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Cognitive behavioral therapy: Current status and future research directions
Psychotherapy Research
Abstract
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.
... These results are consistent with studies on CBT for depressive disorders in non-western countries (e.g., Hwang et al., 2015; Naeem et al., 2015) [17,41]. It is imperative that the favorable outcomes are due to high session attendance and improvements in outcome measures [17,54,55]. It has been suggested that this improvements may be linked to the use of locally relevant metaphors, cultural stories, respecting age-related hierarchical roles, psychoeducation, family involvement, and community-based activities which helped participants to connect emotionally and cognitively with the therapeutic process and change their cognitions and behaviors as per goals of CBT [22,[56][57][58]. ...
... The strategies of Bengali-CBT helped them adjust their thoughts to assist adaptive coping, distress, and alleviate depressive symptoms [60]. Our results further showed a good percentage of comorbid anxiety (85.6%) with primary depression, and there was a significant reduction in comorbid symptoms (anxiety, distress and suicidal thoughts) as well [53][54][55]. This is particularly evident when CBT is tailored to address culturally specific irrational negative thoughts, such as hopelessness, low self-esteem, or suicide, leading to improvements in both depression and anxiety symptoms, ultimately reducing mean scores on measurement scales [3,61,62]. ...
... Consequently, the GHQ-28 is significantly correlated with depression and anxiety, thus representing somatic symptoms of depression [2,54,61]. There is important evidence that CBT can improve health-promoting behaviors by modifying dysfunctional attitudes, changing risky lifestyles, and breaking harmful habits [54,62]. ...
Cultural values and standard social rules of communities strongly influence any psychological therapy. Being developed and modified in the Western world, cognitive behavior therapy (CBT) is not anyway different from such influences. In this study, CBT was adapted in Bengali to determine the functional feasibility of the psychological intervention for people with depression in Bangladesh. This is the first pilot study of an adapted CBT manual for psychological intervention for working with depressive clients in Bangladesh. There were three phases of the study. In the first two phases, the standard protocols of CBT were adapted for the Bangladeshi community, as practiced by mainstream practitioners and mental health professionals around the world. The information gathered during the first phase of the standard protocols of CBT was written in Bengali as the first draft. In the second phase, the CBT manual was judged by seven senior clinical psychologists in Bangladesh who were trained in CBT by British clinical psychologists and later provided training to fellow mental health professionals. After the judges’ evaluation, their comments and suggestions were synthesized and the first draft of the adapted intervention was finalized. In the third phase, to evaluate the functional feasibility of the Bengali CBT-based manual, five patients diagnosed with major depression by psychiatrists were tested. Four valid and reliable psychometric measurements were used to measure symptoms of depression and comorbid symptoms of anxiety, psychological distress, and suicidal risk. Assessments were completed at 2 time points (pretest and posttest) via scales. The intervention was delivered within 6 to 10 sessions, and improvements were monitored over the scores of all the questionnaires. The possibilities of Bengali CBTs to reduce depression and appear to be promising treatment options for depression are discussed in this paper.
... These techniques aim to help the individual develop healthier or more balanced thought patterns (cognitive restructuration), which can then be applied in day-to-day life (behavioral restructuration). This can help with reducing psychiatric symptomatology and decreasing depressive episode duration along with increasing euthymic periods and improving global functioning and quality of life [14][15][16][17][18][19][20]. Furthermore, CBT specific for BD-II often includes techniques to practice acceptance, recognize warning signs of an upcoming mood episode, recognize potentially triggering stimuli, and develop an action plan with helpful steps and considerations to follow before, during, and after a mood episode [8,14,16,17,19,21,22]. ...
... Additionally, e-CBT has been shown to increase help-seeking behaviors among patients and to have similar effectiveness at reducing psychiatric symptomatology as in-person CBT [11,14,[26][27][28]. e-CBT programs often include weekly assignments for the participants and may be either fully self-guided or guided with asynchronous support from an assigned therapist [14]. Despite these benefits over in-person CBT, e-CBT options specific to BD remain significantly understudied and underdeveloped, and very few e-CBT programs have focused on BD-II [15][16][17][18][19]29]. ...
... This is a protocol for an RCT that aims to establish the first e-CBT program for the management of BD-II with residual depressive symptoms. This program will cover helpful coping techniques to increase euthymic periods and improve global functioning by applying the widely validated principles of CBT [14][15][16][17][18][19][20]. Based on literature evidence, previous clinical trials conducted by NA, and the use of a validated therapy approach, this study hypothesizes that this novel e-CBT program will have similar effectiveness as face-to-face CBT for the management of BD-II with residual depressive symptoms [14,33,[35][36][37]. ...
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.
... The focus should be on improving the reasoning or cognitive process itself rather than developing a specific skill [21]. As per our definitions, cognitive training and cognitive interventions that include cognitive behavioral therapy (CBT) or TBS focused on improving cognition will be included [22][23][24]. Cognitive training can be defined as nonpharmacological interventions that involve structured and guided training that aims to maintain or improve certain aspects of cognitive function, including attention, memory, and learning [21]. CBT is defined as an intervention that involves increasing participants' knowledge and understanding of the problem (ie, cognitive function, including attention, memory, and learning); identifying and restructuring dysfunctional thinking and maladaptive beliefs; and developing emotional and behavioral compensatory strategies for the core deficits [22]. ...
... CBT is defined as an intervention that involves increasing participants' knowledge and understanding of the problem (ie, cognitive function, including attention, memory, and learning); identifying and restructuring dysfunctional thinking and maladaptive beliefs; and developing emotional and behavioral compensatory strategies for the core deficits [22]. It is a diverse group of treatments that include cognitive therapy, CBT, acceptance and commitment therapy, dialectical behavior therapy, schema-focused therapy, rational-emotive behavior therapy, mindfulness-based cognitive therapy, metacognitive therapy, cognitive behavioral analysis system of psychotherapy, and cognitive processing therapy [23]. Transcranial brain stimulation is a non-invasive brain stimulation technique that passes an electrical current through the cortex of the brain to alter brain function [24]. ...
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.
... There is a wide range of physical, cognitive, psychological, and social signs and symptoms resulting from the treatments used in breast cancer. Cognitive therapy based on mindfulness, as the third generation of cognitive behavioral therapy, was introduced by McMain et al. (18) to prevent the recurrence of depression. This type of therapy is currently considered one of the most widely used treatments in psychology and is used to change consciousness to create new relationships with thoughts (19). ...
... Therefore, breast cancer patients should try to reduce the abovementioned injuries through different treatment methods. Currently, limited studies have been conducted on the role of thirdgeneration therapy on body image variables, disease perception, and fear of disease recurrence in women with breast cancer (18)(19)(20)(21)(22), and it is necessary to conduct more studies. ...
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.
... Despite the volume of evidence that supports CBT for depression in the Western world (Beltman et al., 2010;Cuijpers, et al., 2013;Garratt et al., 2007;McMain et al., 2015), the inadequate evaluation of the efficacy of CBT has been conducted in low-and middle-income countries (Naeem, 2011). There are, however, aspects of CBT which may assist in applying therapeutic principles to individuals from a range of cultures (Naeem, 2011). ...
... The results supported the efficacy of the intervention with substantial effect sizes for depression. These results are consistent with other studies, as most randomized controlled trials of CBT for depressive disorders yield positive results (Beltman et al., 2010;Cuijpers, et al., 2013;McMain et al., 2015). The current results are also comparable to those seen in other cultures (Cuijpers, et al., 2013;Hwang et al., 2015;Naeem et al., 2015). ...
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.
... In other words, CBT is specific and it focuses on measurable or observable results. CBT has proved to be highly efficacious in the treatment of various psychological disorders (Bernal et al., 2009;Butler et al., 2006;Hwang, 2009;In Albon & Schnelder, 2007;Klein, Jacobs & Reinecke, 2007;Lohmann, 2014;McMain, Newman, Segal, & DeRubeis, 2015;Nicolas et al., 2009). Tucker (2016) reported the experiences of counsellors who used cognitive behaviour therapy for adolescents who experienced or witnessed bullying in school. ...
... This finding extended previous findings on the efficacy of using cognitive behavioural techniques in reducing negative emotions and behaviours attributed to witnessing 220 unpleasant events (Bernal et al., 2009;Butler et al., 2006;;Hwang, 2009;Lohmann, 2014, as cited in-Albon & Schnelder, 2007McMain et al., 2015;Nicolas et al., 2009). Tucker (2016) reported the experiences of counsellors who used cognitive behaviour techniques for adolescents who experienced or witnessed bullying in school. ...
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.
... Cognitive-behavioral therapy (CBT) is a first-line psychotherapeutic treatment that has been proven effective in treating a variety of psychiatric disorders such as major depressive disorder (MDD), anxiety disorder (AD), and obsessive-compulsive disorder (OCD) (Butler et al., 2006;Beck and Dozois, 2011;Hofmann et al., 2012;McMain et al., 2015). This psychotherapy, pioneered by Ellis (1962) and Beck (1970), focuses on identifying maladaptive cognitions and modifying behavioral patterns to alleviate clinical symptoms and improve function (Beck and Dozois, 2011;Hofmann et al., 2012). ...
... This psychotherapy, pioneered by Ellis (1962) and Beck (1970), focuses on identifying maladaptive cognitions and modifying behavioral patterns to alleviate clinical symptoms and improve function (Beck and Dozois, 2011;Hofmann et al., 2012). Moreover, CBT may promote change in conflict and inflexible appraisals of emotional, cognitive, physiological, and social states by reducing avoidance in experience and behavior (McMain et al., 2015). ...
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.
... Astuti (2013) mengatakan bahwa terapi farmakologi adalah terapi yang menggunakan obatobatan untuk mengatasi insomnia, diantaranya adalah Benzodiazepine dan Non-Benzodiazepine (Zaleplon, Zolpidem, Eszopiclone, dan sebagainya). Sedangkan, penyembuhan yang bersifat non-farmakologi yang dapat dilakukan, diantaranya adalah Cognitive Behavior Therapy (CBT) (McMain et al., 2015), relaksasi otot progresif (Hardani & Putri, 2016), Islamic-Cognitive Behavioral Therapy (Nashori et al., 2020), Insomnia-Cognitive Behavioral Therapy (Nashori et al., 2019), dan Mindfulness (Gong et al., 2016). CBT adalah metode terapi yang dikembangkan oleh Aaron Beck yang bertujuan untuk mengubah distorsi kognitif untuk menghasilkan satu perilaku baru yang lebih adaptif (McMain et al., 2015). ...
... Sedangkan, penyembuhan yang bersifat non-farmakologi yang dapat dilakukan, diantaranya adalah Cognitive Behavior Therapy (CBT) (McMain et al., 2015), relaksasi otot progresif (Hardani & Putri, 2016), Islamic-Cognitive Behavioral Therapy (Nashori et al., 2020), Insomnia-Cognitive Behavioral Therapy (Nashori et al., 2019), dan Mindfulness (Gong et al., 2016). CBT adalah metode terapi yang dikembangkan oleh Aaron Beck yang bertujuan untuk mengubah distorsi kognitif untuk menghasilkan satu perilaku baru yang lebih adaptif (McMain et al., 2015). Relaksasi otot progresif adalah latihan relaksasi yang didahului dengan menegangkan tubuh secara sistematis dan kemudian merelaksasikan semua otot tubuh (Hardani & Putri, 2016). ...
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.
... In view of the high rates of misdiagnoses, there is an urgent need to improve diagnostics of mental disorders by disseminating evidence-based assessment procedures into clinical practice. While there is increasing awareness of the importance of disseminating evidence-based treatment [15,16], the foundation of successful treatment, namely evidence-based diagnostics, has not been sufficiently addressed in dissemination research [17,18]. Therefore, the aim of this study was to develop and evaluate a blended learning course to disseminate evidence-based diagnostics of mental disorders. ...
Background:
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.
Objective:
This study aimed to develop and evaluate a blended learning course in a multicenter cluster randomized controlled trial.
Methods:
Undergraduate psychology students (N=350) enrolled in 18 university courses at 3 universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants’ performances in a clinical diagnostic interview after the courses. The secondary outcomes were diagnostic knowledge and participants’ reactions to the courses. All outcomes were analyzed on the individual participant level using noninferiority testing.
Results:
Compared with the synchronous course (74.6% pass rate), participation in the blended learning course (89% pass rate) increased the likelihood of successfully passing the behavioral test (odds ratio 2.77, 95% CI 1.55-5.13), indicating not only noninferiority but superiority of the blended learning course. Furthermore, superiority of the blended learning over the synchronous course could be found regarding diagnostic knowledge (β=.13, 95% CI 0.01-0.26), course clarity (β=.40, 95% CI 0.27-0.53), course structure (β=.18, 95% CI 0.04-0.32), and informativeness (β=.19, 95% CI 0.06-0.32).
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.
... 15 The drawback of CBT is that it necessitates an active approach from the patient, and the outcome may differ based on the patient's characteristics and degree of effort. 16 In addition, the impact of CBT can lessen over time following the intervention. 17,18 Despite these shortcomings, the CBT is an effective treatment for the physical symptoms, mental symptoms, and QoL of cancer survivors, and empirical research has validated multiple CBT techniques. ...
Objective
This study aimed to perform a meta-analysis of randomized control trials to evaluate the effects of cognitive behavioral therapy on depression, anxiety, fatigue, distress, the fear of cancer recurrence, and the quality of life in gynecological cancer patients.
Methods
An extensive literature search of PubMed, Web of Science, Scopus, and CINAHL was performed, and a meta-analysis was conducted on ten studies that included 1027 patients. The quality of the data was evaluated using the Cochrane Risk of Bias tool. The effect size of the mean difference and standardized mean difference were computed using Revman 5.4.1.
Results
Gynecological cancer patients receiving cognitive behavioral therapy showed decreases in depression (P < 0.001), anxiety (P = 0.01), fatigue (P < 0.001), distress (P = 0.03), and the fear of cancer recurrence (P = 0.01) compared to those receiving no treatment, whereas no improvement in quality of life was seen in the cognitive behavioral therapy group (P = 0.05).
Conclusions
Cognitive behavioral therapy was shown to be a useful treatment for the symptoms experienced by women with gynecological cancer, with significant effect sizes. However, more research is required to validate the efficacy of cognitive behavioral therapy in patients with gynecological cancer, considering the limitations of this study's small sample size and statistical heterogeneity.
Systematic review registration
PROSPERO- CRD42024516039.
... Исторически КПТ разрабатывалась как метод лечения различных психических расстройств, включая депрессию и тревожные расстройства [5]. В последние десятилетия значительно увеличилось количество исследований эффективности данного метода в лечении ПА. ...
Представленная статья носит характер обзора. Рассматривается проблема эффективности когнитивно-поведенческой терапии при лечении панических атак. Основная цель работы заключается в систематизации знаний для выявления преимуществ и ограничений когнитивно-поведенческой терапии. Акцент делается на индивидуализированных стратегиях и возможности их комбинации с другими существующими и доказавшими свою эффективность методами лечения. Также обсуждаются альтернативные подходы и методологические недостатки в области оценки эффективности когнитивно-поведенческой терапии. Представленная работа базируется на обзоре научно-методической литературы последних лет. В него включены как статьи, подтверждающие эффективность когнитивно-поведенческой терапии, так и те работы, в которых представлены альтернативные или критические точки зрения. Используется качественный анализ данных, что является относительно новым подходом в изучении данной проблематики. Проанализировав существующие исследования, авторы приходят к выводу о том, что когнитивно-поведенческая терапия является эффективным методом на начальных этапах с возможностью долгосрочного положительного эффекта, но имеет свои ограничения и требует дополнительных исследований для оптимизации лечебных стратегий. Также были обнаружены данные, указывающие на различную эффективность когнитивно-поведенческой терапии на разных этапах лечения, что может иметь важное практическое значение для российских и зарубежных клиницистов. В целом когнитивно-поведенческая терапия демонстрирует хорошие результаты в лечении панических атак, но имеет ряд ограничений, которые необходимо учитывать при выборе метода лечения. Рекомендуется дальнейшее изучение данной проблематики для совершенствования существующих методик и разработки новых, более эффективных подходов. В данной статье выдвигаются предложения для будущих исследований, в том числе – о необходимости индивидуализированного подхода и комбинирования различных методов.
The problem of the effectiveness of cognitive behavioral therapy for the treatment of panic attacks is considered. The main goal of the work is to systematize the knowledge presented in existing studies to identify the benefits and limitations of cognitive behavioral therapy. The emphasis in the work is on individualized strategies and the possibility of combining them with other existing and proven treatment methods. The article also discusses alternative approaches and methodological shortcomings in assessing the effectiveness of cognitive behavioral therapy, which makes this review unique and comprehensive. The methodology of the presented work is based on a review of scientific and methodological literature of recent years. It includes both articles that support the effectiveness of cognitive behavioral therapy and those that present alternative or critical points of view. Qualitative data analysis is used, which is a relatively new approach in the study of this issue. After reviewing existing research, the authors conclude that cognitive behavioral therapy is an effective method in the initial stages with the potential for long- term positive effects, but has its limitations and requires additional research to optimize treatment strategies. Data were also found indicating different effectiveness of cognitive behavioral therapy at different stages of treatment, which may have important practical significance for Russian and foreign clinicians. Overall, cognitive behavioral therapy has shown good results in the treatment of panic attacks, but has a number of limitations that must be considered when choosing a treatment method. Further study of this issue is recommended to improve existing techniques and develop new, more effective approaches. This article makes suggestions for future research, including the need for an individualized approach and a combination of different methods.
... CBT is an umbrella term for a range of related therapies, including for instance cognitive therapy, behavioural therapy, and metacognitive therapy (17). These therapies share a strong commitment to developing clinical interventions grounded in empirical evidence, with CBT described as the most researched form of psychological therapy (18). ...
Introduction
The National Institute for Health and Care Excellence (NICE) recommends Cognitive-Behavioural therapy (CBT) as the psychotherapeutic treatment of choice for adults with Attention Deficit Hyperactivity Disorder (ADHD) in the UK. However, the literature often refers to adapted CBT programs tailored for ADHD and provides limited insight into how adults with ADHD experience and perceive this form of treatment in routine clinical practice.
Methods
This mixed-methods study aims to explore ADHD individuals’ experience and perception of CBT delivered in routine clinical practice, to gain a better understanding of this treatment’s helpfulness and perceived effectiveness.
Results
A survey (n=46) and semi-structured in-depth interviews (n=10) were conducted to explore the experience of CBT and its perceived effectiveness in managing ADHD. The interviews were analysed using thematic analysis and the survey was synthesised using descriptive narratives. The thematic analysis highlighted three key themes: difficulties with the CBT framework, difficulties with CBT therapists, and consequences of CBT. The survey highlighted similar findings. Participants described the CBT framework as, generic, rigid, and too short, and described the CBT therapist as unspecialised, unempathetic, and not sufficiently adapting CBT to ADHD-related difficulties.
Discussions
Overall, participants found non-adapted, generic CBT in the UK to be unhelpful, overwhelming, and at times harmful to their mental well-being. Therefore, it is necessary for clinical bodies in the UK, while following the indicated NICE guidelines, to be mindful of adapting CBT delivery of CBT, to be most effective for people with ADHD and to mitigate potential harm.
... Cognitive behavioral therapy (CBT) is increasingly emerging as a promising intervention for a range of psychological disorders [1][2][3]. Three systematic reviews showed that CBT can effectively reduce symptoms of anxiety and Zhongfang Yang and Shuyu Han have contributed equally to this work. depression in people living with HIV [4][5][6]. ...
Understanding the dose‒response relationship between patient engagement in cognitive behavioral therapy (CBT) and health outcomes is critical for developing and implementing effective CBT programs. In studies of CBT interventions, patient engagement is measured only at a single time point, and outcomes are typically assessed before and after the intervention. Examination of the dose‒response relationship between patient engagement in CBT and outcomes is limited. It is unclear whether a dose‒response relationship exists between patient engagement in on-site CBT intervention and anxiety and depression in people living with HIV (PLWH). If present, does this dose‒response relationship occur early or later in the intervention? This study aimed to address this gap by examining the dose‒response relationships between patient engagement and anxiety and depression in CBT interventions among PLWH. Utilizing data from a pilot randomized trial (10 participants) and a clinical controlled trial (70 participants), our secondary analysis spans baseline, 3-month, and 6-month assessments. Both trials implemented the nurse-led CBT intervention. Cluster analysis identified two groups based on on-site attendance and WeChat activity. Patients with good adherence (6–10 times) of on-site attendance exhibited significantly lower anxiety and depression scores at 3 months (β = 1.220, P = 0.047; β = 1.270, P = 0.019), with no significant differences observed at 6 months. WeChat activity did not significantly influence anxiety or depression scores. The findings highlight a significant short-term dose‒response relationship, endorsing nurse-led CBT interventions for mental health in PLWH. Organizational strategies should focus on incentivizing and facilitating patient engagement, particularly through enhancing WeChat features.
... This can be achieved through cognitive behavioural therapy (CBT) which has strong support and has been shown to be effective in treating mild and moderate anxiety [21][22][23][24] and is also beneficial in treating NCCP [10,25]. CBT is a collaborative and structured process that aims to support patients in evaluating the usefulness and accuracy of their thoughts and can be seen as an umbrella term including therapeutic interventions to treat various psychological problems [20,26]. However, access to CBT is low due to a treatment demand gap [27,28]. ...
Background
Approximately half of patients who seek care at Emergency Departments due to chest pain are diagnosed with Non-Cardiac Chest Pain (NCCP). Concerns for heart disease and misinterpretation of the symptoms increase cardiac anxiety and have a negative impact on patients' lives. Psychological interventions such as internet-delivered cognitive behavioral therapy (iCBT) are effective in treating psychological conditions such as anxiety, by helping patients to learn how to manage chest pain.
Aims
To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and secondary outcomes, as bodily sensations, depressive symptoms, health-related quality of life and chest pain frequency in patients with NCCP at 6- and 12-month follow-up, and to explore predictors that can have impact on the effects of the iCBT program on psychological distress.
Methods
A longitudinal study of a Randomized Controlled Trial (RCT) evaluating the long-term effects of an iCBT program (n = 54) in patients with NCCP, compared to psychoeducation (n = 55). The primary outcome, cardiac anxiety was measured using the Cardiac Anxiety Questionnaire (CAQ), and the secondary outcomes were measured with The Body Sensations Questionnaire (BSQ), Patient Health Questionnaire-9 (PHQ-9), The EuroQol Visual Analog Scale (EQ-VAS) and a self-developed question to measure chest pain frequency. All measurements were performed before and after the intervention, and 3, 6 and 12 months after the intervention. Linear mixed model was used to test between-group differences in primary and secondary outcomes and multiple regression analysis was used to explore factors that may have an impact on the treatment effect of iCBT on cardiac anxiety.
Results
A total of 85% (n = 93/109) participants completed the 12-month follow-up. Mixed model analysis showed no statistically significant interaction effect of time and group between the iCBT and psychoeducation groups regarding cardiac anxiety over the 12-month follow-up. However, there was a statistically significant interaction effect of time and group (p = .009) regarding chest pain frequency favouring the iCBT group. In addition, we found a group effect in health-related quality of life (p = .03) favouring the iCBT group. The regression analysis showed that higher avoidance scores at baseline were associated with improvement in cardiac anxiety at 12-month follow-up.
Conclusions
Cardiac anxiety was reduced in patients with NCCP, but iCBT was not more effective than psychoeducation. Patients with a high tendency to avoid activities or situations that they believe could trigger cardiac symptoms may benefit more from psychological interventions targeting cardiac anxiety.
Trial Registration
The trial was registered at ClinicalTrials.gov NCT03336112 on 08/11/2017.
... Aaron T. Beck developed the CBT-I therapy method. CBT-I is a therapy method that aims to change deviant cognitive behavior in order to produce new, more adaptive and positive behaviors (McMain et al., 2015). CBT-I therapy is a combination of cognitive and behavioral therapy used to treat insomnia, especially chronic insomnia. ...
Background: The relationship between sleep quality and sleep quantity is very close and has a significant impact on a person's sleep needs. If someone does not get enough sleep, then this will have an impact on the quality of their sleep, and vice versa. Therefore, maintaining a good quality of sleep is very important to maintain a healthy body and improve quality of life. The aim of the study was to analyze the effect of cognitive behavior therapy for insomnia (CBT-I) on sleep quality in insomnia patients. Subjects and Method: This study is a meta-analysis with PICO. Population: insomnia patients. Intervention: given cognitive behavior therapy for insomnia (CBT-I). Comparison: not given cognitive behavior therapy for insomnia (CBT-I). Outcome: sleep quality. The articles used in this study were obtained from five databases, namely PubMed, Embase, Web of Science, ScienceDirect, and Google Scholar. The keywords used to search for articles use the medical subject heading (MeSH) term and the emtree of the keywords "Insomnia" AND "Cognitive Behavior Therapy for Insomnia" AND "Sleep Quality". The articles used were full text in English from 2013 to 2023. Articles were selected using the 2021 PRISMA flowchart and analyzed using the RevMan 5.3 application. Results: A total of 10 randomized controlled trial study articles came from Iran, Canada, Spain, Texas, Korea, Kansas and the United States. The total sample size is 473 research subjects. Based on the analysis, insomnia patients who were given CBT-I therapy showed an average PSQI score of 1.88 units lower than those not given CBT-I (placebo), and the difference was statistically significant (SMD = -1.88; 95% CI = -2.55 to -1.22; p<0.001). Then insomnia patients who were given CBT-I showed an average PSQI score of 0.52 units lower than those given other insomnia therapies, and the difference was statistically significant (SMD= -0.52; 95% CI= -0.77 to -0.28; p <0.001) . Then when viewed as a whole, it shows that insomnia patients who are given CBT-I therapy on average have or show a PSQI score of 0.78 units lower than other therapies and without CBT-I therapy (placebo), and this difference is statistically significant (SMD= -0.78; 95% CI= -1.13 to -0.42; p < 0.001). Conclusion: Cognitive behavior therapy for insomnia (CBT-I) can improve sleep quality in insomnia patients (decrease the PSQI score). Keywords: insomnia, cognitive behavior therapy for insomnia, sleep quality. Correspondence: Cynthia Octaviani. Master's Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: Cynthia.octaviani14@gmail.com. Mobile: +6287812315855.
... Our results indicate signi cant and strong reductions in depression, and anxiety, accompanied by particularly great improvements in psychological distress and suicidal ideation. These results are consistent with other studies, as most RCTs of CBT for depressive disorders yield positive results (54)(55)(56). Favorable outcomes were thehigh rate of session attendance, and improvement in pervasive outcome measures (17,57,58). ...
Being developed and modified in the Western world, the cultural values and communities influence cognitive behavioural therapy (CBT) strongly. In this study, CBT was adapted in Bengali to see the functional feasibility of CBT for persons with depression in Bangladesh. This is the first pilot study for an adapted CBT manual for on psychological intervention for working with depressive clients in Bangladesh. There were three phases of the study; in the first two phase’s adaptation of the standard protocols of CBT for the Bangladeshi community, as practiced by mainstream practitioners and mental health professionals in the world were ensured. Information gathered during first phase on the standard protocols of CBT was written up as the first draft of the adapted CBT manual in Bengali. In the second phase, the CBT manual was given to seven senior clinical psychologists in Bangladesh who train CBT to fellow mental health professionals for evaluation. After synthesizing the judge’s comments and suggestions the draft of the Bengali CBT manual was finalized. In the third phase, to evaluate the functional feasibility of the Bengali CBT-based manual, five diagnosed patients with depression referred by the psychiatrists were tested. Four valid and reliable psychometric measurements were used to measure symptoms of depression and comorbid symptoms of anxiety, psychological distress, and suicidal risk. Assessments were completed at 2 time points (pre-test and post-test) using the scales. The intervention was delivered over 6–10 sessions and improvements were found on the scores of all questionnaires. The possibilities of Bengali CBT to reduce depression and appearing to be a promising treatment option for depression are discussed in the paper.
... In view of the high rates of misdiagnoses, there is an urgent need to improve diagnostics of mental disorders by disseminating evidence-based assessment procedures into clinical practice. While there is increasing awareness of the importance of disseminating evidencebased treatment [15,16], the foundation of successful treatment -namely evidence-based diagnostics -has not been sufficiently addressed in dissemination research [17,18]. Therefore, the aim of the present study was to develop and evaluate a blended learning course to disseminate evidence-based diagnostics of mental disorders. ...
BACKGROUND
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.
OBJECTIVE
Therefore, we developed and evaluated a blended learning course in a multicenter cluster randomized trial.
METHODS
Undergraduate psychology 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.
CLINICALTRIAL
ClinicalTrials.gov NCT05294094
... LITs can be used with guidance from a professional or paraprofessional (i.e., guided) or self-guided by the individual user (i.e., unguided). Face-to-face psychotherapy (e.g., cognitive behavioral therapy) is regarded as the standard for common mental disorders like depression, anxiety, or insomnia [14][15][16]. However, research has shown that both guided and unguided LITs can be more effective than care as usual or waitlist controls [17][18][19][20], and guided LITs can be equally as effective as face-to-face care [21]. ...
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.
... In view of the high rates of misdiagnoses, there is an urgent need to improve diagnostics of mental disorders by disseminating evidence-based assessment procedures into clinical practice. While there is increasing awareness of the importance of disseminating evidence-based treatment (e.g., McMain et al., 2015;Weisz et al., 2014), the foundation of successful treatment -namely evidence-based diagnostics -has not been sufficiently addressed in dissemination research (e.g., Hunsley & Mash, 2005;Jensen-Doss & Hawley, 2010). Therefore, the aim of the present study was to develop and evaluate a blended learning course to disseminate evidence-based diagnostics of mental disorders. ...
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.
... Cognitive-behavioral therapy (CBT) is one of the most empirically supported interventions to address BI concerns [8]. In general, CBT aims to modify irrational and dysfunctional thoughts, emotions, and behaviors through various techniques (e.g., cognitive restructuring, self-monitoring, desensitization, psychoeducation, and exposure and response prevention) [41]. Concerning BI issues, Cash and colleagues (1997) [42] were among the first researchers to develop and evaluate CBT programs. ...
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.
... Cognitive behavioral therapy is a form of psychotherapy consisting of a cognitive and a behavioral aspect that addresses thoughts, beliefs, and behaviors detrimental to self-care in chronic health conditions and replaces them with more helpful thoughts and behaviors [14,15]. Psychological interventions such as cognitive behavioral therapy (CBT) have been shown as effective in overcoming behavioral barriers related to self-management and improved glycemic control among people with diabetes [16][17][18]. ...
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
... Psychotherapy, in particular cognitive behavioral therapy (CBT), is established in the treatment of most major mental disorders, and is also applied to treat patients with mental disorders in the context of an underlying physical disease as well as in cardiometabolic disorders themselves (90,(159)(160)(161)(162)(163). In particular, adjustment disorder, anxiety and depressive disorders are frequent comorbidities in CVD, leading to decreased quality of life and in part worsen the disease course of the underlying physical illness (164)(165)(166). ...
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.
... Note that the authors list two categories of games that are based on Cognitive Behavioral Therapy (CBT). CBT is an effective therapy in schizophrenia that requires the patient to act on their thoughts and behavior to reduce symptoms and stabilize (McMain & al., 2015). Table 5: Categories of serious games in mental health (Fleming & al., 2017) The parallel with depression here allows us to see that stress and panic situations can be reduced using these game categories. ...
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
... These unique features may be key contributors to the finding that MYTH participants reported significantly lower post-treatment depressive symtpom scores than their BtB counterparts. Consistent with the psychotherapy and psycho-oncology literature, 36,64,65 treatment engagement is one of the most important factors influencing treatment efficacy and should be a top priority for future research. The promising, though preliminary, finding of MYTH outperforming BtB adds to this important research direction by focusing on delivering an engaging and tailorable tCBT platform to AYAs diagnosed with cancer. ...
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.
... Although diagnosis-based treatments can be effective, they are not practical in cases where comorbidity is high, since repeated episodes of cognitive behavioural therapy (CBT) for each disorder implies longer and more expensive treatments (McMain et al., 2015). Additionally, not all people respond to current diagnosis-based treatments (Kampman et al., 2002;Schottenbauer et al., 2008), and high relapse rates have been reported (Craske et al., 2014). ...
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.
... However, there has been conjecture that CBT is also effective in post-TBI pain (headache or widespread pain). Moreover, CBT has also been recommended as a first-line treatment for other pain-related dysfunctions (such as sleep disorders and neuropathic pain) [19], although no quantitative meta-analysis has been performed to investigate the effects of CBT on sleep quality in adults with TBI. The present systematic review with meta-analysis is therefore aimed at examining the evidence for the effectiveness of CBT programs on pain and sleep quality in patients with TBI. ...
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.
... To decrease barriers to access, technological advancements have been increasingly effective in facilitating the dissemination of evidence-based care, especially CBT [14]. More specifically, blended care models have garnered growing empirical support, as the pairing of traditional face-to-face interventions with relevant digital activities has implications for greater dissemination, decreased costs, and robust treatment outcomes [15,16]. ...
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
... It appeared that commitment and completion of the homework assignment and exercises facilitated positive results in reducing negative emotions and behaviours associated with witnessing bullying in school. This finding extended previous findings on the efficacy of using cognitive behavioural techniques in reducing negative emotions and behaviours attributed to witnessing unpleasant events (Bernal et al., 2009;Hwang, 2009;McMain et al., 2015;Nicolas et al., 2009). ...
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.
... Cognitive behavioral therapy (CBT) is a group of short-term psychological therapies that aim to change unreasonable cognitions and thereby eliminate dysfunctional behaviors (Creswell et al., 2010). CBT can effectively solve general psychological problems and is often used to treat depression, anxiety, sleep disorders, and chronic pain (McMain et al., 2015). In recent years, an increasing number of studies (Abgrall-Barbry and Consoli, 2006;Liu et al., 2017a;Xue et al., 2008) have applied CBT as an intervention for hypertension. ...
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.
... 1). While there is a substantial body of research supporting the efficacy of CBT as a clinical treatment (McMain et al., 2015), the vast majority of CBT research was conducted by researchers, therapists and clients from Western cultural backgrounds (Beck, 2016). Moreover, the principles that underpin CBT are based on Western cultural values which may conflict with the beliefs of some minority cultural groups (Rathod et al., 2019). ...
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.
... Cognitive behavioral therapy (CBT) is a structured method of psychological intervention designed to change dysfunctional thoughts, beliefs and behaviors of patients by identifying and evaluating negative emotions, and helping patients reconstruct cognitive structure. It is a short-term psychotherapy aimed to eliminate negative emotions and behaviors (McMain, Newman, Segal, & DeRubeis, 2015). An early systematic review showed a significant relationship existed between COPD and cognitive impairment, and the cognitive domains memory and attention were significantly impaired in COPD patients (Torres-Sánchez et al., 2015). ...
"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."
... Another aspect to pay attention to is the inclusion of screening costs and health care costs of the absorbing state in such analyses. This is especially important given the research reporting the difficulty with low response rates and implementation of CBT interventions in general (McMain et al., 2015). Finally, we also assumed that the interventions have no spill-over effects and have no substantial side-effects, but it is a risk that participants partaking in the intervention will be stigmatized, which in turn affects adherence (Linden, 2013;Scott and Young, 2016). ...
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.
Objective
Cancer patients generally have high stress levels, which often leads to depression, anxiety and other psychological problems. Laughter therapy has been used to relieve stress, depression and anxiety in cancer patients, but its efficacy is uncertain. The study aims to summarize evidence on the efficacy of laughter therapy on psychological symptoms of people with cancer.
Methods
A search was conducted in 10 electronic databases for randomized controlled trials (RCTs) reported before May 2023. This systematic review was reported based on the PRISMA 2020 statement. The evaluation of methodological quality and risk of biases were conducted by the Cochrane Risk of Bias Assessment tool version 2, and evidence evaluation was conducted using the GRADE pro online assessment tool. Statistical analysis adopted the Review Manager version 5.4 software.
Results
A total of eight studies were included involving 543 participants. Meta‐analysis showed that laughter therapy plus routine nursing produced more positive effects than routine nursing in relieving stress (SMD = −1.18, 95% CI −1.73, −0.62, p < 0.0001), depression (SMD = −1.05, 95% CI −1.30, −0.81, p < 0.00001) and anxiety (SMD = −0.81, 95% CI −1.20, −0.43, p < 0.0001).
Conclusions
Laughter therapy could effectively relieve stress, depression and anxiety of cancer patients. Future studies should improve the methodological quality of randomized controlled trials, conduct appropriate follow‐up, and report details of follow‐up. Additionally, it should perform multi‐center and large‐sample studies, and combine both subjective and objective outcome indications to enhance the persuasiveness of evidence supporting the effectiveness of laughter therapy.
Trial Registration: PROSPERO register: CRD 42023452739
Background
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.
Objective
This study aimed to develop and evaluate a blended learning course in a multicenter cluster randomized controlled trial.
Methods
Undergraduate psychology students (N=350) enrolled in 18 university courses at 3 universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants’ performances in a clinical diagnostic interview after the courses. The secondary outcomes were diagnostic knowledge and participants’ reactions to the courses. All outcomes were analyzed on the individual participant level using noninferiority testing.
Results
Compared with the synchronous course (74.6% pass rate), participation in the blended learning course (89% pass rate) increased the likelihood of successfully passing the behavioral test (odds ratio 2.77, 95% CI 1.55-5.13), indicating not only noninferiority but superiority of the blended learning course. Furthermore, superiority of the blended learning over the synchronous course could be found regarding diagnostic knowledge (β=.13, 95% CI 0.01-0.26), course clarity (β=.40, 95% CI 0.27-0.53), course structure (β=.18, 95% CI 0.04-0.32), and informativeness (β=.19, 95% CI 0.06-0.32).
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.
Trial Registration
ClinicalTrials.gov NCT05294094; https://clinicaltrials.gov/study/NCT05294094
Background
Fear of cancer recurrence is one of the psychological distresses that seriously affects the quality of life of breast cancer patients. However, the evidence for cognitive behavioral therapy on fear of cancer recurrence in breast cancer is limited.
Objective
The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in reducing breast cancer patients’ fear of cancer recurrence.
Methods
Seven databases were searched for randomized controlled studies on cognitive behavioral therapy for fear of cancer recurrence in cancer patients from the inception of the database to April 30, 2023, with no language restrictions. Meta-analysis was performed using Stata MP 17. The Cochrane Risk of Bias Tool version 2 was used to assess the quality of the included studies. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation method.
Results
This review includes a total of 13 randomized controlled trials with 1447 breast cancer patients and survivors. When compared with controls, meta-analysis revealed that cognitive behavioral therapy significantly reduced the fear of cancer recurrence ( g = −0.44; 95% confidence interval, −0.75 to −0.13; P < .001), whereas subgroup analysis revealed that only mindfulness-based cognitive therapy was significant. The overall risk of bias was high. The Grading of Recommendations, Assessment, Development and Evaluation assessment showed a low overall quality of evidence.
Conclusions
Cognitive behavioral therapy may be effective in reducing fear of cancer recurrence in breast cancer patients, and mindfulness-based cognitive therapy is particularly worthy of implementation.
Implications for Practice
Mindfulness-based cognitive therapy may be used as an additional strategy to help manage breast cancer patients’ fears of cancer recurrence.
The cognitive behavioural therapies (CBTs) are the choice psychotherapies for many clinicians treating a wide range of adult psychological disorders including various anxieties, mood, substance use, eating, schizophrenia and personality‐related. Empirical research in the CBTs is ever increasing, and the accumulating evidence supporting efficacious treatments is substantial and well documented. However, with prolific research comes a seemingly accelerating and worrying trend of purportedly different therapies, and numerous hybrids and combinations of therapies and techniques. For many clinicians this is increasingly confusing and not helpful in clinical practice. This article is a critique of current trends and directions in clinical research, which show signs of limited effectiveness, fragmentation, and obfuscation. An alternative strategy is proposed—examining transdiagnostic therapeutic effects, which appear related to treating pervasive dysregulated emotions, with component analyses of four principal self‐regulation components (viz., self‐monitoring; functional analysis; identifying values, goals and treatment‐plans; and feedback). Such a strategy is likely to lead to a more coherently synthesized and effective CBT.
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
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.
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.
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.
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.
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.
Background: Children and adolescents with Autism Spectrum Disorder (ASD) often experience symptoms of various mental disorders along with the characteristics that define ASD. High rates of several psychiatric disorders have been reported in people with ASD such as anxiety, depression, cognitive problems, emotional regulation difficulties and related behavioral problems can occur in children of all ages with ASD. There are many treatment programs that can help autistic persons cope with these symptoms. Cognitive and Behavioral Therapy (CBT), Information and Communication Technology (ICT) and more are treatment programs that can help people with autism recognize and manage their symptoms.
Aim: This paper examines through bibliographic sources of the last 15 years the possible mental disorders that a child or adolescent with ASD may experience, as well as the therapeutic interventions that can help to manage them.
Methodology: For the present bibliographic research, 15 scientific articles from English journals were used. The databases from which the scientific articles were found were PubMed, PsycINFO, MEDLINE, and Google Scholar.
Results: According to the results of various studies, children and adolescents with autism show various symptoms of psychological disorders such as Anxiety Disorders, Depression and Obsessive-Compulsive Disorder. The combination of CBT and ICT can help people with autism recognize and manage their symptoms.
Discussion: The various symptoms of disorders that children and adolescents with autism experience can have a major impact on their family, their daily life, their schooling, and their future work. It is of the utmost importance that these children enter into a treatment program in order to better manage and treat their symptoms. The support of the school is also very important.
Keywords: Mental disorders, autism spectrum disorders, child, adolescents, intervention.
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
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.
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.
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.
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.
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.
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.
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.
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.
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).
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)
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.
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).
Unlabelled:
Although associations with outcome have been inconsistent, therapist adherence and competence continues to garner attention, particularly within the context of increasing interest in the dissemination, implementation, and sustainability of evidence-based treatments. To date, research on therapist adherence and competence has focused on average levels across therapists. With a few exceptions, research has failed to address multiple sources of variability in adherence and competence, identify important factors that might account for variability, or take these sources of variability into account when examining associations with symptom change.
Objective:
(a) statistically demonstrate between- and within-therapist variability in adherence and competence ratings and examine patient characteristics as predictors of this variability and (b) examine the relationship between adherence/competence and symptom change.
Method:
Randomly selected audiotaped sessions from a randomized controlled trial of cognitive-behavioral therapy for panic disorder were rated for therapist adherence and competence. Patients completed a self-report measure of panic symptom severity prior to each session and the Inventory of Interpersonal Problems-Personality Disorder Scale prior to the start of treatment.
Results:
Significant between- and within-therapist variability in adherence and competence were observed. Adherence and competence deteriorated significantly over the course of treatment. Higher patient interpersonal aggression was associated with decrements in both adherence and competence. Neither adherence nor competence predicted subsequent panic severity.
Conclusions:
Variability and "drift" in adherence and competence can be observed in controlled trials. Training and implementation efforts should involve continued consultation over multiple cases in order to account for relevant patient factors and promote sustainability across sessions and patients.
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 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.
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.
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 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.
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.
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.
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.
Recognizing an urgent need for increased access to evidenced-based psychological treatments, public health authorities have recently allocated over $2 billion to better disseminate these interventions. In response, implementation of these programs has begun, some of it on a very large scale, with substantial implications for the science and profession of psychology. But methods to transport treatments to service delivery settings have developed independently without strong evidence for, or even a consensus on, best practices for accomplishing this task or for measuring successful outcomes of training. This article reviews current leading efforts at the national, state, and individual treatment developer levels to integrate evidence-based interventions into service delivery settings. Programs are reviewed in the context of the accumulated wisdom of dissemination and implementation science and of methods for assessment of outcomes for training efforts. Recommendations for future implementation strategies will derive from evaluating outcomes of training procedures and developing a consensus on necessary training elements to be used in these efforts.
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.
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.
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.
Although the gap between psychotherapy practice and research has been present for some time, recent pressures for accountability from outside the system-managed health care and biological psychiatry-necessitate that we take steps to close this gap. One such step has been for psychotherapy researchers to specify a list of empirically validated therapies. However, as researchers who also have a strong allegiance to clinical practice, we are concerned that the conceptual and methodological constraints associated with outcome research may become clinical constraints for the practicing therapist. We firmly believe that, more than ever before, the time is ripe for us to develop a new outcome research paradigm that involves an active collaboration between researcher and practicing clinician.
The efficacy of Cognitive Behaviour Therapy (CBT) in the treatment of depression is now established. However, explanations for the efficacy of CBT are mixed. The evidence needed to support the explanation advanced by cogni