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Abstract

In this era of insistence on evidence-based treatments, cognitive behavioral therapy (CBT) has emerged as a highly preferred choice for a spectrum of psychological disorders. Yet, it is by no means immune to some of the vagaries of client participation. Special concerns arise when clients drop out from treatment. The aim of this study was to answer questions about the rate and timing of dropout from CBT, with specific reference to pretreatment versus during treatment phases. Also explored were several moderators of dropout. A meta-analysis was performed on dropout data from 115 primary empirical studies involving 20,995 participants receiving CBT for a range of mental health disorders. Average weighted dropout rate was 15.9% at pretreatment, and 26.2% during treatment. Dropout was significantly associated with (a) diagnosis, with depression having the highest attrition rate; (b) format of treatment delivery, with e-therapy having the highest rates; (c) treatment setting, with fewer inpatient than outpatient dropouts; and (d) number of sessions, with treatment starters showing significantly reduced dropout as number of sessions increased. Dropout was not significantly associated with client type (adults or adolescents), therapist licensure status, study design (randomized control trial [RCT] vs. non-RCT), or publication recency. Findings are interpreted with reference to other reviews. Possible clinical applications include careful choice and supplementing of treatment setting/delivery according to the diagnosis, and use of preparatory strategies. Suggestions for future research include standardization of operational definitions of dropout, specification of timing of dropout, and exploration of additional moderator variables. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

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... Whilst several reviews have found no difference between dropout rates for differing psychotherapies (Cooper & Conklin, 2015;Swift & Greenberg, 2014), Cuijpers, van Straten, Andersson, and van Oppen (2008) did report higher dropout rates for cognitive behavioural therapy (CBT) compared to other therapies when treating people presenting with depression. In terms of presenting problem, there is also some evidence for higher dropout rates when treating people presenting with personality disorders, eating disorders (Cooper & Conklin, 2015;Swift et al., 2017;Swift & Greenberg, 2014;Wierzbicki & Pekarik, 1993) and depression (Fernandez, Salem, Swift, & Ramtahal, 2015). ...
... Meta-analyses of treatment refusal and dropout rates for other psychotherapies provided comparison benchmarks for the pooled CAT refusal and dropout rates. An electronic search of literature databases for recent meta-analyses of therapy dropout produced five reviews reporting specific therapy pooled dropout rates for CBT (Fernandez et al., 2015), Full-text articles assessed for eligibility (n =82) ...
... This interpretation is supported by previous findings of lower dropout rates in efficacy studies compared to effectiveness studies (Swift & Greenberg, 2014). In addition, comparisons with the CBT treatment refusal rate (Fernandez et al., 2015) that followed a similar method to this review (any publication related to dropout) found nearly identical rates (CAT = 15.4%, CBT = 15.9%). ...
Article
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Aim To estimate treatment refusal and treatment dropout rates for cognitive analytic therapy (CAT) and then benchmark these rates against other psychotherapies. Method PROSPERO registration CRD4202017081. Systematic searches found CAT treatment studies reporting treatment refusal and dropout rates. Studies were narratively and quantitatively synthesised in a proportional random-effects meta-analysis and moderator analyses were performed. Secondary analyses compared refusal and dropout rates for CAT versus other psychotherapies via direct comparisons in the original studies and via benchmarking these rates against other acceptability meta-analyses for other psychotherapies. Results Thirty-four CAT studies were included in the review. The treatment refusal rate was 15.35% (k = 9, 95% CIs 8.78–23.21). The treatment dropout rate was 18.69% (k = 34, 95% CI's 15.02–22.62). CAT generated significantly lower dropout rates relative to treatment comparators in the original studies (OR = 0.67; 95% CI 0.48–0.93). Country and younger age were significant moderators of dropout rates. CAT had a comparable treatment refusal rate and was towards the lower end of the dropout range when benchmarked against other psychotherapies. Conclusions CAT as a brief and integrative psychotherapy for individuals presenting with typically complex psychological disorders appears a relatively acceptable intervention to patients.
... A further highly problematic but neglected fact is that patients prematurely drop out from CBT (Hans & Hiller, 2013). In a metaanalysis by Fernandez et al. (2015) depression showed the highest dropout rates during the waiting phase (21.6%) and over the course of treatment (36.4%). Waiting phases seem to be a weak link in CBT, especially for depression, being characterized by high risk of waning (treatment) motivation. ...
... Waiting phases seem to be a weak link in CBT, especially for depression, being characterized by high risk of waning (treatment) motivation. Fernandez et al. (2015) therefore suggest that individuals with depression must receive special attention during this vulnerable time including preparatory, engaging and encouraging interventions to enhance readiness for treatment. ...
... Thus, both factors may have contributed to the low attrition rates found in the present study. In contrast, a meta-analysis on drop-out rates in CBT (Fernandez et al., 2015) reported a 36.4% drop-out rate during CBT treatment (in addition to another 21.6% pretreatment drop-out) for patients with depression, again underscoring the high relevance of these subjective parameters. ...
Article
Background: Metacognitive Training for Depression (D-MCT) is a novel low-intensity group training for economic treatment of depression. Previous studies demonstrate its efficacy in moderately depressed outpatients. The present study evaluated efficacy and patient's perspective of the D-MCT in severely depressed psychiatric inpatients. Methods: In a randomized-controlled trial, 75 individuals with a major depressive disorder (MDD) were allocated to D-MCT versus Euthymic therapy as add-on (twice a week) to cognitive-behavioural-based (CBT) inpatient-care. Depressive symptoms (HDRS, BDI), dysfunctional (meta)cognition (DAS, MCQ-30), and subjective appraisal were assessed at baseline, 4 weeks (post) and 3 months (follow-up). Results: Participants in both conditions showed a large decline in depression at post and follow-up-assessment. No superior add-effect of D-MCT versus active control emerged for depression severity on top of the inpatient care. However, among patients with a diagnosis of MDD with no (vs. at least one) comorbidity, D-MCT participants showed a larger decline in depressive (meta-)cognition at follow-up with medium-to-large effect sizes. D-MCT was evaluated as superior in overall appraisal, treatment preference, motivation, and satisfaction. Limitations: The follow-up time interval of 3 months may have been too short to detect long-term effects. There is emerging evidence that modification of (meta)cognition unfolds its full effects only with time. Effects of CBT inpatient-care on outcome parameters cannot be differentiated. Conclusions: Although D-MCT as an add-on was not superior in complete case analyses, results suggest greater benefit for patients with MDD and no comorbidity. D-MCT proved feasible in acute-psychiatric inpatient-care and was highly accepted by patients. Future studies should investigate the role of modified (meta)cognition on long-term treatment outcome, including dropout and relapse rates.
... A meta-analysis (Fernandez, Salem, Swift, & Ramtahal, 2015) of CBT dropout found a notably higher dropout rate of 36.4% for depressed adults compared with other client groups, such as those with anxiety disorders, having a dropout rate of 19.6%, and psychosis, with a dropout rate of 20.1%. The dropout figures in this study were estimated by considering the definition of dropout as the failure to complete the planned treatment protocol. ...
... The dropout figures in this study were estimated by considering the definition of dropout as the failure to complete the planned treatment protocol. Given that adult clients with depression have been found to be at an increased risk of dropout (Fernandez et al., 2015) and that adolescents are at greater risk of dropping out than adults (Roseborough et al., 2016), there is a potential need to clinically focus on dropout specifically in relation to adolescent depression and to have ongoing empirical studies to enhance what we understand. ...
... All items indicated high overall satisfaction. The dropout rate was 21%, compared with a mean dropout rate of 26% in CBT across format, and compared with a mean dropout rate of 34% in CBT teletherapy as identified by a meta-analysis (Fernandez et al., 2015). Table 4 includes a summary of responses to all satisfaction post-treatment survey items in Table 4. ...
... Parents also reported a high degree of satisfaction with the program and high rates of perceived improvement in their children's' overall emotional functioning. The dropout rate (21%) was less than the estimated dropout rate typically observed in CBT (26.2%, 95% CIs [23.1%, 29.7%]), especially when compared with telehealth dropout rates (34.2%, 95% Cis [22.5%, 48.3%]) based on a prior meta-analysis (Fernandez et al., 2015). ...
Article
Background The COVID-19 pandemic has led to increased stress, anxiety, and depression in children. A six-session, parent-led, transdiagnostic, cognitive-behavioral teletherapy program was adapted from an established protocol to help youth aged between 5 and 13 years manage emotional problems during the pandemic. Methods One-hundred twenty-nine parents of youth struggling with emotional problems during the COVID-19 pandemic participated in the program. Parents reported on their children's psychosocial functioning before and after treatment using validated assessments. They also reported on treatment satisfaction. Clinician-rated global improvement was assessed at each session to determine clinically significant treatment response. Results Significant improvements in parent proxy-reported anxiety (d = .56), depression (d = .69), stress (d = .61), anger (d = .69), family relationships (d = .32), and COVID-19-related distress (d = 1.08) were found, with 62% of participants who completed the program being classified as treatment responders. Parents reported high levels of satisfaction with the program. Limitations This study was limited by use of primarily parent-report assessments and a lack of a control group. Conclusions Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy appeared to be an effective way to help youth cope with the pandemic and may be a scalable framework in response to large-scale mental health crises.
... The COVID-19 pandemic reinforced the Need for expanding T-CBT access [53,54]. However, existing T-CBTs for depression present engagement-related challenges [55][56][57][58]. Currently available T-CBTs for depression are often text-heavy, academically oriented, and use jargon [55,58], all of which contributes to disengagement and dropout. ...
... Given the myriad of barriers to care experienced by rural residents , including the lack of local mental health professionals [20][21][22], it is imperative to investigate ways to develop capacity to deliver treatment in community settings where rural residents naturally go for help. T-CBT with human support has demonstrated comparable effectiveness to face-to-face CBT for treating depression [43][44][45][46][47]57]; however, user engagement with existing T-CBT programs have been negatively impacted by their text-heavy, academic nature and one-size-fits-all approach [55][56][57][58][59][60][61][62]. This study seeks to address these depression treatment access disparities in rural areas by evaluating the effectiveness of an innovative, entertaining T-CBT for depression, Raising Our Spirits Together (ROST), tailored for the rural context and for delivery by clergy. ...
Article
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This paper presents a methodological description of a randomized controlled trial (RCT) testing the effect of Raising Our Spirits Together (ROST), a technology-assisted cognitive behavioral therapy (T-CBT) for depression, tailored for the rural context and for delivery by clergy, compared to an enhanced control condition. Depression is among the most common mental health conditions; yet the majority of adults with depression do not receive needed treatment due to limited access to mental health professionals, treatment-associated costs, distance to care, and stigma. These barriers are particularly salient in rural areas of the United States. T-CBT with human support is an accessible and effective treatment for depression; however, currently available T-CBTs have poor completion rates due to the lack of tailoring and other features to support engagement. ROST is a T-CBT specifically tailored for the rural setting and delivery by clergy, who are preferred, informal providers. ROST also presents core CBT content in a simple, jargon-free manner that supports multiple learning preferences. ROST is delivered virtually in a small group format across 8 weekly sessions via videoconferencing software consistent with other clergy-based programs, such as Bible studies or self-help groups. In this study, adults with depressive symptoms recruited from two rural Michigan counties will be randomized to receive ROST versus an enhanced control condition (N = 84). Depressive symptoms post-treatment and at 3 months follow-up according to the Patient Health Questionnaire (PHQ-9) will be the primary outcome. Findings will determine whether ROST is effective for improving depression symptoms in underserved, under resourced rural communities.
... Twenty-six clients (28%) did not have a termination session and thus did not have scores on our variables of interest (i.e., SWLS, BDI-II, BAI, CCTS). This rate of missing data is consistent with reported drop out across other studies of CBT clinics and CBT effectiveness (Fernandez et al., 2015;Hans & Hiller, 2013). Missing data on baseline demographics was low (0-2%). ...
... Similarly, another result of using clinic outcomes is attrition and missing data, especially for the CCTS which was not measured throughout the entire study period. It is common in psychology clinics for clients to discontinue services (Wierzbicki & Pekarik, 1993), and effectiveness studies and other studies of CBT clinic outcomes have reported dropout rates similar to the rate of missing data observed in the present sample (Fernandez et al., 2015;Hans & Hiller, 2013). A third limitation is the lack of diversity of the clinic sample. ...
Article
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Increased quality of life (QoL) is rated by patients as a primary factor in determining recovery from psychopathology. Cognitive behavioral therapies (CBTs) are the most well-researched psychotherapies for internalizing disorders and appear effective at reducing symptoms even when delivered by trainees. Existing research suggests that the effects of CBTs on QoL are more modest than their effects on symptoms. However, little is known about the effects of trainee-delivered CBT on life satisfaction, a subjective measure of QoL. We analyzed data from 93 clients treated by students (n = 23) in a graduate-level training clinic using an intent-to-treat approach, completers case analyses, and random forest imputation. Across methods of handling missing data, improvements in anxiety, depression, and CBT skills were more marked than improvements in QoL. Exploratory analyses suggested baseline life satisfaction was the strongest predictor of end-of-treatment life satisfaction. Future research should explore alternatives to “standard” CBT for clients with low life satisfaction.
... This patient had high depressive symptoms at baseline. In ICBT format, the severity of depressive symptoms increases the risk of dropout (Fernandez et al., 2015). Previous research has suggested that most patients with eating disorders (94%) can complete Internet-based interventions, even therapist-guided ICBT (ter Huurne et al., 2015). ...
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Objective The objective of the present study was to investigate the feasibility of guided internet cognitive behavioral therapy (ICBT) for anorexia nervosa. Methods We conducted a prospective single-arm study between January 2020 and March 2021. The intervention was built using videos, web programs, and chat tools. The intervention program was largely based on metacognitive training. Participants performed the self-help program once a week for 12 consecutive weeks. The primary outcome was the global Eating Disorder Examination Questionnaire (EDE-Q) score. Secondary outcomes included clinical symptoms of eating disorders, metacognitive function, body mass index, depression, and generalized anxiety. The main statistical analysis examined whether the EDE-Q score and other outcomes at the end of the intervention differed from the baseline. Results Fourteen participants underwent the trial treatment, and 13 completed the intervention. There was a significant reduction in the global EDE-Q score from 3.48 (SD = 1.4) to 2.54 (SD = 1.5, p = 0.02, Cohen's d = 0.75) from baseline to post-intervention. Some EDE-Q subscales and body checking questionnaire scale demonstrated statistically significant improvements, with moderate to large effect sizes. Although there was no significant improvement in body mass index, metacognitive function, or depressive symptoms, there was a significant improvement in the severity of generalized anxiety (M = −4.0, p = 0.01, Cohen's d = 0.95). No adverse events were observed. Discussion Our findings suggest that guided ICBT for anorexia nervosa is well accepted by female patients and practical as a telemedicine approach that improves symptoms. In the future, tightly controlled randomized controlled trials should be conducted for efficacy verification.
... From all 29 patients who started treatment, a total of six patients dropped out (one being a study participant). This gives a drop-out rate of 20%, a number more in line with the 26% reported from other studies of CBT-treatments [52][53][54]. ...
Article
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Background A majority of psychiatric patients suffer from insomnia or insomnia-like problems. In addition to impairing quality of life, sleep problems can worsen psychiatric conditions, such as depression and anxiety, and can make treatment of various psychiatric conditions less successful. Several international guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as first line treatment. However, patients in psychiatric care are rarely offered this treatment, and there is a lack of studies evaluating the treatment in regular psychiatric settings. In this pilot study, we aimed to determine the clinical feasibility of a group-based CBT-I intervention in an outpatient clinical setting for patients with depression, bipolar disorder, anxiety disorders and PTSD. We also aimed to investigate if symptoms of insomnia, depression and anxiety changed after CBT-I. Methods Seventeen patients at an out-patient psychiatric clinic for mixed psychiatric problems of anxiety, affective disorders and PTSD, were enrolled in a six-week long group-based CBT-I intervention. Primary outcomes were pre-defined aspects of treatment feasibility. Secondary outcomes were changes in self-reported symptoms of insomnia severity, depression, and anxiety between pre – and post intervention. Assessment of insomnia severity was also performed 3 months after treatment. Feasibility data is reported descriptively, changes in continuous data from pre- to post-treatment were analysed with dependent t-tests. Results All feasibility criteria were met; there were enough patients to sustain at least one group per semester (e.g., minimum 8), 88% of included patients attended the first session, mean of attended sessions was 4.9 of 6, and drop-out rate was 5.9%. Therapists, recruited from clinical staff, found the treatment manual credible, and possible to use at the clinic. Symptoms of insomnia decreased after treatment, as well as symptoms of depression and anxiety. Conclusion CBT-I could prove as a clinically feasible treatment option for insomnia in a psychiatric outpatient setting. Trial registration Clinicaltrials.gov identifier: NCT05379244. Retrospectively registered 18/05/2022.
... Andererseits gibt es immer noch viel zu viele Patientinnen und Patienten, die nicht ausreichend von ihrer Psychotherapie profitieren und beispielsweisekeineswegs remittieren (Barlow 2010;Cuijpers et al. 2021;Barkham und Lambert 2021), und Behandlungen, die aus unterschiedlichen Gründen scheitern (Strauß 2021). Immerhin bis zu ein Viertel aller Patienten im Durchschnitt bricht die Therapie vorzeitig ab (Cahill et al. 2003;Fernandez et al. 2015;Swift und Greenberg 2012;Swift et al. 2017). ...
... Despite its efficacy, the uptake of in-person CBT is suboptimal across all ages [12][13][14][15]. In young people, this is due in part to the affordability and availability of trained practitioners, perceived stigma, poor mental health literacy, and a preference for self-reliance [16][17][18]. ...
Preprint
BACKGROUND Digital, self-guided cognitive behavioural therapy (CBT) interventions circumvent many barriers to in-person therapy for young people; although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. OBJECTIVE This systematic review synthesizes the literature on digital CBT interventions for depression and anxiety in young people to describe (i) how appropriate use has been defined and communicated to users as instructions for use; (ii) how adherence has been measured; and (iii) to determine the associations between adherence and treatment outcomes. METHODS A systematic review was conducted with two reviewers extracting data independently. Four electronic databases (Embase, Medline, PsycINFO and The Cochrane library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12-24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioural-only interventions were excluded. Methodological quality was assessed using the using the Cochrane Risk of Bias Tool (ROB) and the Integrated Quality Criteria for the Review of Multiple Study designs (ICROMS). RESULTS There were 32 manuscripts that met inclusion criteria, of which 28 were unique studies (total N=16 578 youth). Definitions of appropriate use varied between the different interventions in terms of intended recipients, duration and frequency of use, and the features employed to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies were inconsistent with no study systematically describing components of appropriate use nor providing information on how recommendations for use were relayed to users. Most often definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the nine studies that examined this. CONCLUSIONS Definitions of appropriate use are unique to each digital CBT intervention. Yet, statements of appropriate use are not systematically reported in the literature. Further, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We propose a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. CLINICALTRIAL This protocol was registered with PROSPERO [CRD42020208668].
... Limitations of this study are diverse . We want to highlight the dropout rates, which were 21% (expected) and 13% (lower than expected) from the CBT and PCT groups, respectively, these rates are comparable to those in other studies of CBT for depression (Fernandez et al., 2015). Moreover, another limitation to attain the desired number of participants was the difficulty in detecting fibromyalgia diagnoses at the collaborating centers. ...
Article
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Background/Objective Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia. Method We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models. Results Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β = -0.47, t = -0.49, p = .63) and at follow-up (β = -1.12, t = -1.09, p = .28). Results were similar between conditions for anxiety, fibromyalgia's impact, and the distribution of clinically significant changes in depressive symptoms and pain. Conclusions PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.
... First, the early onset of anxiety disorders, and their association with subsequent comorbidity (Beesdo et al., 2007;Beesdo-Baum & Knappe, 2012;Bulley, Miloyan, Brilot, Gullo, & Suddendorf, 2016;Kessler et al., 2005;Plana-Ripoll et al., 2019) raise the question of whether a better understanding of the relevant underlying mechanisms might ultimately be useful for preventive interventions. Second, although there is now a growing evidence-base of efficacious and cost-effective interventions for anxiety disorders, many individuals do not respond to first-line treatments, do respond but do not remit, or have relapse and recurrence of their illness (Fernandez, Salem, Swift, & Ramtahal, 2015;Loerinc et al., 2015;Taylor, Abramowitz, & McKay, 2012). Improvements in health-care delivery could lead to earlier diagnosis and scaling up of currently available, efficacious treatments that can close the treatment gap (Alonso et al., 2018). ...
Article
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Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.
... In terms of drop out, a lower drop-out rate was noted in the EFT condition, although this was not statistically significant. The rate of drop out in the CBT condition (27.5%) was comparable to the drop out from that therapy found in other studies (see meta-analysis by Fernandez et al., 2015). A bigger problem for the study was research attrition (missing data) that copied drop out to the extent that we practically had only per-protocol data (i.e., we only had data from clients who stayed in therapy). ...
Article
Generalized anxiety disorder (GAD) is a chronic mental health difficulty typically present in primary care settings. Cognitive-behavioral therapy (CBT) is the psychological intervention with the best evidence for its efficacy for GAD. The development of other psychological interventions can increase client choice. This feasibility trial examined an initial assessment of the efficacy of EFT in comparison to CBT in the treatment of GAD in the context of an Irish public health service. The trial provided information on recruitment, therapist training/adherence, and client retention relevant for a potential noninferiority trial. A randomized controlled trial compared the efficacy of EFT versus CBT for GAD. Both therapies were offered in a 16-20 sessions format. Therapists (n = 8) were trained in both conditions and offered both therapies. Clients were randomly assigned to the two therapies EFT (n = 29) and CBT (n = 29). Outcomes were assessed using several measures, with the Generalized Anxiety Disorder-7 (GAD-7) being the primary outcome. Clients were assessed at baseline, week 16, end of therapy, and at 6-month follow-up. Therapists were able to learn the two models after a short training and showed moderate levels of adherence. Although not statistically significant, the drop out from treatment was 10% for EFT and 27% for CBT. The two therapies showed large pre-post change and similar outcomes across all measures, with these benefits retained at 6-month follow-up. Results suggest that EFT is a potentially promising treatment for GAD. Further investigation is indicated to establish its potential to expand the available psychological therapies for GAD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... We acknowledge that undertaking a self-directed CBT program may not be of interest to all patients with needle fear. Based on previous studies reporting on the use of CBT interventions, dropout rates for psychotherapy range from 16% at the pretreatment phase to 26% at the treatment phase, with some studies reporting an average dropout rate of 47% [35,36]. Acceptability will be assessed qualitatively, and we anticipate that the intervention will be acceptable from our qualitative approaches. ...
Article
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Background Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention—an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses. Methods This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes. Conclusion The results will inform the protocol for larger trials addressing needle distress in HD patients. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/.
... Maples-Keller et al. [40] report that for certain disorders like autism spectrum disorder (ASD), studies have shown lower drop-out rates with the use of VR. Another meta-analysis found that for social anxiety, the dropout rate for virtual reality for anxiety disorders is 16%, slightly lower the 19.6% reported using another technique (cognitive-behavioural) [41] and the 19.7% reported by a meta-analysis of attrition from traditional therapy [42]. ...
... Compared to the study of its efficacy, there is a paucity of work on essential therapeutic or potentially countertherapeutic processes within CBT (Kazantzis et al., 2018). Psychotherapy dropout is a well-recognized problem (Fernandez et al., 2015). Recommendations for how to help clients adhere often assume that clients are rational actors (e.g., motivational interviewing, shared decision making; Corrigan et al., 2014). ...
Article
Objective: Dropout rates from trauma-focused PTSD treatments (TFTs) in VA clinics are particularly high. We conducted in-depth qualitative interviews with 29 veterans and their therapists to better understand this phenomenon. Method: Participants were part of a multisite, mixed-methods study of TFT adherence in VA clinics. Veterans were eligible for interviews if they exhibited poor TFT adherence and screened positive for PTSD in follow-up surveys. Interviews were analyzed using qualitative dyadic analysis approaches. Results: Therapists relied on stereotypes of poor adherence to understand veterans' experiences and were missing information critical to helping veterans succeed. Veterans misunderstood aspects of the therapy and struggled in ways they inadequately expressed to therapists. Therapist attempts at course corrections were poorly matched to veterans' needs. Many dyads reported difficulties in their therapeutic relationships. Veterans reported invalidating experiences that were not prominent in therapists' interviews. Conclusions: Future work is needed to test hypotheses generated and find effective ways to help veterans fully engage in TFTs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... However, amongst anxiety-related disorders, SAD and OCD are associated with the lowest remission rates, i.e., 40 and 37%, respectively (7). In addition, dropout rates are relatively common with around 15% of patients with SAD and 9-17% of patients with OCD prematurely leaving the treatment course (8,9). ...
... Bezüglich der Betrachtung der Rahmenbedingungen, des Settings und der Besonderheiten von Therapieprogrammen sind die bisherigen Studienergebnisse uneindeutig. So zeigen sich widersprüchliche Ergebnisse hinsichtlich der Überlegenheit von stationären oder ambulanten, sowie Einzel-oder Gruppensettings (Fernandez et al., 2015;Piper et al., 1984;Rush & Watkins, 1981). Ein plausibler Faktor für das Ablehnen eines Therapieangebots oder das Abbrechen nach einer geringen Anzahl an Sitzungen, vor allem bei einem ambulanten Therapieangebot, könnte in der Distanz zwischen Wohnort und Therapieeinrichtung liegen und somit primär organisatorisch begründet sein. ...
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Zusammenfassung Es ist eine verbreitete Annahme, dass Pädophilie eine nahezu ausschließlich bei Männern vorkommende Störung der Sexualpräferenz darstellt. In diesem Artikel werden überblicksartig Befunde und Theorien zu Geschlechtsunterschieden bezüglich der Häufigkeit sexueller Fantasien und paraphiler Interessen (insbesondere Pädophilie) sowie zu sexuellem Kindesmissbrauch dargestellt und kritisch diskutiert, auch hinsichtlich forschungsmethodischer Artefakte. Im Anschluss werden drei Fallbeispiele nicht-männlicher Betroffener mit auf Kindern ausgerichteten sexuellen Fantasien aus dem Präventionsnetzwerk Kein Täter werden vorgestellt. Dabei identifizieren sich zwei der Personen als eindeutig weiblich, eine Person ordnet sich als Frau-zu-Mann-Transsexueller ein. Anhand dieser Beispiele werden Gemeinsamkeiten und Unterschiede nicht-männlicher Personen mit pädophilen Fantasien erörtert und Implikationen für die praktische Arbeit mit weiblichen bzw. nicht-männlichen Betroffenen diskutiert. Schlüsselwörter: Pädophilie, Geschlechtsunterschiede, Frauen, Transsexualität, sexuelle Fantasien Abstract It is a widespread assumption that pedophilia is a sexual preference disorder that almost exclusively affects males. In this article, findings and theories on sex/gender differences regarding the frequency of sexual fantasies and paraphilic interests (especially pedophilia) as well as child sexual abuse are outlined and critically discussed, also with regard to artifacts of research methodology. Subsequently, we present three case studies of non-male participants with sexual fantasies directed at children who attended the prevention network. Two of the participants identify themselves as unambiguously female, one participant classifies himself as a female-to-male transsexual. Based on these examples, similarities and differences of non- male persons with pedophilic fantasies are elaborated and implications for practical work with female (or, more broadly, non-male) participants are drawn. Keywords: Pedophilia, Sex differences, Women, Transsexuality, Sexual fantasies https://www.kein-taeter-werden.de/uploads/2021-11-Sexuologie-10-Jahre-Praeventionsnetzwerk-Kein-Taeter-werden.pdf
... The rate of attendance reported in our program (i.e., 77.7%) could be considered as good when compared to previous PPI studies for people with psychosis with a rate of 54.2% . Nonadherence is a main concern related to psychological interventions for people with SPC (Fernandez et al., 2015;Swift & Greenberg, 2014), having schizophrenia is associated with the highest rates of dropout in comparison with other mental health disorders (Hamilton et al., 2011) and with low adherence to homework assignments (Dunn et al., 2002). In this sense, regarding the number of in-sessions and homework exercises completed, the adherence was relatively high. ...
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Objective: The aim of this study was to examine the efficacy and effectiveness of a theory-driven multicomponent positive psychology intervention to improve well-being for individuals with severe psychiatric conditions (SPCs) in comparison with treatment as usual (TAU). This intervention moves away from the traditional psychiatric perspectives that focused on symptoms and deficits, promoting a broader view of outcomes such as noncritical self-acceptance, strengths, and positive relationships with others, among other things. Method: A two-arm randomized and outcome-blinded trial with pre-post and 6-month follow-up evaluations was conducted to assess the intervention. A total of 141 participants were allocated to either the experimental condition or the waiting list group receiving their TAU. A mixed-effect model was used to examine the efficacy of the intervention and a repeated-measures Student's t-test for the follow-up effectiveness analysis. Results: The intervention protocol was highly acceptable for participants, showing very high participant satisfaction as well as good attendance and adherence rates. At the end of the group therapy, participants reported a significant improvement in self-acceptance and environmental mastery and, these changes were maintained in the follow-up assessment after 6 months. Conclusions and implications for practice: The results of this randomized control trial provide further evidence supporting that positive psychology approaches can be a powerful complementary strategy to promote more comprehensive psychiatric rehabilitation services for people with SPCs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Additionally, this is the first study to examine the expression level of genes related to stress and inflammation in a population of depressed and anxious older-adults after 8-weeks of MBCT. Moreover, we have a below average dropout rate 13% (8/61) for a psychotherapy RCT of this size (56) and 100% of enrolled participants consented to blood draws in addition to the battery of questionnaires. ...
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Background: Depression and anxiety are prevalent in older-adults and often difficult to treat: up to 55% of patients are unresponsive to pharmacotherapy. Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment, however, its biological mechanisms remain unknown in older-adults. Methods: We examined if, in older-adults, decreased depression and anxiety symptoms after MBCT are associated with changes in the expression levels of C-reactive protein, Interleukin-1β, Monocyte chemoattractant protein-1 and mineralocorticoid receptor compared to treatment as usual (TAU). Older-adults (age ≥60) with depression and anxiety were randomized to MBCT or treatment as usual. Gene expression levels from blood samples were measured using quantitative polymerase chain reaction ( n = 37) at baseline and after 8-weeks of MBCT or TAU. Results: As previously published, we found a significant reduction in symptoms of depression F (1, 35) = 10.68, p = 0.002, partial η ² = 0.23 and anxiety F (1, 35) = 9.36, p = 0.004, partial η ² = 0.21 in geriatric participants following MBCT compared to TAU. However, the expression levels of measured genes were not significantly different between groups and were not associated with changes in depression and anxiety symptoms. Conclusion: Our results suggest that the symptom reduction following MBCT in older-adults may not be accompanied by changes in the stress-response and inflammatory pathways. Future research should address other potential biological alterations associated to MBCT that may be responsible for the reduction of symptoms.
... While a full course of CBSM may be efficacious in reducing state anxiety for pregnant women, these findings are qualified by the fact that improvements were not maintained at follow-up. Moreover, in line with substantial data identifying depression as a robust predictor of premature dropout in CBTs (Fernandez et al., 2015), women with greater baseline depressive symptoms were less likely to complete the intervention, and thus showed less favorable state anxiety outcomes post-treatment. Many intervention components in CBSM-thought monitoring and challenging, improving social support, assertiveness training-show benefit for both depression and anxiety (Dour et al., 2014;Driessen & Hollon, 2010;Speed et al., 2017). ...
Article
Objective: Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety. Method: A sample of 100 primarily ethnic and racial minority pregnant women with subclinical anxiety (74% Latina, 18% Black; Mage = 26.5) were randomized to an 8-week cognitive behavioral stress management (CBSM) intervention (n = 55), or to an attentional control condition (n = 45). Two forms of anxiety (state and pregnancy-specific) were measured at baseline, post-treatment, and at follow-up in the postpartum using the State–Trait Personality Inventory-State and the Pregnancy Related Anxiety scale, respectively. Intent-to-treat (ITT) and completer analyses were conducted using linear mixed models to test mean differences in both forms of anxiety by group assignment and by intervention completion (<7 vs. ≥7 sessions) at post-treatment and follow-up timepoints. Results: ITT results revealed no intervention Group × Time interactions for state, F(3, 356) = .51, p = .68, or pregnancy-specific anxiety, F(2, 184.39) = .75, p = .47, indicating no intervention effect post-treatment or at follow-up. Completer analyses showed that women who received all intervention content (34.5%) had significantly less state anxiety at post-treatment compared to women who had not completed the intervention, (65.5%; Msessions = 3.62); F(6, 270.67) = 2.35, p = .03, and those in the control condition. Conclusions: While we did not find support for the use of CBSM to treat prenatal anxiety among low-income women, those who received a full dose benefited in state anxiety immediately post-intervention.
... While drop-out rates from CBT of up to 26% implies some degree of unacceptability of the treatment [15], adverse events or reactions are not systematically monitored or reported in psychotherapy trials [16]. One study reported that psychotherapists within childand adolescent psychiatric services in Sweden were unfamiliar with the concept of adverse events in psychotherapy [17]. ...
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Background: Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias. Methods: This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8-17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient < 70; or treatment with CBT, PRT, antidepressant or antipsychotic medication within the last 6 months prior to trial entry. Participants are randomised 1:1 to the experimental intervention (FCBT) versus the control intervention (FPRT) each consisting of 14 75-min sessions. All therapists deliver both interventions. Follow-up assessments occur in week 4, 8 and 16 (end-of-treatment). The primary outcome is OCD symptom severity assessed with CY-BOCS at end-of-trial. Secondary outcomes are quality-of-life and adverse events. Based on sample size estimation, a minimum of 128 participants (64 in each intervention group) are included. Discussion: In our trial design we aim to reduce risk-of-bias, enhance generalisability, and broaden the outcome measures by: 1) conducting an investigator-initiated, independently funded RCT; 2) blinding investigators; 3) investigating a representative sample of OCD patients; 3) using an active control intervention (FPRT) to tease apart general and specific therapy effects; 4) using equal dosing of interventions and therapist supervision in both intervention groups; 5) having therapists perform both interventions decided by randomisation; 6) rating fidelity of both interventions; 7) assessing a broad range of benefits and harms with repeated measures. The primary study limitations are the risk of missing data and the inability to blind participants and therapists to the intervention. Trial registration: ClinicalTrials.gov : NCT03595098, registered July 23, 2018.
... Another limitation is the relatively small sample size which did not allow us to examine therapist effects, and therefore it was not possible to examine adherence and competence. Moreover, the dataset had relatively high rates of missing data, although similar to previous studies (e.g., 26.2% dropout rate in CBT; Fernandez et al., 2015). Consistent with recommended practices, we relied on imputed data in our analyses which is preferable to other methods of handling missing data as far as Type I and Type II error rates are concerned (Collins et al., 2001), especially if missingness could be predicted by observed variables, as in our case (Schafer et al., 2002). ...
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Objective The therapeutic alliance is related to treatment outcome but less is known about the agreement on alliance between patients and therapists and its relationship to outcomes. We examined the association of patient-therapist congruence of alliance perceptions, early and late in cognitive behavioral therapy for panic disorder in relation to symptom reduction and dropout. Method: Patients (n = 181) and their therapists provided alliance ratings early and late during 11-session treatment. Independent evaluators rated patients' symptomatic levels post-treatment. Polynomial regression and response surface analysis were used to examine congruence as a predictor of outcome. Results: Early in therapy, stronger combined patient-therapist alliances, regardless of agreement, predicted lower symptom severity at the end of therapy and a lower likelihood of dropout. Late in treatment, the outcome was worse when therapist ratings of the alliance were higher than those of the patient. Conclusions: Therapist-patient agreement on the strength of the alliance is important for symptom improvement and dropout. The study highlights the importance of understanding the dyadic nature of the alliance and its impact on therapeutic change.
... The dropout rate of 33% during the active phase of therapy is within the range of studies of other cognitive interventions for negative symptoms (e.g., 43% and 25% in Klingberg et al., 2011 and23% in Velligan et al., 2014) and standard MCT (e.g., 26.5% in Briki et al., 2014 and27% in Ochoa et al., 2017). A meta-analysis (Fernandez et al., 2015) of the dropout rate for CBT for various mental health disorders which covered more than 20,000 participants found that the weighted average attrition rate during treatment was 26%. Given that we recruited from a population with chronic and treatment resistant difficulties, this provides a favourable comparison. ...
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Objective Although patients often prioritise the treatment of negative symptoms, few psychological interventions targeting negative symptoms exist. This study attempts to fill this gap by piloting a modified Metacognitive training programme, specifically targeted at negative symptoms (MCT-N), with a group of patients with prominent negative symptoms. Method We adopted a mixed methods case series design, providing detailed quantitative data on changes over time, to focus on potential mechanisms underlying the intervention, in combination with qualitative interviews. Results The intervention showed good feasibility as demonstrated by the attendance rate, the positive feedback from participants and the multidisciplinary team, and the improvements on negative symptoms observed following the intervention. Multilevel modelling showed that depression, internalised stigma, and reflective functioning explained the variance in negative symptoms. Discussion The pilot study indicated that the intervention has high feasibility and that improvements in negative symptoms can be partially explained by improvements on depression, stigma, and reflective functioning.
... Additionally, some studies have reported a reduction in sleep discrepancy and improvement in sleep quality after five to eight sessions of CBTi (Kay et al., 2015;Okajima et al., 2011). Although CBTi is the recommended treatment for insomnia, it can be expensive, and the dropout rate as well as the non-response rate are relatively high (Fernandez et al., 2015). Moreover, limited access to experienced CBTi providers remains a barrier in its implementation (Koffel et al., 2018). ...
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Older adults with poor sleep tend to show a discrepancy between objective and self-reported sleep parameters, which can trigger a vicious cycle that worsens their sleep complaints. Cognitive-behavioral therapy can reduce this bias, but alternative behavioral therapies remain untested. The present exploratory study aimed to investigate the effects of Mindfulness-Based Therapy for Insomnia (MBTI) on reducing sleep discrepancies in comparison with a Sleep Hygiene, Education, and Exercise Program (SHEEP). Older adults were randomly allocated into the MBTI group (n = 55) or SHEEP group (n = 58). Subjective and objective sleep parameters were measured using sleep diaries, polysomnography (PSG), and actigraphy. Sleep discrepancies were calculated using the Bland-Altman method for sleep onset latency (SOL) and wake after sleep onset (WASO). Additionally, correlations between the change in sleep discrepancies and the change in subjective sleep quality and trait mindfulness were measured within each group. SOL discrepancy measured by PSG and actigraphy decreased significantly post-MBTI and SHEEP interventions. In contrast, there was no significant change in WASO discrepancy in either group. The change in SOL discrepancy was correlated with the change in insomnia symptoms and objectively measured trait mindfulness. MBTI was effective in reducing SOL discrepancies and improving sleep perception in older adults with sleep disturbances, which in turn drove improvement in sleep quality and insomnia symptoms. Increases in trait mindfulness may have been an important mechanism in improving sleep perception in the MBTI group.
... Furthermore, a meta-analysis that investigated the dropout rate during individual ACT across 56 randomised controlled trials (RCTs) demonstrated a pooled dropout rate of 16% (Ong et al., 2018). A similar meta-analysis of 115 RCTs of CBT demonstrated a pooled dropout rate of 26.2% during treatment (Fernandez et al., 2015). Considering that the efficacy of group CBT is limited, it may be worth investigating the efficacy of group ACT as a potential alternative to such conventional group approaches since individual ACT may be as effective as individual CBT and the dropout rate for individual ACT may be comparative or lower than individual CBT. ...
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Background A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors. Methods Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomized controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). Results The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30–0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31–0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited. Limitations The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results. Conclusion The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.
... Abb. 1; [17] [4,14]. Unter den Gründen für den vorzeitigen Abbruch der Behandlung wurde für VRET an erster Stelle angegeben, dass die VRET als nicht immersiv genug erlebt wurde. ...
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Background: Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. Methods: Selective literature search in PubMed and Google Scholar. Results: An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. Conclusions: VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.
... In low-intensity or minimal contact (MC) treatments [47] for example, the patient receives a limited number of face-to-face clinic sessions with most skills learned independently using home lessons reinforced through self-study materials. Beyond an efficacy profile equivalent to high intensity CBT for centralized pain disorders [48], MC-CBT advantages include greater patient satisfaction [48], good homework compliance (68%) [48], lower dropout (9% [48] vs 13-26% for traditional CBT [49,50]), rapid onset of action [51], and reduced cost ($348 [52] vs. $715 [53] for traditional CBT). ...
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Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response. Methods UCPPS patients (240) ages 18–70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief. Discussion Empirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine. Trial Registration Clinicaltrials.gov NCT05127616. Registered on 9/19/21.
... It has been suggested that setting up exposure as a behavioral experiment can promote inhibitory learning (Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014). However, attrition rates for CBT in anxiety disorders are high; studies have found that 11-20% of patients drop-out before CBT starts, and another 20-24% drop out during treatment (Bentley et al., 2021;Carpenter et al., 2018;Fernandez, Salem, Swift, & Ramtahal, 2015). ...
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Distressing mental images are common in anxiety disorders and can make it difficult for patients to confront feared situations. This study examined whether imagery rescripting focused on a feared social situation prepares participants to engage in a feared situation. Sixty healthy individuals were asked to formulate a behavioral experiment to test negative beliefs about a social situation they feared. They were assigned to one of two groups: imagery rescripting focused on the feared outcome of the behavioral experiment or no imagery rescripting (i.e., a break). All participants were then asked to complete ratings scales and to conduct the behavioral experiment. Before the behavioral experiment, the imagery rescripting condition, compared to the control condition, showed reduced anticipated probability and severity of the feared outcome, lower anxiety and helplessness levels, and increased willingness to conduct the behavioral experiment. Imagery-based interventions focused on feared outcomes seem promising to prepare anxious individuals to engage in treatment.
... While strong evidence for the use of cognitive behavioral therapy (CBT) to treat depression was found in a review of 106 meta-analyses published between 2000 and 2012 [14], another meta-analysis found that dropout rates from CBT programs were significantly higher in virtual or e-therapy conditions than in treatments provided face-to-face (F2F). Such noncompletion of CBT was more common among people experiencing depression than among those with other mental health challenges [17]. Expeditious advancement of our understandings about the predictors and moderators of the effectiveness of such Internet-based treatments is needed now and likely will still be needed well into the pandemic's aftermath. ...
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Global rates of depression have increased significantly since the beginning of the COVID-19 pandemic. It is unclear how the recent shift of many mental health services to virtual platforms has impacted service users, especially for the male population which are significantly more likely to complete suicide than women. This paper presents the findings of a rapid meta-analytic research synthesis of 17 randomized controlled trials on the relative efficacy of virtual versus traditional face-to-face cognitive behavioral therapy (CBT) in mitigating symptoms of depression. Participants’ aggregated depression scores were compared upon completion of the therapy (posttest) and longest follow-up measurement. The results supported the noninferiority hypothesis indicating that the two modes of CBT delivery are equally efficacious, but the results proved to be significantly heterogeneous indicating the presence of moderating effects. Indirect suggestive evidence was found to support moderation by gender; that is, depressed males may benefit more from virtual CBT. Perhaps, this field’s most telling descriptive finding was that boys/men have been grossly underrepresented in its trials. Future trials ought to oversample those who have been at this field’s margins to advance the next generation of knowledge, allowing us to best serve people of all genders, those who live in poverty, Indigenous, Black, and other Peoples of Colour, as well as any others at risk of being marginalized or oppressed in contemporary mental health care systems.
... It is worth noting that patients have to repeatedly face these stimuli or contexts that they feared during the exposure therapy, which would make them feel every painful during the treatment. There are 11-27% patients who refuse to receive exposure therapy and 15-52% patients who discontinue the therapy before successful intervention because they cannot tolerate the torment during the therapy (Fernandez, Salem, Swift, & Ramtahal, 2015). Therefore, how to improve the acceptability of traditional exposure therapy is an unavoidable problem in clinical practice. ...
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The extinction memory is often at a disadvantage in the competition with the fear memory, which leads to high relapse rate in the intervention of some anxiety disorders. Yet, less is known about the mechanism that fear memory is easier to retain for a long time and easier to generalize to other similar stimuli or contexts than extinction memory. We compared the effects of the traditional extinction protocol (TE-group) and the novel extinction protocol that have a pre-exposure of elements of CS+ prior to extinction training (PECS-group) on enhancing the retention and generalization of extinction memory. The results showed that the second group was able to effectively prevent recurrence compared to the traditional extinction procedure, and could generalize the extinction memory to other stimuli similar to CS+ . These results provide a new approach to improve the traditional exposure therapy and a possible explanation for why fear memory is easier to retain and generalize than extinction memory.
... A large meta-analysis of 115 studies (N = 20 995) examining dropout rates found group CBT to have higher pretreatment dropout rates of 14.5% compared with 9.7% for individual CBT, and a dropout rate of 24.6% during group CBT that was comparable to the rate for individual CBT. 25 High dropout rates occur in both individual and group interventions for depression and anxiety because of the symptoms of the conditions themselves (i.e., those with anxiety disorders often practise avoidance and those with depression often suffer from poor motivation and fatigue). The group setting can be especially anxiety-provoking for individuals with mental health symptoms. ...
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ABSTRACT Background: The total cost of mental health disorders to Canada’s economy is estimated to be more than $50 billion annually. Although evidence supports the use of cognitive-behavioral therapy for depression and anxiety disorders, access to therapy is limited. This is especially the case in the Vancouver Island community of Victoria, where depression and anxiety are prevalent but treatment is difficult to obtain. In 2015 the Cognitive Behavioural Therapy (CBT) Skills Group program was initiated to provide early, destigmatizing, equitable, and timely intervention on a large scale and to enhance collaborative care between psychiatrists and family physicians. Funding was provided by the Shared Care Committee with contributions from the Victoria Division of Family Practice and Island Health. Family physicians were trained by psychiatrists to facilitate the CBT-based training to be delivered in 90-minute group medical visits over 8 consecutive weeks. A referral centre was established and participants were asked to sign up online to join a skills group of 15 members. Methods: Four psychometric scales were used to measure participant depression symptoms, anxiety symptoms, and functional disability: the Patient Health Questionnaire-8 (PHQ-8), the Generalized Anxiety Disorder-7 (GAD-7) scale, the Work and Social Adjustment Scale (WSAS), and the Sheehan Disability Scale (SDS). Participants used these scales to provide preintervention and postintervention self-reports. As well, participants rated the impact of the program and provided qualitative feedback. All participant responses were converted into non-nominal data and analyzed by an external agency (Reichert and Associates). A wait-time analysis was also conducted partway through the project period. Results: From September 2015 to April 2018, a total of 2352 participants registered in 149 CBT skills groups. The majority of participants were female (1820) and their average age was 46 years. More than half of participants attended most sessions. Self-reports were collected from 874 of 1403 participants attending six or more of the eight sessions for a response rate of 62%. Mean symptom scores on psychometric scales for anxiety, depression, and functional disability indicated improvement, with many participants demonstrating a shift from moderate to mild levels of symptom severity (n = 802). The average participant satisfaction rating for the program on a 5-point Likert scale was 4.66. The wait-time analysis showed that approximately three-quarters of participants referred had entered a group within 3 months of referral (628 of 832), and approximately one-quarter entered a group within 1 month of referral (204 of 832). Conclusions: The self-report data analyzed during the project suggest participants in the CBT Skills Group program experienced a reduction in symptoms of depression and anxiety. How­ever, these results must be interpreted cautiously because data were not collected for research purposes but for program quality improvement. A particular challenge encountered during the project was the lack of resources to individually screen and prepare each patient. Consequently, patients who were not a good fit for group CBT delivery (e.g., patients with personality disorder or active trauma symptoms) were occasionally referred. While it may seem costly to use family physicians to facilitate CBT skills groups, the cost of usual care wherein family physicians provide four 20-minute individual appointments ($209.80) was comparable to the per-person cost of the intervention ($197.52), where patients receive 12 hours of physician-led group time, making the skills groups a cost-effective and equitable way to deliver early intervention services. Current limitations in mental health care also make physicians the only viable service providers. Furthermore, having family physicians deliver mental health services may reduce stigma by showing that mental health affects general health and is valued as a vital part of primary care.
... RCTs may have a number of methodological problems and biases, including (1) small sample size (Button et al., 2013;Sakaluk et al., 2019), (2) allegiance bias (Leichsenring et al., 2017;Leykin & DeRubeis, 2009), (3) selective outcome reporting (Bradley et al., 2017;Miguel et al. 2021;Shinohara et al., 2015), (4) the strictness of inclusion or exclusion criteria (Hoertel et al., 2014(Hoertel et al., , 2015Westen et al., 2004;von Wolff et al., 2014), (5) using wait-list as a control group Furukawa et al., 2014;Munder et al., 2019), (6) randomization and blinding problems (Cuijpers et al., 2010;), (7) the exclusion of drop-out participants from the analyses (Cooper & Conklin, 2015;Fernandez et al., 2015), and (8) ignoring psychotherapists' effects (Del Re et al., 2012;Johns et al., 2019;Leichsenring et al., 2017;Owen et al., 2015). These problems can be prevented by applying a rigorous methodology. ...
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Son 10 yıldır psikoloji alanında kendini gösteren ve alanı derinden sarsan tekrarlama krizi, psikolojinin her alt alanını, araştırma bulgularını ve genel kabullerini yeniden değerlendirmesi için harekete geçirmiştir. Klinik psikoloji alanının geç de olsa tekrarlama krizi tartışmalarına katılmaya başladığı görülmektedir. Uzun yıllardır gerçekleştirilen psikoterapi etkililik (efficacy) çalışmaları, klinik psikoloji içindeki başlıca deneysel alanlardan birini oluşturmaktadır. Psikoterapi etkililik çalışmaları çeşitli psikolojik tedavilerin psikolojik rahatsızlıklar üzerindeki etkilerini değerlendirmek için gerçekleştirilmektedir. Tekrarlama krizi bağlamında ortaya çıkan bulgular, psikoterapilerin etkililiklerini değerlendirmek için sıkça kullanılan seçkisiz kontrollü çalışmaların ve bu çalışmaların sonuçlarının toplu olarak değerlendirilmesine yardımcı olan meta-analizlerin pek çok yöntemsel problem ve yanlılık içerdiğini ortaya çıkarmıştır. Seçkisiz kontrollü çalışmalar düşük örneklem sayısı, bağlılık yanlılığı, seçici sonuç raporlama, örnekleme dahil etme ya da dışarıda bırakma kriterlerinin katılığı, kontrol grubu olarak bekleme listesi kullanımı, seçkisizleştirme ve körleştirme sorunları, çalışmayı bırakan katılımcıların analizlere dahil edilmemesi ve psikoterapist etkilerinin ihmal edilmesi gibi problemler ve yanlılıklar içermektedir. Meta-analizler ile ilişkili başlıca sorunlar ise yayın yanlılığı ve düşük kaliteli çalışmaların metaanalizlere dahil edilmesidir. Tüm bu durumlar psikoterapilerin olumlu etkilerini olduğundan daha yüksek gösterirken, edinilen bulguların sağlıklı bir şekilde değerlendirilmesini engellemektedir. Uzun yıllardır gerçekleştirilen çalışmalar, psikoterapilerin çeşitli psikolojik rahatsızlıkların tedavisinde tercih edilebilecek etkili araçlar olduğunu göstermektedir. Ancak dikkat edilmesi gereken iki önemli husus vardır. Bunlardan ilki psikoterapilerin etkililiğini gösteren çalışmaların yöntemsel anlamda güncel bilimsel standartları yakalamakta zorlanmasıdır. İkinci önemli husus ise psikoterapilerin gerçek etkilerinin çalışmalarda bulunan etkilerden daha az olabileceğidir. Bu derleme makalesinin amacı, psikoterapi etkililik çalışmalarını ve meta-analizleri etkileyen yöntemsel problemlere ve onların çözümlerine değinerek klinik psikoloji alanında bu konuda ortaya çıkan farkındalığın arttırılmasına ve gerçekleştirilecek çalışmaların yöntemsel olarak güçlendirilmesine yardımcı olmaktır.
... Despite its efficacy, the uptake of in-person CBT is suboptimal across all ages [12][13][14][15]. In young people, this is due in part to the affordability and availability of trained practitioners, perceived stigma, poor mental health literacy, and a preference for self-reliance [16][17][18]. ...
Article
Background: Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. Objective: This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. Methods: A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. Results: There were 32 manuscripts that met the inclusion criteria, of which 28 (88%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. Conclusions: Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. Trial registration: PROSPERO CRD42020208668; https://tinyurl.com/4bu2yram.
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Introduction Endometriosis can cause chronic pain and subfertility thereby negatively affecting quality of life (QoL). Surgical removal of endometriosis lesions leads to improved health-related QoL, although not to the level of QoL of healthy controls. Pain intensity and cognitions regarding pain can play a crucial role in this health-related QoL following surgical treatment. Cognitive behavioural therapy (CBT) is a psychological treatment. In patients with chronic pain caused by a variety of medical conditions, CBT is effective in improving QoL. We designed a research protocol to investigate the effect of CBT on QoL in patients with endometriosis-associated chronic pain who are undergoing surgery. Methods and analysis This is a study protocol for a randomised controlled trial in which 100 patients, undergoing endometriosis removal surgery due to endometriosis-associated chronic pain, will be randomised between post-surgery usual care with CBT and post-surgery usual care only. Participants in the CBT group will additionally receive seven sessions of CBT, focused on expectancy management, cognitions regarding pain and emotional and behavioural impact of pain. To determine the primary outcome Quality of life, both groups will complete questionnaires assessing QoL. The secondary outcomes pain intensity, pain cognitions, fatigue and perceived stress are also measured using questionnaires. Additionally, a marker for stress (cortisol extracted from a hair sample) will be assessed at T0 (baseline assessment), T1 (post-intervention; 2 weeks after completion of all CBT sessions) and T2 (follow-up; 14 weeks after T1). Statistical analysis will be performed using SPSS software. Ethics and dissemination The study protocol has been approved by the Medical Ethical Committee of the region Arnhem-Nijmegen from the Radboud University Medical Centre on 2 September 2020. The findings of this study will be published in scientific journals and will be presented at scientific conferences. Trial registration number NCT04448366 .
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Background: Because regular visits to distant hospitals may be a burden to patients, both in terms of time and cost, some patients with chronic musculoskeletal pain may discontinue multidisciplinary pain treatment, unable to maintain motivation to attend. Objective: To evaluate and compare the pre-program characteristics of patients who dropped out and patients who continued treatment, thereby clarifying the characteristics of patients at risk of dropping out. Methods: A multidisciplinary pain management treatment program was implemented for patients at the Pain Management Center, Hoshi General Hospital. From April 2015 to March 2018, 23 patients participated in the program. Twelve of the 23 patients lived outside the prefecture where the hospital is located. Of these 12 patients, five completed the program, while seven did not. We compared the dropout and continuation groups in terms of patient characteristics, pain severity, pain-related psychosocial factors, and quality of life. Results: We found significant differences (p< 0.05) in median age, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire walking ability dysfunction score, and Roland-Morris Disability Questionnaire score. Conclusions: The characteristics of patients who dropped out were older age, walking ability dysfunction, and low quality of life associated with low back pain.
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Background Stigma against lesbian, gay, bisexual or queer (LGBQ) people may increase their risk of mental illness and reduce their access to and/or benefit from evidence-based psychological treatments. Little is known about the feasibility, acceptability and effectiveness of adapted psychological interventions for sexual minority individuals in the UK. Aims To describe and evaluate a novel LGBQ Wellbeing group therapy for sexual minority adults experiencing common mental health problems, provided in a UK Improving Access to Psychological Therapies (IAPT) service. Method An eight-session LGBQ Wellbeing group intervention was developed drawing on CBT and LGBQ affirmative principles. We compare the socio-demographic and clinical characteristics of patients who completed and dropped out of the groups, and explore changes in self-reported symptoms of depression, anxiety and functional impairment. Results Over eight courses provided, 78 service-users attended at least one session, of whom 78.2% completed the intervention (drop-out rate 21.8%). Older participants were more likely to drop out. There was a lower proportion of female and bisexual or ethnic/racial minority individuals than would be expected. There were significant reductions in severity of depression, anxiety and functional impairment following the group, and more than half of those who completed the intervention needed no further treatment. Conclusions There was preliminary evidence of the feasibility of, and potential clinical benefit in, a group therapy intervention for sexual minority adults experiencing common mental health problems. Future research should investigate access and outcomes for participants with additional social disadvantage, e.g. those who are female, older, bisexual or ethnic/racial minority.
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Background : Symptoms of anxiety, depression, and emotion dysregulation are common among individuals with MS and their support partners. Dialectical behavior therapy (DBT) – a type of cognitive behavioral intervention – may be a promising treatment for individuals affected by MS. This pilot randomized controlled trial (RCT) assessed the effects and feasibility of remotely delivered DBT skills on anxiety and depression symptoms and emotion dysregulation in individuals with MS and their support partners. Methods : This study featured a single-masked, two-arm, parallel group design. Twenty pairs of individuals with MS and their support partners (n = 40) were randomized to 12 weeks of DBT or facilitated peer support (FPS). Masked assessments were completed at weeks 0 (baseline), 13 (post-intervention), and 26 (follow-up). Results : At post-intervention (primary endpoint), participants randomized to DBT exhibited significantly greater reductions in anxiety and depression symptoms compared to FPS (B = 4.45, p = .04, Cohen's d = 0.57). Secondary outcomes of emotion dysregulation and well-being favored the DBT group but did not reach statistical significance (ds = 0.51, ps = .07). Effects were not maintained at follow-up. Most (86%) individuals screened were eligible for the trial, and retention (70%) did not differ between study arms. Conclusions : This pilot RCT provides encouraging evidence that DBT skills is feasible and may improve depression, anxiety, and emotion dysregulation for individuals with MS and their support partners. Future research is needed to optimize maintenance of DBT skills, investigate mechanisms for these improvements, and replicate these promising effects in a fully powered trial.
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Background: A cystic fibrosis-specific cognitive-behavioral therapy intervention (CF-CBT) was developed in partnership with the CF community to advance preventive mental health care. Multidisciplinary providers across 3 centers were trained to deliver CF-CBT for this pilot assessing feasibility/acceptability and preliminary effectiveness of an integrated model of care. Methods: The 8-session CF-CBT was delivered to 14 adults with mild depression and/or anxiety symptoms in-person and via audio telehealth. Assessment of attrition, engagement, homework completion, treatment satisfaction, and treatment fidelity informed feasibility/acceptability assessment. Mental health outcomes included depression, anxiety, quality of life (CFQ-R), perceived stress and coping. Preliminary effectiveness was evaluated with Cohen's d metric of effect sizes (ES) of pre-post mean change scores. Results: A total of 108 sessions were conducted; 13 adults completed the intervention; 1 discontinued early. Engagement, homework completion, and treatment acceptability were highly rated (mean=30; SD=2, range 27-32 on a 32-point scale). Fidelity scores ranged from 85.7% to 93.6%. Large ES changes reflected improvements in depressive symptoms (-0.83), CFQ-R (Vitality scale; 1.11), and Relaxation Skills (0.93); moderate ES for CFQ-R Role Functioning (0.63), Awareness of Tension (0.62), Coping Confidence (0.70) and CF-Specific Coping (0.55); and small ES for anxiety symptoms (-0.22), perceived stress (-0.25), Behavioral Activation (0.29), and several CFQ-R domains, including Emotional Functioning (0.29). Two CFQ-R subscales decreased (Body Image, Eating Concerns). Conclusions: Results indicated feasibility and acceptability of CF-CBT and its integration into team-based CF care with promising effectiveness, especially for depression. A multi-center RCT of CF-CBT will further examine effectiveness of a CF-specific integrated care model. This article is protected by copyright. All rights reserved.
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Background: A feasibility randomised-controlled trial found that a cognitive-behavioural therapy intervention for renal fatigue has the potential to reduce fatigue in patients receiving haemodialysis, but uptake was low. Objectives: Nested in the randomised-controlled trial (RC) qualitative interviews were undertaken to understand the acceptability of renal fatigue, the facilitators of, and barriers to, engagement, and the psychosocial processes of change. Design: The trial included 24 participants at baseline. Semi-structured interviews were conducted with nine participants from the intervention arm (n = 12). Approach Interviews were carried out immediately following treatment (3 months post-randomisation). Data were analysed using inductive thematic analysis. Findings: Five main themes were formulated. The overarching theme was a sense of coherence (whether the illness, symptoms and treatment made sense to individuals), which appeared to be central to acceptability and engagement. Two themes captured the key barriers and facilitators to engagement, cognitive and illness/treatment burdens and collaboration with the therapist. Participants described changes related to their activity, thoughts and social identity/interactions, which shaped perceptions of change in fatigue. Lastly, participants discussed the optimal delivery of the intervention. Conclusions: This study revealed the importance of patients' understanding of fatigue and acceptance of the treatment model for the acceptability of and engagement with a cognitive-behavioural therapy-based intervention for fatigue. Overall, there was an indication that such an intervention is acceptable to patients and the mechanisms of change align with the proposed biopsychosocial model of fatigue. However, it needs to be delivered in a way that is appealing and practical to patients, acknowledging the illness and treatment burdens.
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Previous studies suggest that excessive attention to speech motor control may lead to inappropriate coping behaviors and clinical distress for adults who stutter. However, when combined with psychological-based approaches, such as cognitive behavioral therapy (CBT), it is possible that these behaviors and distress could be effectively alleviated. This study investigated whether group CBT, with a specific focus on decreasing the excessive attention to speech motor control, could reduce stuttering frequency as well as the psychological and behavioral difficulties associated with stuttering. A group CBT training program for adolescents and adults who stutter was conducted over the course of five weeks. Forty-eight adolescents and adults who stutter participated in eleven groups. Changes in stuttering frequency and self-reported outcomes (questionnaire scores) from the baseline (pre-intervention) were investigated immediately post-intervention and six months post-intervention. Results show that stuttering frequency was significantly reduced after interven- tion. Additionally, some questionnaire scores, including those on overall impact of stuttering, social anxiety, and coping behaviors, showed significant improvement both immediately post-intervention and six months post-intervention. Therefore, it is suggested that group CBT focusing on the reduction of excessive attention to speech motor control is effective in reducing stuttering frequency as well as the psychological and behavioral difficulties associated with stuttering. 吃音のある成人では,発話運動制御に過度に注意が向くことが不適切な対処行動を引き起こし,臨床的な困難につながるという仮説があり,認知行動療法などの心理・行動面での支援が効果的であると考えられる。本研究は,発話運動制御に対する過度な注意を弱める認知行動療法が,吃音中核症状頻度,心理・行動面での困難の緩和につながるかを調べることを目的とした。吃音のある成人48名が参加し,介入前・後での吃音頻度(吃音検査法・フリースピーチ; 主要アウトカム)・質問紙得点(副次アウトカム)の変化と,介入6ヶ月後での質問紙得点の変化を調べた。その結果,吃音頻度は,吃音検査法とフリースピーチ共に有意に減少し,一部の質問紙得点は,介入前に比べて介入6ヶ月後でも有意な改善を示していた。発話運動制御に対する過度な注意を弱める認知行動療法は,吃音頻度の減少に加え,長期的な心理・行動面の困難の緩和にもつながり得ると考えられた。
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Objective: The literature regarding dropout from psychotherapy has suffered from issues of diverse operationalization of the construct. Some have called for a more uniform definition to aid in generalization across research; this study aimed to assess the viability of such a definition by examining the rate of occurrence for three distinct definitions simultaneously. In addition, therapist and center level variances are explored to further understand the differences between definitions. Method: We compared the prevalence rates and overlap of three distinct operationalizations of dropout (based on last session attendance, therapist judgment, and symptom change) using data gathered from a national practice research network (N = 2977). Higher-order therapist and center-level effects were assessed for each definition. Results: There was very little overlap among definitions, with less than one percent of clients simultaneously meeting criteria for all three definitions. Additionally, therapist and center effects were found for each definition, especially notable for therapist-rated and last-session attendance definitions of dropout. Conclusion: Rather than a singular definition of dropout, these results instead suggest that multiple, specific, and unique definitions more accurately depict clinical reality, and future research might benefit from uncovering predictors of different "classes" of dropouts and examining the different practices of therapists and centers.
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The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms. Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session. Large treatment effects were observed for depression (CES-D: d=0.99, p<.001; PHQ-9: d=0.87, p=.002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d=0.88-0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p=.289), or only exhibited statistical tendencies (p=.049 to .071). Client satisfaction, system usability, and treatment adherence were high. Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.
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Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) and have been disseminated throughout the U.S. Veterans Health Administration. Treatment non-completion is common and lessens clinical effectiveness; however, prior work has failed to identify factors consistently associated with non-completion. Semi-structured interviews were conducted with a national sample of veterans who recently completed (n = 60) or did not complete (n = 66) PE or CPT. Non-completer interviews focused on factors that contributed to veterans' decisions to drop out and efforts undertaken to complete PE/CPT. Completer interviews focused on challenges faced in completing treatment and facilitators of completion. Transcripts were coded using a mixed deductive/inductive approach; constant comparison was used to identify differences between completers and non-completers. Completers and non-completers differed in the extent of treatment-specific therapist support received, therapists’ flexibility in treatment delivery, the type of encouragement offered by the care team and social supports, their interpretation of symptom worsening, the perceived impact of treatment on functioning, and the impact of stressors on their treatment engagement. Treatment-specific therapist support, more patient-centered and flexible treatment delivery, leveraging the full care team, and addressing functional concerns are potential targets for PE and CPT engagement interventions.
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Trauma‐focused psychotherapies, such as prolonged exposure (PE), are strongly recommended to treat posttraumatic stress disorder due to their effects in reducing symptoms. However, such therapies may also suffer from high dropout rates. To investigate how clients might benefit from trauma‐focused therapy while minimizing dropout, we conducted a meta‐analysis of 1,508 adults from 35 randomized controlled trials (RCTs) of outpatient PE programs to evaluate treatment frequency as a predictor of dropout. When an RCT prescribed PE sessions at least twice weekly compared to less frequently, the dropout rate was significantly lower at 21.0%, 95% CI [13.9%, 30.4%], compared to 34.0%, 95% CI [28.9%, 39.4%], OR = 0.52, 95% CI [0.30, 0.89], p = .018. It was not possible to draw causal conclusions, as only one RCT compared two PE treatment frequencies head‐to‐head. Nonetheless, the findings remained significant after controlling for study characteristics. These data invite reconsideration of the common practice of weekly psychotherapy in favor of twice‐weekly sessions in standard outpatient treatment.
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Background: Insomnia in depression is common and difficult to resolve. Unresolved depression-related sleep disturbances increase risk of relapse at high costs for individuals and society. Trials have suggested music for insomnia in various populations, but there is little research on the effectiveness of music for depression-related insomnia. Methods: We examined the efficacy of a music intervention on insomnia, depression symptoms and quality of life in adults with depression-related insomnia. A two-armed randomized controlled trial was conducted, including depression outpatients with insomnia (n = 112) in a 1:1 ratio to music intervention and waitlist control group. The intervention group listened to music at bedtime for 4 weeks. Participants received treatment as usual during 8 weeks with assessments at baseline, at 4 and 8 weeks. The primary outcome measure was Pittsburgh Sleep Quality Index (PSQI), secondary outcomes comprised Actigraphy, the Hamilton Depression Rating Scale (HAMD-17) and World Health Organisation well-being questionnaires (WHO-5, WHOQOL-BREF). Results: The music intervention group experienced significant improvements in sleep quality and well-being at 4 weeks according to global PSQI scores (effect size = -2.1, 95%CI -3.3; -0.9) and WHO-5 scores (effect size 8.4, 95%CI 2.7;14.0). At 8 weeks, i.e. 4 weeks after termination of the music intervention, the improvement in global PSQI scores had decreased (effect size = -0.1, 95%CI -1.3; 1.1). Actigraphy sleep assessments showed no changes and there was no detection of change in depression symptoms. Conclusions: Music intervention is suggested as a safe and moderately effective sleep aid in depression-related insomnia. Trial registration: Clinicaltrials.gov. ID NCT03676491.
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Background Animal and clinical studies suggest a link between inflammation and oxidative stress. Because oxidative stress is an inherent part of inflammation, and inflammation is associated with behavioral aggression in lower mammals and humans, we hypothesized that markers of oxidative stress would be related to aggression in human subjects. In this case-control study, markers of oxidative stress and aggression were assessed in human subjects with histories of recurrent, problematic, impulsive aggressive behavior and in nonaggressive comparator subjects. Methods Plasma levels of 8-hydroxy-2?-deoxyguanosine and 8-isoprostane were examined in the context of measures of aggression and impulsivity in physically healthy subjects with intermittent explosive disorder (n = 69), nonaggressive subjects with Axis I or II disorders (n = 61), and nonaggressive subjects with no history of Axis I or II disorders (n = 67). Results Levels of plasma 8-hydroxy-2?-deoxyguanosine and 8-isoprostane were significantly higher in subjects with intermittent explosive disorder compared with psychiatric or normal control subjects. In addition, both oxidative stress markers correlated with a composite measure of aggression; more specifically, 8-hydroxy-2?-deoxyguanosine correlated with measures reflecting a history of actual aggressive behavior in all subjects. Conclusions These data suggest a positive relationship between plasma markers of oxidative stress and aggression in human subjects. This finding adds to the complex picture of the central neuromodulatory role of aggression in human subjects.
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Affective disturbance is a central feature of bipolar disorder. Many investigators have hypothesized that euthymic people with bipolar disorder might display elevated emotional reactivity, but laboratory studies of emotional reactivity have had mixed results. Drawing on theories of bipolar disorder that emphasize dysregulation of goal pursuit, we hypothesized that people with bipolar disorder might be emotionally hyperreactive to frustration of goal pursuit. Forty-seven euthymic participants with bipolar disorder and 43 control participants played a computer game for a monetary reward. To induce frustration, we programmed the game to respond inconsistently to user input during two periods. The frustration induction was successful as measured by self-report, physiological responding, and facial behavior, but contrary to the hypothesis of emotional hyperreactivity in bipolar disorder, the bipolar and control groups were equally reactive to frustration. Future studies will benefit from more specific hypotheses about how emotion might be altered in bipolar disorder.
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Many psychiatric disorders are widely thought to involve problematic patterns of emotional reactivity and emotion regulation. Unfortunately, it has proven far easier to assert the centrality of “emotion dysregulation” than to rigorously document the ways in which individuals with various forms of psychopathology differ from healthy individuals in their patterns of emotional reactivity and emotion regulation. In the first section of this article, we define emotion and emotion regulation. In the second and third sections, we present a simple framework for examining emotion and emotion regulation in psychopathology. In the fourth section, we conclude by highlighting important challenges and opportunities in assessing and treating disorders that involve problematic patterns of emotion and emotion regulation.
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Aims and method The evidence of the efficacy of cognitive-behavioural interventions is well established. Despite this, clinicians often face a consistent number of not attended appointments or early treatment discontinuation rates. This paper reviews the literature to date regarding the possible causes of early termination of cognitive-behavioural interventions. A literature search was done using Medline, PsycINFO, Embase and the Cochrane Library. Results We reviewed 14 articles. Out of these, two were randomised controlled trials, one was a controlled trial and the rest were cohort studies. Drop-out was defined differently across papers. There are many factors that may affect early treatment discontinuation rates and they are described individually. Clinical implications There does not appear to be a single strong predictor of early treatment discontinuation. Specific literature relating to cognitive-behavioural therapy is scarce. However, some factors such as young age, education level and psychopathology appear to be more strongly associated with early treatment discontinuation than others.
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Background Previous research has shown that cognitive- behavioral group therapy (group CBT) is an effective treatment for depression. However, the effectiveness of this approach in routine care needs more research. The current study retrospectively examines the outcomes of patients who received group CBT for depression at a psychiatric outpatient clinic between 2003 and 2013.Methods Based on patient records, 143 patients were identified as having received the treatment, and 88 patients were included in the outcome analyses. The Beck Depression Inventory (BDI-II) score was the main outcome measure.ResultsThe dropout rate was 17.5%. The average BDI-II score decreased from 28.5 to 18.5 from pre-treatment to post-treatment and remained stable at 3-months follow-up. The effect sizes at post-treatment and follow-up were large (d¿=¿.97 and d¿=¿1.10, respectively). At post-treatment, 44% of the patients showed a significant improvement in depression, including 30% who recovered; at follow-up, the proportions increased to 57% and 40%, respectively. No predictors of dropout or treatment response were found.Conclusions Group CBT for depression can be delivered in routine care settings with good results. However, there are still many patients who drop out or do not benefit from treatment.
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The present study generated normative data for anger in a forensic sample in comparison to a non-forensic sample. The former sample comprised 125 incarcerated adults from an adult detention center in a large metropolitan city and the latter consisted of 182 adult patrons of a public library within the same city. Anger was assessed using the Anger Parameters Scale which taps into five parameters: Frequency, Duration, Intensity, Latency, and Threshold. Significant differences were found between both samples on three of the five parameters: incarcerated individuals experienced anger more frequently, more intensely, and for longer periods of time than participants within the non-forensic sample. These findings indicate that certain specific aspects of anger experience require greater clinical attention when treating detainees. The modest but nonsignificant gender differences across these five parameters is consistent with previous research, thus making it appropriate for treatment to target the same parameters of anger in male and female detainees.
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Response inhibition, defined as the ability to withhold a response, is considered to be a core deficit in various mental illnesses. Measures of response inhibition have been used to define functional deficits, as markers of genetic risk, in neuroimaging studies, and for diagnostic purposes in these disorders. However, the magnitude of the deficit across psychopathologies has not been systematically assessed. We conducted a systematic review and meta-analysis of performance on commonly used measures of the ability to withhold a response: go/no-go task, Conners' continuous performance task (CCPT), and sustained attention to response task (SART). The primary variable of interest in each of these tasks was commission errors (CE), which provides an index of one's ability to correctly withhold a response. In addition, we examined omission errors (OE) which are an index of sustained attention; and mean reaction time (RT; MRT). Three-hundred and 18 studies in 11 different psychiatric disorders met inclusion criteria. Weighted mean effect sizes (ESs) were calculated to measure the magnitude of the deficit. In general, we found low-to-medium ESs for commission errors ranging from g = -0.10 for anxiety disorder to medium ESs of g = 0.52 for bipolar disorder. Small-to-medium deficits in withholding were found in various disorders. Results indicate that deficits in withholding are insufficiently sensitive or specific to be used individually as a diagnostic measure or biomarker in most disorders. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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This study compared a 9-week individualised Cognitive Behaviour Therapy (CBT) programme for people with epilepsy (PWE), with a wait-list control. Fifty-nine PWE were randomised and 45 (75%) completed post-treatment outcomes. People with lower quality of life (QoL), particularly for cognitive functioning, were more likely to drop out. Analyses based on treatment completers demonstrated significant improvements on the Neurological Depressive Disorders Inventory for Epilepsy (p = .045) and Hospital Anxiety Depression Scale-Depression subscale (p = .048). Importantly, CBT significantly reduced the likelihood of clinical depressive symptoms (p = .014) and suicidal ideation (p = .005). Improvements were not observed for anxiety, QoL or maintained overtime for depression. Results suggest that CBT was effective, however, and could be improved to increase patient retention and long-term outcomes.
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