to brain networks remain sparsely described. In this study, we applied tools from graph theory and network science to better understand the transdiagnostic neural mechanisms of this treatment for depression. A sample of 64 subjects was included in a study of network dynamics: 33 patients (15 MDD, 18 PTSD) received longitudinal fMRI resting state scans before and after 12 weeks of CBT. Depression severity was rated on the Montgomery-Asberg Depression Rating Scale (MADRS). Thirty-one healthy controls were included to determine baseline network roles. Univariate and multivariate regression analyses were conducted on the normalized change scores of within- and between-system connectivity and normalized change score of the MADRS. Penalized regression was used to select a sparse set of predictors in a data-driven manner. Univariate analyses showed greater symptom reduction was associated with an increased functional role of the Ventral Attention (VA) system as an incohesive provincial system (decreased between- and decreased within-system connectivity). Multivariate analyses selected between-system connectivity of the VA system as the most prominent feature associated with depression improvement. Observed VA system changes are interesting in light of brain controllability descriptions: attentional control systems, including the VA system, fall on the boundary between-network communities, and facilitate integration or segregation of diverse cognitive systems. Thus, increasing segregation of the VA system following CBT (decreased between-network connectivity) may result in less contribution of emotional attention to cognitive processes, thereby potentially improving cognitive control.

Disentangling the Neural Basis of Cognitive Behavioral Therapy in Psychiatric Disorders: A Focus on Depression

Article

Full-text available

Aug 2018
BSRCCS

Background: Major depressive disorder (MDD) stands among the most frequent psychiatric disorders. Cognitive behavioral therapy (CBT) has been shown to be effective for treating depression, yet its neural mechanisms of action are not well elucidated. The objective of this work is to assess the available neuroimaging studies exploring CBT's effects in adult patients with MDD. Methods: Computerized databases were consulted till April 2018 and a research was conducted according to PRISMA guidelines in order to identify original research articles published at any time in English and French languages on this topic. Results: Seventeen studies were identified. Only one study was randomized comparing CBT to pharmacological interventions, and none included an effective control. Following CBT, changes occurred in cerebral areas that are part of the fronto-limbic system, namely the cingulate cortex, prefrontal cortex and amygdala-hippocampal complex. However, the pattern of activation and connectivity in these areas varied across the studies. Conclusion: A considerable heterogeneity exists with regard to study design, adapted CBT type and intensity, and employed neuroimaging paradigms, all of which may partly explain the difference in studies' outcomes. The lack of randomization and effective controls in most of them makes it difficult to draw formal conclusion whether the observed effects are CBT mediated or due to spontaneous recovery. Despite the observed inconsistencies and dearth of data, CBT appears to exert its anti-depressant effects mainly by modulating the function of affective and cognitive networks devoted to emotions generation and control, respectively. This concept remains to be validated in large scale randomized controlled trials.

Clinical Supervision of CBT with Youth, Adolescents, and Families

Chapter

Sep 2023

This chapter discusses clinical supervision with children and families, focusing on competencies that are especially relevant to working with this population. This chapter also examines some of the unique challenges of supervision work with children and families, such as the balancing of boundaries and relationships between parent and child. Finally, this chapter provides recommendations that address these specific concerns.KeywordsCognitive behavioral therapy Supervision Children Families Adolescents Competencies Assessment Evidence-based practice Role-play Modeling Evaluation Feedback Case conceptualization Supervisory alliance Dissemination Implementation

Cognitive behavioural therapy for functional abdominal pain disorders in children and adolescents: A systematic review of randomized controlled trials

Article

Sep 2023
BEHAV RES THER

Aim: Although Cognitive behavioural therapy (CBT) potentially holds efficacy in addressing functional abdominal pain disorders (FAPDs) amongst children and adolescents, the persistent efficacy is uncertain. Methods: We searched three databases to identify related randomized controlled trials (RCTs). Meta-analysis was performed using RevMan and Stata. Subgroup analyses were mainly conducted based on follow-up time. The GRADE approach was used to evaluate the certainty of the evidence. Results: A total of 14 RCTs evaluating 858 patients were included. All RCTs were rated as having a high risk of bias. Compared with control groups, CBT was associated with improvement of general functional impairment (standardized mean difference (SMD) = -0.77, 95% CI [-1.12, -0.42], p < 0.05), higher treatment success (relative risk (RR) = 2.35, 95% CI [1.50, 3.69], p < 0.05), improvement of abdominal pain symptoms (SMD = -0.48, 95% CI [-0.73, -0.23], p < 0.05), QoL (SMD = 0.42, 95% CI [0.20, 0.64], p < 0.05), and psychological states (SMD = -0.95, 95% CI [-1.62, -0.27], p < 0.05). Conclusion: This meta-analysis provides low to moderate quality evidence that CBT could significantly improve clinical outcomes and QoL for children and adolescents with FAPDs with improvement persisting until short-term follow-up. However, there were discrepancies regarding CBT's effects at mid- and long-term follow-up across different outcomes. More high-quality and longer-duration studies are thus warranted to explore the effectiveness of CBT in the future. Systematic review registration on prospero: CRD42022369353.

Online cognitive behavioral therapy (eCBT) for the management of depression symptoms in unipolar and bipolar spectrum disorders, a systematic review and network meta-analysis

Article

Sep 2023
J AFFECT DISORDERS

Background: Face-to-face cognitive behavioral therapy (CBT) is effective in the management of depression symptoms in unipolar and bipolar spectrum disorders. Though, compared to electronic adaptations of CBT (eCBT), it carries several accessibility limitations. Furthermore, unlike eCBT for depression symptoms (eCBTg), eCBT specific for bipolar depression (eCBT-Bipol) remains largely understudied. Thus, supplementing this gap, this systematic review and network meta-analysis (NMA) synthesized the available literature on eCBT for the treatment of unipolar and bipolar depression symptoms. Method: MEDLINE, CINAHL, PsycINFO, EMBASE, and Cochrane were searched for relevant randomized controlled trials (RCTs) on eCBTg and eCBT-Bipol The review followed PRISMA guidelines and used the Cochrane risk of bias tool and GRADE criteria for quality assessment. Effect sizes were summarized using standardized mean differences (SMDs) and risk ratios (RRs). Results: eCBT-Bipol was comparable to eCBTg (SMD: 0.05, 95 % CI: -0.18; 0.28) and other psychotherapeutic interventions (SMD: 0.14, 95 % CI: -0.07; 0.35) for the management of mild to moderate depression symptoms. eCBT-Bipol was significantly more effective than attention controls (SMD: 0.35, 95 % CI: 0.11; 0.59), treatment as usual (SMD: 0.55, 95 % CI: 0.21; 0.90) and no intervention controls (SMD: 0.66, 95 % CI: 0.40; 0.93) in mitigating symptoms. Limitations: The scarcity of eCBT-Bipol studies impacted the quality of the evidence in terms of risk of bias and imprecision. Conclusions: The findings of this systematic review suggest that eCBT-Bipol has comparable effectiveness to eCBTg in managing depressive symptoms of unipolar and bipolar spectrum disorder. Though, they also highlighted the need for more studies on eCBT-Bipol.

Whole Person Modeling: a transdisciplinary approach to mental health research

Article

Full-text available

Aug 2023

The growing global burden of mental illness has prompted calls for innovative research strategies. Theoretical models of mental health include complex contributions of biological, psychosocial, experiential, and other environmental influences. Accordingly, neuropsychiatric research has self-organized into largely isolated disciplines working to decode each individual contribution. However, research directly modeling objective biological measurements in combination with cognitive, psychological, demographic, or other environmental measurements is only now beginning to proliferate. This review aims to (1) to describe the landscape of modern mental health research and current movement towards integrative study, (2) to provide a concrete framework for quantitative integrative research, which we call Whole Person Modeling, (3) to explore existing and emerging techniques and methods used in Whole Person Modeling, and (4) to discuss our observations about the scarcity, potential value, and untested aspects of highly transdisciplinary research in general. Whole Person Modeling studies have the potential to provide a better understanding of multilevel phenomena, deliver more accurate diagnostic and prognostic tests to aid in clinical decision making, and test long standing theoretical models of mental illness. Some current barriers to progress include challenges with interdisciplinary communication and collaboration, systemic cultural barriers to transdisciplinary career paths, technical challenges in model specification, bias, and data harmonization, and gaps in transdisciplinary educational programs. We hope to ease anxiety in the field surrounding the often mysterious and intimidating world of transdisciplinary, data-driven mental health research and provide a useful orientation for students or highly specialized researchers who are new to this area.

Psicologia em Pesquisa A história das Terapias Cognitivo-Comportamentais na região Sudeste do Brasil The history of Cognitive-Behavioral Therapies in the Southeast region of Brazil La historia de las Terapias Cognitivo-Conductuales en la región Sudeste de Brasil

Article

Jan 2023

To clarify how Cognitive-Behavioral Therapies (CBTs) have become part of psychological practices in Brazil, it is necessary to understand its historical background. The Southeast region has contributed to the diffusion of CBT in the country. In this respect, we aimed to analyze the historical development of CBT in that region. The historical method of information assessment was used. The results demonstrated that the background which created the foundations for the appearance and development of the CBTs was different in each state of the Southeast region. In community, there was a greater investment in teaching, clinical care, research, and scientific communication. In any case, it is important to note that any historical research can be rethought through new findings and explanations.

Experience of internet‐delivered cognitive behavioural therapy among patients with non‐cardiac chest pain

Article

Oct 2022

Aims and objective: To explore the experiences of patients with non-cardiac chest pain and cardiac anxiety regarding participation in an internet-delivered cognitive behavioural therapy program. Background: Non-cardiac chest pain is common and leads to cardiac anxiety. Internet-delivered cognitive behavioural therapy may be a possible option to decrease cardiac anxiety in these patients. We have recently evaluated the effect of an internet-delivered cognitive behavioural therapy program on cardiac anxiety. Design: An inductive qualitative study using content analysis and the COREQ checklist. Methods: Semi-structured interviews with 16 Swedish patients, who had participated in the internet-delivered cognitive behavioural therapy program. Results: Three categories were found. The first, 'Driving factors for participation in the internet-delivered cognitive behavioural therapy program' described the impact of pain on their lives and struggle that led them to participating in the program. The second, 'The program as a catalyst' described that the program was helpful, trustworthy and useful and the last category, 'Learning to live with chest pain' described the program as a tool for gaining the strength and skills to live a normal life despite chest pain. Conclusions: The program was experienced as an opportunity to return to a normal life. The program was perceived as helpful, trustworthy and useful, which helped the participants challenge their fear of chest pain and death, and gain strength and new insights into their ability to live a normal life. Relevance to clinical practice: A tailored internet-delivered cognitive behavioural therapy program delivered by a nurse therapist with clinical experience of the patient group is important to improve cardiac anxiety. Patient or public contribution: Patients or the general public were not involved in the design, analysis or interpretation of the data of this study, but two patients with experience of non-cardiac chest pain were involved in the development of the pilot study. Trial registration: ClinicalTrials.gov NCT03336112; https://www. Clinicaltrials: gov/ct2/show/NCT03336112.

Clarifying Identity and the Self in a CBT Context

Chapter

Jan 2022

Two important psychological frameworks, self psychology and cognitive behavioural theory, are brought together in this chapter as one way of advancing our understanding of the role that identity and ‘the self’ play in psychological disturbance and its treatment. Numerous definitions of the self have been discussed across multiple disciplines, and these are referred to either implicitly or explicitly in cognitive behavioural formulations of psychopathology. Researchers have consistently emphasised the complex transactional associations between psychological disturbance and ruptures in self-structures or self-processes such as self- identity, esteem, regulation, stability, cohesion, complexity, incongruence, discrepancy, schemas and ambivalence. Furthermore, early developmental influences are known to impact on the emergence of both the self and a range of psychological disorders, which could also impact on aspects of psychological treatment. Moreover, while cognitive behavioural therapy (CBT) is considered the gold standard treatment for many psychological disorders, efficacy and targets of treatment vary widely from disorder to disorder, with the emergence of the Third Wave of psychological therapies focusing attention on the need to target a broader range of factors in CBT to improve outcomes, inclusive of the self. For instance, the emergence of successful strategies targeting dysfunctional self-processing in disorders such as social anxiety and borderline personality has seen greater interest specifically in evidence-based self-related interventions. Such considerations are important in evolving CBT, inclusive of advancing personalised approaches to psychological treatment, as well as preventative mental health, education and even public mental health policies.KeywordsSelfIdentityCognitionsPsychopathologyCBTAttachment

Acceptance and commitment therapy and its unacknowledged influences: Some old wine in a new bottle?

Article

Aug 2022

Miguel M. Gonçalves

Recently, Goldfried suggested that one main reason for the underdevelopment of psychotherapy as a scientific enterprise was the lack of acknowledgment of past contributions. In this article, this issue is illustrated by analyzing the particular case of acceptance and commitment therapy (ACT). ACT has clear overlaps with therapies from the systemic tradition, such as strategic therapy in the line of the Mental Research Institute in Palo Alto, and with the more recent models of solution‐focused therapy and narrative therapy. This article analyzes theoretical overlaps with these models (e.g., the paradoxical nature of human problems and the nature of language) as well as examples of similarities in therapeutic strategies (externalization and the miracle question). It concludes by suggesting that this practice of inadvertently obliterating the past does not favor the development of the field or the creation of consensus but rather contributes to the ongoing proliferation of “new” psychotherapy models. Trends that may contribute to circumventing this problem are discussed.

The effect of early cognitive behavior therapy for first-episode treatment-naive major depressive disorder

Article

Apr 2022
J AFFECT DISORDERS

Background Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders. Cognitive behavioral therapy (CBT) has been widely applied in MDD treatment, yet mechanistic understanding toward CBT remains limited. Methods Twenty-two MDD patients and twenty-seven matched healthy controls were enrolled. Patients with MDD were given structural early CBT treatment once a week for 6 weeks. Cognitive reconstruction, emotional transformation and behavioral training were included in the treatment process. Local and long-range brain functional connectivity densities (FCD) were obtained to identify abnormal connectivity of MDD by using resting-state functional magnetic resonance imaging (RS-fMRI). Results After CBT treatment, MDD patients showed increased FCD in the bilateral dorsolateral prefrontal cortex (dlPFC). Functional connectivity (FC) was used to further explore the role of dlPFC in CBT. The results revealed that by the completion of CBT treatment course, the FC between the dlPFC and hippocampus was enhanced. Conclusions Cognitive behavioral therapy played significant role in alleviating depressive symptoms of MDD patients, evidenced by improved brain connectivity between dlPFC and hippocampus. Further study of dlPFC pathophysiology is needed to better understand these abnormalities in patients with depressive symptoms and the effect of early CBT treatment.

IDOSOS: CONDIÇÕES NUTRICIONAIS E CONSTIPAÇÃO FUNCIONAL

Chapter

Sep 2021

Predictors and moderators of treatment efficacy in reducing custodial grandmothers’ psychological distress

Article

Jan 2021

It is increasingly recommended that hypothesis-generating studies be conducted after initial RCTs in order to identify moderators of differential treatment efficacy on individual outcomes. Such analyses are important because they help clarify the best inclusion and exclusion criteria or choice of stratification for maximizing power in subsequent RCTs, reduce the chances of discarding interventions that may appear to lack efficacy when only average treatment effects are taken into consideration, and facilitate the matching of individual clients to treatment alternatives. We identified predictors and moderators of treatment-related change in psychological distress among custodial grandmothers (n = 343) assigned within a prior RCT to behavior parent training (BPT), cognitive behavior therapy (CBT), or information only control (IOC) conditions. Latent change scores in psychological distress were estimated for each grandmother across pre-test to post-test and pre-test to six months, as indicated by self-reported and clinical ratings of depression and anxiety symptoms. These estimates served as outcomes in classification and regression tree analyses conducted separately within the CBT and BPT conditions to identify predictors of treatment efficacy. Matched groups based upon identified predictors were then formed across all RCT conditions, and Predictor × RCT Condition interactions were computed to test for moderation of differential treatment efficacy. Grandmother age was the only predictor and moderator of BPT efficacy at both measurement points, whereas multifaceted predictors and moderators emerged for CBT which varied by time since treatment.

Heeding the psychological concerns of young cancer survivors: a single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress

Article

Full-text available

Mar 2020

Background A subgroup of adolescent and young adult (AYA) survivors of cancer during adolescence report high levels of psychological distress. To date, evidence-based psychological interventions tailored to the cancer-related concerns experienced by this population are lacking. The present study aimed to (1) examine the feasibility and preliminary efficacy of an individualized cognitive behavioral therapy (CBT) intervention for AYA survivors of cancer during adolescence; and (2) identify and conceptualize cancer-related concerns as well as maintaining factors using cognitive-behavioral theory. Methods A single-arm trial, whereby AYA survivors of cancer during adolescence (aged 17–25 years) were provided individualized face-to-face CBT at a maximum of 15 sessions. Clinical outcomes were assessed at baseline, post-intervention, and three-month follow-up. Intervention uptake, retention, intervention delivery, and reliable change index scores were examined. An embedded qualitative study consisted of two unstructured interviews with each participant pre-intervention. Along with individual behavioral case formulations developed to guide the intervention, interview data was analyzed to identify and conceptualize cancer-related concerns and potential maintaining factors. Results Ten out of 213 potential participants invited into the study were included, resulting in an overall participation rate of 4.7%. Nine participants completed the intervention, with respectively seven and eight participants completing the post-intervention and three month follow-up assessment. The majority of reported cancer-related concerns and maintaining factors were conceptualized into four themes: social avoidance, fear of emotions and bodily symptoms, imbalance in activity, and worry and rumination. Conclusions Given significant recruitment difficulties, further research is required to examine barriers to help-seeking in the AYA cancer survivor population. However, the conceptualization of cancer-related concerns and maintaining factors experienced by the population may represent an important first step in the development of psychological support tailored toward AYA cancer survivors’ unique needs.

Knowledge Structure of Cognitive Behavioral Therapy Studies in Korea: Co-word Analysis

Article

Full-text available

Dec 2019

(KOR) 본 연구는 인지행동치료(Cognitve Behavioral Therapy: CBT)분야 학술지에서 나타난 키워드의 출현패턴을 조사하여 국내 CBT 연구의 지식구조를 규명하는 데에 목적이 있다. 국내·외에서 수행된 CBT 연구를 비교하고자 ‘인지행동치료’에서 출판된 논문 234편(2008-2019)과 ‘Cognitive Therapy and Research’에서 출판된 논문 2,316편(1977-2019)이 수집되었다. 자료는 NetMiner 4.3 프로그램으로 분석되었으며 동시출현단어 분석은 코사인 유사도 행렬을 산출하고, 네트워크를 시각화하는 절차로 수행되었다. 본 연구의 결과로 국내 CBT연구자들의 주요 관심사가 식별되었고, 국내 CBT 지식구조는 9개의 연구영역으로 범주화되었다: ‘척도 타당화’, ‘완벽주의와 속박감’, ‘조현병 환자의 인지, 정서, 관계적 특성’, ‘경계선 성격장애와 우울/양극성 장애 환자의 인지적 특성과 치료’, ‘적응과 심리적 건강’, ‘사회불안장애 환자의 인지적 특성과 치료’, ‘우울의 원인과 공존이환’, ‘수용전념치료’, ‘폭식 장애 환자의 이해와 치료’. 본 연구는 지난 11년 동안 국내 CBT 분야에서 축적된 지식을 점검하였다는 데에 의의가 있으며 국내 CBT 연구의 향후 발전과제로 임상적 실천 표준을 제고하기 위한 연구가 필요하다고 제안한다. (ENG)The purpose of this study is to examine the patterns of the keywords in journals in the field of Cognitive Behavioral Therapy (CBT) to identify the knowledge structure of CBT studies in Korea. To compare CBT studies from Korea and abroad, 234 articles (2008-2019) published on "Cognitive Behavior Therapy in Korea" and 2,316 articles (1977-2019) published on "Cognitive Therapy and Research" were collected. The data were analyzed using NetMiner 4.3. The co-word analysis was done by calculating the cosine similarity matrix of major keywords, followed by visualizing the network. The results of this study identified the main interests of Korean CBT scholars, and categorized the knowledge structure of CBT in Korea into 9 research areas: "scale validation"; "perfectionism and entrapment"; "cognitive, emotional, and relationship characteristics of schizophrenic patients"; "cognitive characteristics and treatment of borderline personality disorder and depression/bipolar disorder patients"; "adaptation and psychological health"; "cognitive characteristics and treatment of patients with social anxiety disorder"; "causes and co-morbidities of depression"; "acceptance and commitment therapy"; and "understanding and the treatment of binge eating disorder patients." This study is meaningful in that it has reviewed the accumulated knowledge in the CBT field in Korea for the past 11 years, and suggests future tasks for development to improve the standards of CBT practice.

Treatment Resistance in Psychiatry Risk Factors, Biology, and Management: Risk Factors, Biology, and Management

Book

Jan 2019

Yong-Ku Kim

This book reviews all the important aspects of treatment-resistant psychiatric disorders, covering issues such as definitions, clinical aspects, neurobiological correlates, treatment options, and predictors of treatment response. The book is divided into three sections, the first of which examines the most recent thinking on treatment resistance in psychiatry, including definition and epidemiology, paradigm shift in the study of the subjects, individual susceptibility and resilience, abnormal structural or functional connectivity, and insights from animal models. The second section then discusses treatment resistance in each of the major psychiatric disorders, with particular focus on the responsible clinical and biological factors and the available management strategies. Finally, more detailed information is presented on diverse pharmacological and non-pharmacological therapeutic interventions. The book, written by leading experts from across the world, will be of value to all who seek a better understanding of the clinical-neurobiological underpinnings and the development of management for treatment resistance in psychiatric disorders.

Cognitive Behavioral Therapy and Behavioral Activation Therapy for Treatment-Resistant Depression: Traditional and Digital Therapy Perspectives

Chapter

Jan 2019

Major depressive disorder (MDD) is among the leading causes of chronic disease and a major contributor to the global burden of mental illness. Although effective antidepressant medications are available, treatment resistance is a significant issue for patients. Cognitive behavioral therapy (CBT) is an evidence-based adjunctive or stand-alone psychological therapy for treatment-resistant depression (TRD). In addition to CBT, which has high demands on cognitive functioning, simpler approaches like behavioral activation (BA) are proven to be effective for depression. To overcome the scarcity of resources in routine care and the associated treatment gaps, the Internet is suggested for the provision of standardized programs to a broader range of patients. It could reduce barriers to seek help and improve the access to treatment. This chapter aims to provide an overview about the effectiveness and applications of CBT and BA.

Conducting research and collaborating with researchers: The experience of clinicians in a residential treatment center

Article

Full-text available

Aug 2014

Abstract This paper describes the experience of clinicians in conducting research and collaborating with academic researchers. As part of clinical routine of a residential program for adolescent substance abusers, empirical data have been collected to assess client's needs before and after treatment, improve clinical practice, and identify barriers to change. Some of the challenges faced and the benefits learned in conducting these studies are presented. In addition to highlighting the convergence of research interests between clinicians and academicians, the conclusion offers general recommendations to foster these partnerships and solidify the scientific-practitioner model.

Practice-oriented research: What it takes to do collaborative research in private practice

Article

Full-text available

Aug 2014

Abstract The goal of this paper is to describe the authors' experience conducting research in and for private practice. Based on two distinct research programs (one guided by a scientist practitioner leading various groups of clinicians and another from a network of practitioners and researchers), a number of practice-oriented studies are presented. Lessons learned from these collaborative projects are discussed in terms of challenges and strategies to deal with them, as well as benefits that can be earned from conducting empirical studies within clinical routine. General recommendations are then offered to foster the engagement of clinicians in their own working environment and to facilitate partnerships between researchers and practitioners in developing and implementing valid, feasible, and informative clinical studies.

Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial

Article

Full-text available

Jun 2014
BEHAV RES THER

Unlabelled: A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7-10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities. Trial registration: Clinicaltrials.gov: NCT01390168.

The Personalized Advantage Index: Translating Research on Prediction into Individualized Treatment Recommendations. A Demonstration

Article

Full-text available

Jan 2014
PLOS ONE

Advances in personalized medicine require the identification of variables that predict differential response to treatments as well as the development and refinement of methods to transform predictive information into actionable recommendations. To illustrate and test a new method for integrating predictive information to aid in treatment selection, using data from a randomized treatment comparison. Data from a trial of antidepressant medications (N = 104) versus cognitive behavioral therapy (N = 50) for Major Depressive Disorder were used to produce predictions of post-treatment scores on the Hamilton Rating Scale for Depression (HRSD) in each of the two treatments for each of the 154 patients. The patient's own data were not used in the models that yielded these predictions. Five pre-randomization variables that predicted differential response (marital status, employment status, life events, comorbid personality disorder, and prior medication trials) were included in regression models, permitting the calculation of each patient's Personalized Advantage Index (PAI), in HRSD units. For 60% of the sample a clinically meaningful advantage (PAI≥3) was predicted for one of the treatments, relative to the other. When these patients were divided into those randomly assigned to their "Optimal" treatment versus those assigned to their "Non-optimal" treatment, outcomes in the former group were superior (d = 0.58, 95% CI .17-1.01). This approach to treatment selection, implemented in the context of two equally effective treatments, yielded effects that, if obtained prospectively, would rival those routinely observed in comparisons of active versus control treatments.

A Randomized Controlled Trial of Ecological Momentary Intervention Plus Brief Group Therapy for Generalized Anxiety Disorder

Article

Full-text available

Sep 2013

Momentary intervention has been proposed as a cost-effective, generalizable, and ecologically valid method to increase the efficiency of face-to-face cognitive-behavioral therapy (CBT). The purpose of the current pilot study was to evaluate the efficacy of a six-session palmtop computer-assisted Group CBT for generalized anxiety disorder (GAD) (CAGT6) in comparison with a six-session Group CBT for GAD without the computer (CBGT6) and typical (12 session) Group CBT for GAD (CBGT12) in a randomized controlled trial. Thirty-four individuals with a primary diagnosis of GAD were randomized to one of the three conditions and completed measures of GAD and anxiety before therapy, after therapy, and at 6-, and 12-month follow-ups. Results indicated that CAGT6 was superior to CBGT6 at posttreatment, but not significantly different from CBGT12. At 6- and 12-month follow-ups, CAGT6 was neither significantly different from CBGT6, nor from CBGT12. Percentages of individuals achieving reliable change on two of the three GAD measures favored CAGT6 over CBGT6 at posttreatment, suggesting promise for the added value of the mobile technology. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Psychological treatments for chronic Psychological treatments for chronic

Article

Full-text available

Toward a Neuroimaging Treatment Selection Biomarker for Major Depressive Disorder

Article

Full-text available

Jun 2013

Importance Currently, fewer than 40% of patients treated for major depressive disorder achieve remission with initial treatment. Identification of a biological marker that might improve these odds could have significant health and economic impact.Objective To identify a candidate neuroimaging “treatment-specific biomarker” that predicts differential outcome to either medication or psychotherapy.Design Brain glucose metabolism was measured with positron emission tomography prior to treatment randomization to either escitalopram oxalate or cognitive behavior therapy for 12 weeks. Patients who did not remit on completion of their phase 1 treatment were offered enrollment in phase 2 comprising an additional 12 weeks of treatment with combination escitalopram and cognitive behavior therapy.Setting Mood and anxiety disorders research program at an academic medical center.Participants Men and women aged 18 to 60 years with currently untreated major depressive disorder.Intervention Randomized assignment to 12 weeks of treatment with either escitalopram oxalate (10-20 mg/d) or 16 sessions of manual-based cognitive behavior therapy.Main Outcome and Measure Remission, defined as a 17-item Hamilton Depression Rating Scale score of 7 or less at both weeks 10 and 12, as assessed by raters blinded to treatment.Results Positive and negative predictors of remission were identified with a 2-way analysis of variance treatment (escitalopram or cognitive behavior therapy) × outcome (remission or nonresponse) interaction. Of 65 protocol completers, 38 patients with clear outcomes and usable positron emission tomography scans were included in the primary analysis: 12 remitters to cognitive behavior therapy, 11 remitters to escitalopram, 9 nonresponders to cognitive behavior therapy, and 6 nonresponders to escitalopram. Six limbic and cortical regions were identified, with the right anterior insula showing the most robust discriminant properties across groups (effect size = 1.43). Insula hypometabolism (relative to whole-brain mean) was associated with remission to cognitive behavior therapy and poor response to escitalopram, while insula hypermetabolism was associated with remission to escitalopram and poor response to cognitive behavior therapy.Conclusions and Relevance If verified with prospective testing, the insula metabolism-based treatment-specific biomarker defined in this study provides the first objective marker, to our knowledge, to guide initial treatment selection for depression.Trial Registration Registered at clinicaltrials.gov (NCT00367341)

Dialectical Behaviour Therapy for Post-traumatic Stress Disorder after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder: A Randomised Controlled Trial

Article

Full-text available

May 2013
PSYCHOTHER PSYCHOSOM

Background: Post-traumatic stress disorder (PTSD) with co-occurring severe psychopathology such as borderline personality disorder (BPD) is a frequent sequel of childhood sexual abuse (CSA). CSA-related PTSD has been effectively treated through cognitive-behavioural treatments, but it remains unclear whether success can be achieved in patients with co-occurring BPD. The aim of the present study was to determine the efficacy of a newly developed modular treatment programme (DBT-PTSD) that combines principles of dialectical behaviour therapy (DBT) and trauma-focused interventions. Methods: Female patients (n = 74) with CSA-related PTSD were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. About half of the participants met the criteria for co-occurring BPD. Individuals with ongoing self-harm were not excluded. The primary outcomes were reduction of PTSD symptoms as assessed by the Clinician-Administered PTSD Scale (CAPS) and by the Posttraumatic Stress Diagnostic Scale (PDS). Hierarchical linear models were used to compare improvements across treatment groups. Assessments were carried out by blinded raters at admission, at end of treatment, and at 6 and 12 weeks post-treatment. Results: Under DBT-PTSD the mean change was significantly greater than in the control group on both the CAPS (33.16 vs. 2.08) and the PDS (0.70 vs. 0.14). Between-group effect sizes were large and highly significant. Neither a diagnosis of BPD nor the severity or the number of BPD symptoms was significantly related to treatment outcome. Safety analyses indicated no increase in dysfunctional behaviours during the trial. Conclusion: DBT-PTSD is an efficacious treatment of CSA-related PTSD, even in the presence of severe co-occurring psychopathology such as BPD.

Psychotherapy Outcome: An Issue Worth Re-Revisiting 50 Years Later

Article

Full-text available

Mar 2013

Louis Castonguay

Responding to an invitation to celebrate the 50th anniversary of the journal Psychotherapy, the goal of this article is to describe three general ways by which the impact of psychotherapy might be improved: (a) clinically, by encouraging the assimilation of empirically based principles of change and psychopathology research into day-to-day practice; (b) empirically, by fostering process and outcome research focused on a wide range of common factors and basic findings; as well as (c) clinically and empirically, by facilitating active collaboration of practitioners and researchers in various types of practice-oriented research. Reflected in these three potential avenues of growth are the assumptions that (a) we can improve our understanding and impact of psychotherapy by building on convergences and complementarities across different theoretical orientations, domains of research, and professional expertise, and that (b) most of the clinical and research suggestions derived by such convergence and plurality may not require drastic changes in the practice of many psychotherapists. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Article

Full-text available

Oct 2012

Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.

Psychological therapies for people with borderline personality disorder

Article

Full-text available

Aug 2012

Psychotherapy is regarded as the first-line treatment for people with borderline personality disorder. In recent years, several disorder-specific interventions have been developed. This is an update of a review published in the Cochrane Database of Systematic Reviews in 2006. To assess the effects of psychological interventions for borderline personality disorder (BPD). We searched the following databases: CENTRAL 2010(3), MEDLINE (1950 to October 2010), EMBASE (1980 to 2010, week 39), ASSIA (1987 to November 2010), BIOSIS (1985 to October 2010), CINAHL (1982 to October 2010), Dissertation Abstracts International (31 January 2011), National Criminal Justice Reference Service Abstracts (15 October 2010), PsycINFO (1872 to October Week 1 2010), Science Citation Index (1970 to 10 October 2010), Social Science Citation Index (1970 to 10 October 2010), Sociological Abstracts (1963 to October 2010), ZETOC (15 October 2010) and the metaRegister of Controlled Trials (15 October 2010). In addition, we searched Dissertation Abstracts International in January 2011 and ICTRP in August 2011. Randomised studies with samples of patients with BPD comparing a specific psychotherapeutic intervention against a control intervention without any specific mode of action or against a comparative specific psychotherapeutic intervention. Outcomes included overall BPD severity, BPD symptoms (DSM-IV criteria), psychopathology associated with but not specific to BPD, attrition and adverse effects. Two review authors independently selected studies, assessed the risk of bias in the studies and extracted data. Twenty-eight studies involving a total of 1804 participants with BPD were included. Interventions were classified as comprehensive psychotherapies if they included individual psychotherapy as a substantial part of the treatment programme, or as non-comprehensive if they did not.Among comprehensive psychotherapies, dialectical behaviour therapy (DBT), mentalisation-based treatment in a partial hospitalisation setting (MBT-PH), outpatient MBT (MBT-out), transference-focused therapy (TFP), cognitive behavioural therapy (CBT), dynamic deconstructive psychotherapy (DDP), interpersonal psychotherapy (IPT) and interpersonal therapy for BPD (IPT-BPD) were tested against a control condition. Direct comparisons of comprehensive psychotherapies included DBT versus client-centered therapy (CCT); schema-focused therapy (SFT) versus TFP; SFT versus SFT plus telephone availability of therapist in case of crisis (SFT+TA); cognitive therapy (CT) versus CCT, and CT versus IPT.Non-comprehensive psychotherapeutic interventions comprised DBT-group skills training only (DBT-ST), emotion regulation group therapy (ERG), schema-focused group therapy (SFT-G), systems training for emotional predictability and problem solving for borderline personality disorder (STEPPS), STEPPS plus individual therapy (STEPPS+IT), manual-assisted cognitive treatment (MACT) and psychoeducation (PE). The only direct comparison of an non-comprehensive psychotherapeutic intervention against another was MACT versus MACT plus therapeutic assessment (MACT+). Inpatient treatment was examined in one study where DBT for PTSD (DBT-PTSD) was compared with a waiting list control. No trials were identified for cognitive analytical therapy (CAT).Data were sparse for individual interventions, and allowed for meta-analytic pooling only for DBT compared with treatment as usual (TAU) for four outcomes. There were moderate to large statistically significant effects indicating a beneficial effect of DBT over TAU for anger (n = 46, two RCTs; standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.43 to -0.22; I(2) = 0%), parasuicidality (n = 110, three RCTs; SMD -0.54, 95% CI -0.92 to -0.16; I(2) = 0%) and mental health (n = 74, two RCTs; SMD 0.65, 95% CI 0.07 to 1.24 I(2) = 30%). There was no indication of statistical superiority of DBT over TAU in terms of keeping participants in treatment (n = 252, five RCTs; risk ratio 1.25, 95% CI 0.54 to 2.92).All remaining findings were based on single study estimates of effect. Statistically significant between-group differences for comparisons of psychotherapies against controls were observed for BPD core pathology and associated psychopathology for the following interventions: DBT, DBT-PTSD, MBT-PH, MBT-out, TFP and IPT-BPD. IPT was only indicated as being effective in the treatment of associated depression. No statistically significant effects were found for CBT and DDP interventions on either outcome, with the effect sizes moderate for DDP and small for CBT. For comparisons between different comprehensive psychotherapies, statistically significant superiority was demonstrated for DBT over CCT (core and associated pathology) and SFT over TFP (BPD severity and treatment retention). There were also encouraging results for each of the non-comprehensive psychotherapeutic interventions investigated in terms of both core and associated pathology.No data were available for adverse effects of any psychotherapy. There are indications of beneficial effects for both comprehensive psychotherapies as well as non-comprehensive psychotherapeutic interventions for BPD core pathology and associated general psychopathology. DBT has been studied most intensely, followed by MBT, TFP, SFT and STEPPS. However, none of the treatments has a very robust evidence base, and there are some concerns regarding the quality of individual studies. Overall, the findings support a substantial role for psychotherapy in the treatment of people with BPD but clearly indicate a need for replicatory studies.

The Relationship Between Agreeableness and the Development of the Working Alliance in Patients with Borderline Personality Disorder

Article

Full-text available

Aug 2012

The working alliance between therapist and patient is an important component of effective interventions for borderline personality disorder (BPD). The current study examines whether client personality affects the development of the working alliance during the treatment of BPD, and whether this influences treatment effectiveness. Data was based on 87 patients with BPD who were participants in a randomized controlled trial comparing Dialectical Behavior Therapy (DBT) and general psychiatric management. Higher levels of trait Agreeableness were associated with steeper increases in working alliance throughout treatment, but only in the DBT condition. Increases in working alliance were in turn associated with better clinical outcomes. Mediation models revealed a significant indirect path from Agreeableness to better clinical outcomes, mediated through larger improvements in working alliance over time. These results highlight the role that patient personality can play during the therapeutic process, with a specific focus on the importance of Agreeableness for alliance development.

The Science of Training in Evidence-Based Treatments in the Context of Implementation Programs: Current Status and Prospects for the Future

Article

Full-text available

Jul 2011
ADM POLICY MENT HLTH

Knowledge of and Attitudes Towards Evidence-Based Practices in Community Child Mental Health Practitioners

Article

Full-text available

Jul 2011
ADM POLICY MENT HLTH

Research in the dissemination of evidence-based practices (EBPs) suggests that practitioners' knowledge of and attitudes towards EBPs influence their decisions to adopt such practices. This study investigated the relationships between practitioner background variables and EBP knowledge and attitudes, as well as the relationship between knowledge and attitudes among public sector youth direct service providers (n = 240). Findings suggest that knowledge and attitudes relate to practitioners' most advanced degree, practice setting, and licensure status. Additionally, lack of knowledge in the form of EBP under-identification was related to negative attitudes. Findings are discussed as they relate to the dissemination of EBPs.

Skills of Cognitive Therapy (SoCT): A New Measure of Patients' Comprehension and Use

Article

Full-text available

Feb 2011
PSYCHOL ASSESSMENT

The authors describe the development and psychometric properties of a new measure called the Skills of Cognitive Therapy (SoCT) in depressed adults and their cognitive therapists. The 8-item SoCT assesses patients' understanding and use of basic cognitive therapy (CT) skills rated from the perspectives of both observers (SoCT-O; therapists in this report) and patients (SoCT-P). Ratings of patients' skill usage are made on 5-point Likert-type scales ranging from 1 (never) to 5 (always or when needed). Higher scores reflect greater patient skill in applying cognitive therapy principles and coping strategies. To develop this scale, a 33-item pool was used, rated by both patients and their therapists at the middle and end of CT (Ns = 359-416), and evaluated the reliability and concurrent and predictive validity of both versions of the scale. The SoCT has excellent internal consistency reliability and moderate correlations between the observer and patient versions. It is important to note that the SoCT showed good predictive validity for response when collected at the midpoint of acute phase CT. Considering both patients' self-ratings and clinicians' SoCT ratings, the odds ratio for responding to CT was 2.6. The practical utility of the SoCT is discussed, as well as its theoretical importance in research of patient CT skills (e.g., acquisition, comprehension, and generalization) as putative moderators or mechanisms of symptom change in the therapy.

Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: Systematic review

Article

Full-text available

Nov 2010
BRIT J PSYCHIAT

Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments. To evaluate the effectiveness of early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis. Systematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis. Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission. For people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research.

Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis

Article

Full-text available

Oct 2010
PLOS ONE

Depression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited. Review evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term. Systematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g) on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted. 22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13), and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial. Computerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated. Australian New Zealand Clinical Trials Registry ACTRN12610000030077.

Therapist Competence in Cognitive Therapy for Depression: Predicting Subsequent Symptom Change

Article

Full-text available

Jun 2010
J CONSULT CLIN PSYCH

The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes. In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia) than for those patients without these characteristics. Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. those who did not meet) criteria for a personality disorder (i.e., among personality disorders represented in the clinical trial). These findings provide support for the potential utility of CT competence ratings in applied settings.

Psychotherapeutic and Psychosocial Approaches in Bipolar Disorder: A Systematic Literature Review

Article

Full-text available

Jun 2010
TURK PSIKIYATR DERG

Aim of this systematic review was critical presentation of psychosocial approaches in bipolar disorders with regard to their fundamentals and impact on the clinical course and outcome of the illness. PubMed, Medline, PsycINFO and Turkish databases between 1980 and 2009 were searched by using keywords "bipolar disorder" and "psychotherapy", "psychosocial approaches", "psychological intervention". Randomized controlled trials, reviews and meta analysis were included. Fifty studies met the inclusion criteria where four types of interventions -psychoeducation, family focused, cognitive behavioral and interpersonal psychosocial rhythm therapy-were studied. Twenty two of 24 original research papers were randomized controlled trials, 23 were reviews and 3 were meta analysis. In almost all studies psychotherapeutic approach was applied as adjunctive to pharmacotherapy. Group psychoeducation was more effective in preventing manic relapses, whereas cognitive behavioral and family focused therapies showed efficacy in preventing depressive episodes. Additional benefits on such secondary outcomes as medication compliance, number and duration of hospitalizations, time to recurrence were reported. Effects on functionality and quality of life were assessed rarely, but reported to be beneficial. Cultural adaptation studies are scarce and needs exploration. Psychosocial interventions adjunctive to pharmacotherapy in bipolar disorder seem to be effective in relapse prevention. Stage of illness where the therapy is initiated and the targeted episode for prevention varies between interventions. Future studies are needed to strengthen the place of psychosocial interventions in treatment guidelines and would contribute to narrow the gap between effectiveness of pharmacotherapy and functional improvement.

A Meta-analysis of the Psychological Treatment of Anger: Developing Guidelines for Evidence-Based Practice

Article

Full-text available

Jan 2009
J AM ACAD PSYCHIATRY

Michael Saini

There is no clear evidence to guide mental health professionals in assessing and treating angry clients. Recent reviews have considered cognitive and behavioral approaches to the treatment of anger, but little is known about the potential effectiveness of other treatment modalities. A meta-analytic review was conducted to examine the effects of treating dimensions of anger by using various psychological treatments found in the scientific literature. The final analysis included 96 studies and 139 treatment effects. The nine types of psychological treatments included cognitive, cognitive behavior therapy, exposure, psychodynamic, psychoeducational, relaxation-based, skills-based, stress inoculation, and multicomponent. The overall weighted standardized mean difference across all treatments was 0.76 (95% confidence interval [CI], 0.67-0.85, Q = 403.13, df 138, p < .001, I(2) = 65.76), which suggests that psychological treatments are generally effective in treating anger. The results also suggest a considerable degree of variability in the effect sizes of specific treatments for anger. The results show that at least some of the variability may be explained by the number of treatment sessions offered to participants, the use of manuals to guide delivery of the treatment, the use of fidelity checks, the setting of the research, and whether the study was published or unpublished. This review builds on previous evidence of the effectiveness of psychological treatments of maladaptive anger, and it provides the basis for developing evidence-based guidelines for specific populations with anger problems.

Personality, Stressful Life Events, and Treatment Response in Major Depression

Article

Full-text available

Dec 2009
J CONSULT CLIN PSYCH

The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self-criticism.

Implications for the treatment of bulimia nervosa: A meta-analysis of efficacy trials and a naturalistic study of treatment in the community.

Thesis

Jan 2002

Heather Jean Thompson-Brenner

Prior meta-analyses of the clinical trials of treatments for Bulimia Nervosa have concluded that short-term cognitive-behavioral therapy (CBT) is the treatment of choice for all patients. This dissertation first presents a multidimensional meta-analysis of the same clinical trial data previously analyzed, using additional variables bearing on generalizability and outcome. The data suggest that short-term treatments do result in substantial improvement: However, almost forty percent of the patients who applied for treatment were excluded from the clinical trials; over half of the patients who entered treatment did not recover; and the average patient who completed treatment showed high symptom levels at the post-treatment timepoint. The selection procedure for inclusion in these studies raises questions about representativeness and generalizability of these clinical samples, while the outcome results raise questions about the efficacy of short-term CBT as tested in clinical trials. To assess treatment techniques and outcomes in a less selected sample, this dissertation next presents original data from a naturalistic study of treatment of patients with bulimic symptoms in the community. The clinician-report data suggest that treatments in the community (unconstrained by the limitations of clinical trials) are of much longer duration than the treatments provided in the manuals for clinical trials, and address a much more varied population. Comorbid axis I and axis II diagnoses were extremely common in the naturalistic sample, and it appeared that at least forty percent of the patients with bulimic symptoms treated in the community would have been excluded from clinical trials under four common exclusion criteria. The data suggested that there were three subtypes of bulimia represented in the sample: a High Functioning/Perfectionistic subtype; a Dysregulated/Undercontrolled subtype; and a Constricted/Overcontrolled subtype. These subtypes showed different patterns of comorbidity and different treatment outcomes. The Dysregulated patients had the most comorbidity, the longest treatments, and the least successful outcomes. In addition, the therapists reported using different therapeutic techniques with the different subgroups: both self-declared CBT and Psychodynamic therapists used more Psychodynamic interventions with the Dysregulated patients. Both CBT and Psychodynamic approaches appeared to have specific effects on treatment outcome: the use of CBT was correlated with shorter overall therapies and shorter times to improvement in eating symptoms, while the use of Psychodynamic psychotherapy was correlated with more overall improvement (particularly among the Constricted and Dysregulated subgroups). The two studies taken together imply that previous claims on behalf of short-term CBT as the treatment of choice are in need of clarification.

Psychotherapy process-outcome research

Article

Jan 2013

Empirically supported treatments: 10 years later

Article

Jan 2005

Sudden gains and critical sessions in CBT for depression

Article

Dec 1999

In this study of cognitive-behavioral therapy for depression, many patients experienced large symptom improvements in a single between sessions. These sudden gains' average magnitude was 11 Beck Depression Inventory points, accounting for 50% of these patients' total improvement. Patients who experienced sudden gains were: less depressed than the other patients at posttreatment, and they remained so IB months later. Substantial cognitive changes were observed in the therapy sessions preceding sudden gains, but few cognitive! changes were observed in control sessions, suggesting that cognitive change in the pregain sessions triggered the sudden gains, improved therapeutic alliances were also observed in the therapy sessions immediately after the sudden gains, as were additional cognitive changes, suggesting a three-stage model for these patients' recovery: preparation --> critical session/sudden gain --> upward spiral.

Psychotherapy practic

Cognitive behavioral therapy: Current status and future research directions

Abstract

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