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A cognitive-behavioural therapy assessment model for use in everyday clinical practice
Abstract
Cognitive–behavioural therapy (CBT) is a shortterm, problem-focused psychosocial intervention. Evidence from randomised controlled trials and metaanalyses shows that it is an effective intervention for depression, panic disorder, generalised anxiety and obsessive–compulsive disorder (Department of Health, 2001). Increasing evidence indicates its usefulness in a growing range of other psychiatric disorders such as health anxiety/hypochondriasis, social phobia, schizophrenia and bipolar disorders. CBT is also of proven benefit to patients who attend psychiatric clinics (Paykel et al , 1999). The model is fully compatible with the use of medication, and studies examining depression have tended to confirm that CBT used together with antidepressant medication is more effective than either treatment alone (Blackburn et al , 1981) and that CBT treatment may lead to a reduction in future relapse (Evans et al , 1992). Generic CBT skills provide a readily accessible model for patient assessment and management and can usefully inform general clinical skills in everyday practice.
... Die Gefräßigkeit wird vom Heiligen Gregorius als letzte gesetzt und sie wird mit dem Wort "Uterus (ςτϋρα)" 32 verglichen, weil er damit deutlich machen will, daß die Gefräßigkeit zwar ein natürliches Ereignis ist, wie die Geburt des Menschen aus dem Uterus der Frau, aber auch zugleich an der Spitze der körperlichen und anderen Abhängigkeiten steht. Trotzdem glaubt er nicht, daß die Gefräßigkeit eine einzelne natürliche Situation (....ἔμφυτον ἡμῖν οὗςαν...) 33 ist, aber er includiert auch die beiden vorigen Leidenschaften, worüber er an einer anderen Stelle notiert, daß diejenigen "...Leiden, die einen 26 Idem, (4, 102, 24-25) 27 Idem, (4, 102, 24-25) 28 Idem, (4, 102, 24-25) 29 Idem, (4, 102, 24-25) 30 (4,104,(30)(31)(32)(33)(34)(35) 31 Idem, (4,104,(30)(31)(32)(33)(34)(35) 32 Idem, (4, 104, 30-35) 33 Idem, (4,104,(30)(31)(32)(33)(34)(35) freiausgesuchten und natürlichen Ursprung haben...viel leichter -für jemanden -verlaßt zu werden sind (...τῶν ἀπὸ φύςεωσ ἐχόντων τὴν ἀρχὴν παθῶν...εὐαπαλλακτότερα εἰςι...τὰ ἐκ προαιρϋςεωσ)" 34 , man muß nur allmählich versuchen, sich von diesen zu befreien. "Schwer zu beseitigen (Δυςαπόβλητα)" 35 sind die Leidenschaften die von der "Geldliebe (φιλαργυρύα)" 36 augehen, weil sie wegen "-unserer -Ungläubigkeit (τῆσ ἀπιςτύασἡμῶν)" 37 mit der göttlichen Vorsehung (...τῆσ τοῦ Θεοῦ προνούασ) 38 zweiter Art entsteht, wenn das Libido, das vorher in äußeren Liebesgegenständen -z. ...
... Die Gefräßigkeit wird vom Heiligen Gregorius als letzte gesetzt und sie wird mit dem Wort "Uterus (ςτϋρα)" 32 verglichen, weil er damit deutlich machen will, daß die Gefräßigkeit zwar ein natürliches Ereignis ist, wie die Geburt des Menschen aus dem Uterus der Frau, aber auch zugleich an der Spitze der körperlichen und anderen Abhängigkeiten steht. Trotzdem glaubt er nicht, daß die Gefräßigkeit eine einzelne natürliche Situation (....ἔμφυτον ἡμῖν οὗςαν...) 33 ist, aber er includiert auch die beiden vorigen Leidenschaften, worüber er an einer anderen Stelle notiert, daß diejenigen "...Leiden, die einen 26 Idem, (4, 102, 24-25) 27 Idem, (4, 102, 24-25) 28 Idem, (4, 102, 24-25) 29 Idem, (4, 102, 24-25) 30 (4,104,(30)(31)(32)(33)(34)(35) 31 Idem, (4,104,(30)(31)(32)(33)(34)(35) 32 Idem, (4, 104, 30-35) 33 Idem, (4,104,(30)(31)(32)(33)(34)(35) freiausgesuchten und natürlichen Ursprung haben...viel leichter -für jemanden -verlaßt zu werden sind (...τῶν ἀπὸ φύςεωσ ἐχόντων τὴν ἀρχὴν παθῶν...εὐαπαλλακτότερα εἰςι...τὰ ἐκ προαιρϋςεωσ)" 34 , man muß nur allmählich versuchen, sich von diesen zu befreien. "Schwer zu beseitigen (Δυςαπόβλητα)" 35 sind die Leidenschaften die von der "Geldliebe (φιλαργυρύα)" 36 augehen, weil sie wegen "-unserer -Ungläubigkeit (τῆσ ἀπιςτύασἡμῶν)" 37 mit der göttlichen Vorsehung (...τῆσ τοῦ Θεοῦ προνούασ) 38 zweiter Art entsteht, wenn das Libido, das vorher in äußeren Liebesgegenständen -z. ...
... Die Gefräßigkeit wird vom Heiligen Gregorius als letzte gesetzt und sie wird mit dem Wort "Uterus (ςτϋρα)" 32 verglichen, weil er damit deutlich machen will, daß die Gefräßigkeit zwar ein natürliches Ereignis ist, wie die Geburt des Menschen aus dem Uterus der Frau, aber auch zugleich an der Spitze der körperlichen und anderen Abhängigkeiten steht. Trotzdem glaubt er nicht, daß die Gefräßigkeit eine einzelne natürliche Situation (....ἔμφυτον ἡμῖν οὗςαν...) 33 ist, aber er includiert auch die beiden vorigen Leidenschaften, worüber er an einer anderen Stelle notiert, daß diejenigen "...Leiden, die einen 26 Idem, (4, 102, 24-25) 27 Idem, (4, 102, 24-25) 28 Idem, (4, 102, 24-25) 29 Idem, (4, 102, 24-25) 30 (4,104,(30)(31)(32)(33)(34)(35) 31 Idem, (4,104,(30)(31)(32)(33)(34)(35) 32 Idem, (4, 104, 30-35) 33 Idem, (4,104,(30)(31)(32)(33)(34)(35) freiausgesuchten und natürlichen Ursprung haben...viel leichter -für jemanden -verlaßt zu werden sind (...τῶν ἀπὸ φύςεωσ ἐχόντων τὴν ἀρχὴν παθῶν...εὐαπαλλακτότερα εἰςι...τὰ ἐκ προαιρϋςεωσ)" 34 , man muß nur allmählich versuchen, sich von diesen zu befreien. "Schwer zu beseitigen (Δυςαπόβλητα)" 35 sind die Leidenschaften die von der "Geldliebe (φιλαργυρύα)" 36 augehen, weil sie wegen "-unserer -Ungläubigkeit (τῆσ ἀπιςτύασἡμῶν)" 37 mit der göttlichen Vorsehung (...τῆσ τοῦ Θεοῦ προνούασ) 38 zweiter Art entsteht, wenn das Libido, das vorher in äußeren Liebesgegenständen -z. ...
As the reader can understand from the title, the present paper will deal with the topic of cognitive-behavioural psychology of religion in two parts: 1. The first part will examine St Gregory Palamas's writing on Passions and Virtues in a comparative study to Sigmund Freud's writings. 2. The second part will present and discuss psychological ideas coming out of Saint Gregory's writings in relation to the topic of cognitive-behavioural psychology of religion. The first part will be presented and discussed in German; the second part will be presented and discussed in English. The reason is I intend to engage readers in studying my paper either through German and/or English. In this way, the topic of cognitive-behavioural psychology of religion that I introduce wishes to make sound and clear that the Fathers of the Church through their writings are contributing to a spiritual and academic framework that preoccupies both with human psychology and modern scientific strands, one of which is the above topic. In the second part, there will be discussed St Gregory Palamas's cognitive-behavioural psychology of religion under the empirical findings of modern psychology. Not all works of St Gregory Palamas will be presented and discussed in this paper. Same writing, as above, will be considered so the topic of cognitive-behavioural psychology of religion to be explored in an interdisciplinary comparison. Finally, the integration I am looking to pursue is that of the Fathers of the Church interdisciplinary salience to issues and endeavours entertained by modern scientific psychology. Keywords: Cognitive-behavioural psychology of religion, faulty cognitive appraisals, passions and virtues in a cognitive perspective. First Part Wer die Schriften der Kirchenväter studiert, stellt sich dabei fest, daß solche Texte eine außerordentlich große
... Moreover, although behavioral problems during dental procedures are a characteristic feature of dental anxiety, they may be related to other disorders such as dental phobia [12]. On the other hand, according to the 5-component model of anxiety, different aspects of dental anxiety include a person's undesirable thoughts, feelings, physical symptoms, behaviors, and situational factors (such as parental anxiety) [12,13]; that is why the questionnaires that only focus on one component of dental anxiety are not useful for this purpose [13]. ...
... Moreover, although behavioral problems during dental procedures are a characteristic feature of dental anxiety, they may be related to other disorders such as dental phobia [12]. On the other hand, according to the 5-component model of anxiety, different aspects of dental anxiety include a person's undesirable thoughts, feelings, physical symptoms, behaviors, and situational factors (such as parental anxiety) [12,13]; that is why the questionnaires that only focus on one component of dental anxiety are not useful for this purpose [13]. ...
... In general, there are three ways to assess a child's behavior and anxiety, including direct observation of behavioral responses in the dental field by the therapist or researcher, completion of a questionnaire by parents, and personal reports completed by the child [13,14]. Clinical observation alone is not reliable because there is a moderate to weak agreement between dentist scoring compared to child scoring for anxiety [14]. ...
Objectives: Dental anxiety is a common phenomenon experienced by children in the dental setting. However, there is limited research on the effectiveness of cognitive-behavioral interventions in managing this anxiety. Therefore, the aim of this study was to evaluate the impact of a cognitive-behavioral psychologic intervention on dental anxiety in children.
Materials and Methods: A total of thirty children, aged 7-10 years, underwent prophylaxis and fluoride therapy. The baseline anxiety levels of the children were determined using the Modified Child Dental Anxiety Scale (MCDAS). The intervention group (N=15) received two 30-minute sessions of cognitive-behavioral exercises. Additionally, a short film demonstrating a cooperative child undergoing pulpotomy was created and parents were instructed to show it to their children at home. During the treatment session, the exercises were reinforced at each step, and the MCDAS questionnaire was administered again. The children’s behavior was also assessed using the Venham Clinical Cooperation Scale. Independent t-test, Mann-Whitney, chi-square, and Pearson’s correlation coefficient were used for statistical analysis and P
... A network analysis recently determined that such upward social comparisons play a bridging role between frequency of social media use and symptoms of anxiety, depression, and stress (Faelens et al., 2019). Warrender and Milne (2020) recently applied Williams and Garland's (2002) five systems cognitive-behavioural therapy model to explain how mental health problems are initiated and maintained through interactions between looking at social media (comparing self with others) and thoughts (e.g., other people are better than me), feelings (e.g., envy), behaviours (e.g., spending time on social media, problematic use), and physical sensations (e.g., sleeplessness). From a psycho-behavioural perspective, the five systems model suggests that clustering variables should not only assess time, frequency, and problematic use, but also variables that assess the valence of emotional responses to social media and interactions with other users. ...
... Both studies included time, frequency, and problematic social media use as clustering variables, but the other clustering variables differed. Shensa and colleagues also included intensity (daily integration) and multiple platforms, whereas the current study added indicators that were informed by Warrender and Milne's (2020) application of the Five Systems Model (Williams & Garland, 2002). This model posits that comparing oneself to others on social media interacts with behaviours, thoughts, and feelings to predict mental health problems. ...
... Using a continuous variable to assess time spent on social media may also return more accurate results. Fourth, it may be worthwhile to include physical sensations as an additional social media use indicator, as suggested by the Five Systems Model (Warrender & Milne, 2020;Williams & Garland, 2002). Finally, this study did not control for the possible contributions of the COVID-19 pandemic to social media behaviours and levels of anxiety and depression symptoms. ...
This study identified patterns of social media use, examined their relationships with anxiety and depression, and investigated whether levels of self-compassion moderated these relationships. Three-hundred university students who used social media (Mage = 34.90, SD = 11.19, 77.3% female) completed an online survey. Variables that assessed time spent on social media, frequency of use, problematic social media use, fear of missing out, emotional responses to using social media, and perceptions of online interactions were subjected to a two-step cluster analysis. Four distinct social media use profiles emerged: Problem Users, Disenchanted Dabblers, Moderate Users, and Contented Dabblers. ANOVAs revealed that Problem Users reported higher mean levels of anxiety and depression than did the other three groups. However, subsequent moderation analyses found that self-compassion buffered these relationships, with highly self-compassionate Problem Users reporting similar levels of anxiety and depression to the other profile groups. These findings suggest that self-compassion may protect vulnerable social media users against anxiety and depression. Implications of the findings are discussed.
... The Children's Experiences of Dental Anxiety Measure (CEDAM- 14) was therefore developed as a child-centred measure of dental anxiety [2] for children aged 9-16 years. It was derived from interviews with children [3] and based on a Cognitive Behaviour Therapy (CBT) assessment model of dental anxiety [4]. The CEDAM-14 includes items designed to assess the behavioural, cognitive and physical symptoms/feelings that maintain children's dental anxiety (e.g., lack of perceived control, low levels of trust, behavioural avoidance), which could be discussed with the patient and addressed in order to effectively manage the individual's anxiety. ...
... The original CEDAM measure (CEDAM-14) was developed with children and was based on a CBT assessment model of dental anxiety with the aim of assessing experiences/symptoms which influence and maintain children's dental anxiety over time [2,4]. The original CEDAM measure was unidimensional but included a broad range of experiences based on the CBT model used [4], such as unhelpful thoughts, behaviours and physical symptoms/feelings. ...
... The original CEDAM measure (CEDAM-14) was developed with children and was based on a CBT assessment model of dental anxiety with the aim of assessing experiences/symptoms which influence and maintain children's dental anxiety over time [2,4]. The original CEDAM measure was unidimensional but included a broad range of experiences based on the CBT model used [4], such as unhelpful thoughts, behaviours and physical symptoms/feelings. Short forms can broaden the application of a measure by reducing the amount of time and costs associated with assessment and the risk of missing items [8,21]. ...
Background: The Children’s Experiences of Dental Anxiety Measure (CEDAM-14) is a child-centred measure of dental anxiety which assesses a range of behaviours, thoughts and feelings/physical symptoms related to dental anxiety. A short form of the CEDAM-14, which places less time burden on patients and clinicians, could promote the feasibility and applicability of the CEDAM in clinical settings. The aim of the study was to develop a short version of the CEDAM that can be used to assess children’s dental anxiety in clinical practice. Methods: A short version of the CEDAM was developed using a combination of item impact and regression methods. Measurement properties including floor/ceiling effects, variance, criterion validity, construct validity and internal consistency was calculated for the short form. Results: An eight-item CEDAM short form was developed (CEDAM-8) that had good psychometric properties, was significantly correlated with the CEDAM measure (r = 0.90; p < 0.01), had minimal floor and ceiling effects (3.5% and 1.2%, respectively) and was sensitive to change. Conclusion: The CEDAM-8 is a useful assessment tool for clinicians that is easy and quick to administer and could help to understand children’s experiences of dental anxiety and changes in anxiety over time and following intervention.
... Dental anxiety can be measured by selfreport instruments [7] Different measures, presenting strengths and limitations [14], have been developed over the years. The Children's Experiences of Dental Anxiety Measure (CEDAM) was developed according to an established cognitive behavioral clinical evaluation model [15] to measure the negative cognitive e emotional aspects of the preoccupation in children [7]. The use of this instrument follows a holistic approach that assesses how much the aforementioned situations contribute to the onset and persistence of anxiety [7,15]. ...
... The Children's Experiences of Dental Anxiety Measure (CEDAM) was developed according to an established cognitive behavioral clinical evaluation model [15] to measure the negative cognitive e emotional aspects of the preoccupation in children [7]. The use of this instrument follows a holistic approach that assesses how much the aforementioned situations contribute to the onset and persistence of anxiety [7,15]. ...
Objective: The Children’s Experiences of Dental Anxiety Measure (CEDAM) was originally developed in English to assess important aspects of dental anxiety for children. The aims of the study were to translate and perform the cultural adaptation of the CEDAM to Brazilian Portuguese. Material and Methods: The CEDAM consists of 14 items, measured by a Likert scale of 3 points, that indicates the intensity of dental anxiety. The questionnaire was translated to Brazilian Portuguese, back-translated to English, reviewed by an Expert Committee and pretested in 10 eight- to twelve-year-old schoolchildren. Results: The Expert Committee Review compared the original, translated (T1, T2) and back-translated (BT1, BT2) versions and recommended some changes in order to achieve good understanding of the items. In the pretest, only question 8 was misunderstood by one child, i.e., the translated version was wellunderstood by more than 85% of the participants. Conclusion: The Brazilian CEDAM was culturally adapted for the evaluated population of children. KEYWORDS Child; Dental anxiety; Pediatric dentistry; Surveys and questionnaires; Translating.
... This study utilises the Williams and Garland Five Areas Assessment Model (Williams & Garland, 2002) and the Media System Dependency Theory (Ball-Rokeach & DeFleur, 1976). The improved model is able to justify the negative effects of social media on teenagers by examining the five systems (Situation, Thoughts, Feelings, Behaviors and Physical Sensation) which illustrates the causes and effects on cyber-bullying, pornography and violent online gaming. ...
... Five Areas assessment model of CBT (Williams & Garland, 2002) The letter "C" which represents cognition carries the meaning of something related to the concept of knowing through thought, understanding and mental which is also explained by Crooks, 2019 that this word is very much related to motivation and emotion. The thought pattern is considered as unhelpful if the thought often tends towards the negative and affects daily life especially when the person is not confident of being able to deal with the problems faced. ...
The advent of social media has revolutionized how people interact online. While social media platforms have substantially brought positive influences on the world such as job placements, online donations, and business opportunities to name a few; it has undeniably created a plethora of negative problems to the young, particularly teenagers which has become a growing concern in recent times. This study seeks to answer the following questions impacting teenagers in Singapore and Malaysia: 1. What role does social media play in cyber-bullying which led to teenagers committing suicides? 2. How the prevalent of pornographic materials in social media causes underage and premarital sex among the teenagers? 3. Why do violent online gaming lead to addiction and eventual aggression among teenagers? To illustrate how the role of social media has contributed to the causes and effects of negative influences in the areas of cyber-bullying, pornography, and violent online gaming, we elaborated concepts in the Williams and Garland Five Areas Model and included the Media System Dependency Theory. Albeit the concepts and theories in the use of negative influences contributed by social media are not exhaustive, suggesting future research directions, it nonetheless contributes to a better understanding on the causes and effects of the negative influences on cyber-bullying, pornography, and violent online gaming among teenagers in the social media. As a result of this study, we have also examined the currently implemented measures in social media to combat the negative influences and suggested new precautions to protect the teenagers.
... This study utilises the Williams and Garland Five Areas Assessment Model (Williams & Garland, 2002) and the Media System Dependency Theory (Ball-Rokeach & DeFleur, 1976). The improved model is able to justify the negative effects of social media on teenagers by examining the five systems (Situation, Thoughts, Feelings, Behaviors and Physical Sensation) which illustrates the causes and effects on cyber-bullying, pornography and violent online gaming. ...
... Five Areas assessment model of CBT (Williams & Garland, 2002) The letter "C" which represents cognition carries the meaning of something related to the concept of knowing through thought, understanding and mental which is also explained by Crooks, 2019 that this word is very much related to motivation and emotion. The thought pattern is considered as unhelpful if the thought often tends towards the negative and affects daily life especially when the person is not confident of being able to deal with the problems faced. ...
Prosiding Seminar Falsafah Sains dan Ketamadunan 2021 4(1) 2022 merupakan himpunan kertas kerja sempena penawaran kursus UHIS6013 dan UICW6023 Falsafah Sains dan Ketamadunan yang ditawarkan kepada para pelajar Pasca Siswazah peringkat Sarjana dan Doktor Falsafah. Himpunan kertas kerja ini membincangkan empat tema utama dengan puluhan kertas kerja tentang isu semasa. Tema tersebut terdiri dalamnya:
Idea, Inovasi, dan Penyelidikan
Seni dan Hiburan
Jantina & Minoriti
Etika dan Akhlak Tamadun
Review Book
Himpunan kertas kerja ini diharap dapat menjadi medan penting kepada para pelajar dan pensyarah untuk menghasilkan tulisan yang berkualiti tentang isu semasa menurut perspektif Islam dan daripada hasil pengkajian berbentuk perpustakaan atau penyelidikan kecil. Himpunan tulisan ini juga diharap boleh dijadikan rujukan akademik buat semua para pelajar, pensyarah, dan masyarakat umum di Nusantara dan masyarakat dunia.
... social isolation) 6,7 , economic downturn 8 and fear of the pandemic itself 9,10 . In the US for instance, depression levels increased significantly during the pandemic (April 2020), but even more so among young adults (age [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] 11 . Understanding and monitoring the extent to which the pandemic affects public mental health is therefore critical to prevent indirect increases in suicide and substance abuse-related deaths during pandemics 12,13 . ...
... This is because absolutist thoughts, devoid of nuance, increase unfounded perceptions of threats, unrealistic expectations and ultimately foster more maladaptive coping strategies. Hence, having an extreme, absolute cognitive style or though pattern is a key risk factor for anxiety-depression and cognitive rigidity is an important component of psychological models for those disorders 23,24 . ...
The assessment of population mental health relies on survey data from representative samples, which come with considerable costs. Drawing on research which established that absolutist words (e.g. never) are semantic markers for depression, we propose a new measure of population mental health based on the frequency of absolutist words in online search data (absolute thinking index; ATI). Our aims were to first validate the ATI, and to use it to model public mental health dynamics in France and the UK during the current COVID-19 pandemic. To do so, we extracted time series for a validated dictionary of 19 absolutist words, from which the ATI was computed (weekly averages, 2019-2020, n = 208) using Google Trends. We then tested the relationship between ATI and longitudinal survey data of population mental health in the UK (n = 36,520) and France (n = 32,000). After assessing the relationship between ATI and survey measures of depression and anxiety in both populations, and dynamic similarities between ATI and survey measures (France), we tested the ATI's construct validity by showing how it was affected by the pandemic and how it can be predicted by COVID-19-related indicators. A final step consisted in replicating ATI's construct validity tests in Japan, thereby providing evidence for the ATI's cross-cultural generalizability. ATI was linked with survey depression scores in the UK, r = 0.68, 95%CI[0.34,0.86], β = 0.23, 95%CI[0.09,0.37] in France and displayed similar trends. We finally assessed the pandemic's impact on ATI using Bayesian structural time-series models. These revealed that the pandemic increased ATI by 3.2%, 95%CI[2.1,4.2] in France and 3.7%, 95%CI[2.9,4.4] in the UK. Mixed-effects models showed that ATI was related to COVID-19 new deaths in both countries β = 0.14, 95%CI[0.14,0.21]. These patterns were replicated in Japan, with a pandemic impact of 4.9%, 95%CI[3.1,6.7] and an influence of COVID-19 death of β = 0.90, 95%CI[0.36,1.44]. Our results demonstrate the validity of the ATI as a measure of population mental health (depression) in France, the UK and to some extent in Japan. We propose that researchers use it as cost-effective public mental health "thermometer" for applied and research purposes.
... Psychoeducation about psychological distress in the context of being a parent of a child treated for cancer is also provided. Parents are introduced to two case vignettes that are used throughout EJDeR based on the Five Areas CBT model [88,89] to facilitate an understanding of the CBT rationale. To enhance engagement, case vignettes were informed by our previous research [5,51]. ...
... This module is based on a relapse prevention protocol for LICBT [54,68] and is completed at the end of the 12-week intervention period or before if a collaborative decision is made between the parent and the e-therapist. Parents identify warning signs that may indicate relapse using the Five Areas CBT model [88,89] completed in the introduction and psychoeducation module. Next, parents identify what activities, skills, and techniques they have learned and found helpful during EJDeR to inform a staying-well toolkit. ...
Background:
Following the end of a child's treatment for cancer, parents may report psychological distress. However, there is lack of evidence-based interventions tailored to the population, with psychological support needs commonly unmet. An internet-administered low-intensity Cognitive Behavioral Therapy (LICBT) based intervention (EJDeR; internetbaserad självhjälp för föräldrar till barn som avslutat en behandling mot cancer) may provide a solution.
Objective:
The first objective is to provide an overview of the multi-method approach informing the development of the EJDeR intervention. The second objective is to provide a detailed description of the EJDeR intervention in accordance with the Template for Intervention Description and Replication (TIDieR) checklist.
Methods:
EJDeR was developed through a multi method approach, including the use of existing evidence, conceptualization of distress, participatory action research, cross-sectional survey, and professional and public involvement. Dependent on the main presenting difficulty identified during assessment, LICBT behavioral activation or worry management treatment protocols are adopted for the treatment of depression and/or generalized anxiety disorder respectively. EJDeR is delivered via the U-CARE-portal, an online platform designed to deliver internet-administered LICBT interventions and includes secure videoconferencing. To guide parents in the use of EJDeR, weekly written messages via the Portal are provided by e-therapists, comprising final year psychology program students with training in CBT.
Results:
An overview of the development process and a description of EJDeR informed by the TIDieR checklist are presented, with adaptations made in response to public involvement highlighted.
Conclusions:
EJDeR represents a novel guided internet-administered LICBT intervention to support parents of children treated for cancer. Adopting the TIDieR checklist offers potential to enhance fidelity to the intervention protocol and facilitate later implementation. The intervention is currently being tested in a feasibility study (the ENGAGE study).
Clinicaltrial:
ENGAGE study: ISRCTN 57233429.
International registered report:
RR2-10.1136/bmjopen-2018-023708.
... Key methods of change for those in distress included: motivational interviewing; reduce negative emotions; problem solving; planning coping responses; goal setting; action planning; self-monitoring; implementation intentions; and social support [58][59][60][61][62][63][64][65][66][67][68]. We also drew upon established theoretical models and perspectives such as the diathesis-stress model, the integrated motivationalvolitional model of suicidal behaviour, compassion, and techniques within established psychotherapies such as cognitive behaviour therapy [6,42,[69][70][71][72][73][74][75]. To limit repetition the practical applications of these methods are elaborated in the following step describing production of the intervention materials. ...
Background
Mental health problems, self-harm and suicide are major public health concerns. Following national strategic commitments to improve the response and follow-up support for adults in Scotland presenting to frontline services in emotional distress, this study describes the development of the first national Distress Brief Intervention, a multi-agency service to provide connected, compassionate support for people in distress.
Methods
The six step Intervention Mapping protocol was used to account for the complexity of the intervention and to guide development, testing and implementation. Data/information sources comprised: literature and evidence review; delivery partner and stakeholder consultations (n = 19); semi-structured interviews and/or focus-groups with frontline services staff experienced in responding to distress (n = 8); interviews and/or focus groups with adults with experience of distress (n = 9); feedback from test training for staff (n = 16); self-assessed confidence ratings provided by staff immediately before and following training (n = 388).
Results
We developed a time-limited, two-level, complex intervention for adults experiencing emotional distress, provided by ‘frontline’ statutory services (primary and acute healthcare, police, ambulance) and third-sector community organisations in Scotland. Intervention components included competency-based training programmes for staff, information, protocols and guidance for providers, personalised distress management planning and behaviour change tools. During the development phase, 525 intervention providers (n = 472 frontline statutory service staff; n = 53 third-sector community organisation staff) completed training programmes in four pilot areas in Scotland. Training evaluations from 388 providers (74%) indicated significantly greater confidence following training on key competencies.
Conclusions
A multi-agency national Distress Brief Intervention was systematically developed and implemented in a range of non-specialist frontline and community settings in Scotland. Up-take of training and evaluations of training indicate it is highly acceptable to potential providers and improves key competencies. Following independent evaluation, the Distress Brief Intervention has been rolled out nationally across the whole of Scotland, and has significant potential as a model of care and prevention internationally, including countries with low statutory health resources.
... Goal setting is already a crucial component of cognitive behavioral therapy (CBT), an effective approach for the treatment of MDD. In CBT, the roles of goal setting include enhancing patient motivation by establishing specific and achievable objectives, fostering a common understanding between the patient and physician regarding the trajectory of treatment, and objectively assessing the effectiveness of treatment and adjusting the treatment plan as necessary [18,19]. Accordingly, appropriate goal setting is considered beneficial to the overall therapeutic process of MDD treatment [18]. ...
Background
Major depressive disorder (MDD) is a common and debilitating cause of disability worldwide. Recently, it has been suggested that individualized goal setting may play a role in patient-centered recovery. This study aimed to survey the landscape of patient–physician communication around goal setting for MDD treatment, as well as understand whether goal setting using the SMART (specific, measurable, attainable, realistic, and time-bound) framework is associated with positive treatment indicators in MDD.
Methods
Patients in Japan (≥ 18 years of age) who self-reported a verified MDD diagnosis were eligible to complete a self-administered survey through the Personal Health Record service, a web-based smartphone app. Patients were asked about whether they communicated with physicians about treatment prospects and/or goals. A ‘SMART-Goal score’ tool was developed to evaluate patient goals against the five SMART criteria. Treatment satisfaction scores and scores on the Wake Forest Physician Trust Scale Short Version (TRUST) were assessed as indicators of outcomes in this study. Descriptive questions were used to explore patients’ perceptions of goal setting.
Results
In total, 466 patients were eligible for inclusion in the analysis. The majority (70.0%) reported communicating with their physicians about treatment prospects and/or goals. These patients (Com + group) had a median (Q1, Q3) TRUST score of 70.0 (60.0, 80.0), compared with 50.0 (40.0, 70.0) in patients who reported an absence of communication (Com − group). Median (Q1, Q3) treatment satisfaction scores were 5.0 (4.0, 6.0) and 4.0 (3.0, 5.0) for the Com + and Com − groups, respectively. In high SMART-Goal scoring groups, approximately 75% of patients exceeded the overall median scores for TRUST (70.0) or treatment satisfaction (5.0) reported for the Com + group; only 25% of patients in low SMART-Goal scoring groups achieved the same in either measure. Most patients (89.3%) who set goals recommended goal setting.
Conclusions
This exploratory study suggests that communication between patients and physicians regarding goal setting in MDD treatment may be associated with positive patient perceptions of treatment. High-quality SMART goal setting also appears to have positive aspects for patients with MDD, which may in turn affect treatment outcomes. Further studies are needed to confirm these initial findings.
Trial registration
Registered on the UMIN Clinical Trials Registry (ID: UMIN000050370) on 17 February 2023.
... Table 1 details the criteria used for study selection, presented using the Population, Intervention, Comparison, Outcomes (PICO) framework (Eriksen & Frandsen, 2018). Inclusion was limited to outpatients diagnosed with anorexia nervosa receiving first-or second-wave CBT, defined as time-limited, structured, evidencebased psychotherapy containing cognitive and/or behavioural interventions (Fenn & Byrne, 2013;Williams & Garland, 2002). Third-wave CBT was excluded because the foci of treatment are far broader than first-and second-wave CBT, and the evidence base is less robust (Linardon, Fairburn, et al., 2017). ...
Anorexia nervosa is commonly treated using outpatient cognitive-behavioural therapy (CBT), but its effectiveness needs to be established. This systematic review and meta-analysis (PROSPERO CRD42023484924) assessed outpatient CBT's effectiveness for anorexia nervosa and explored potential moderators (pre-treatment Body Mass Index (BMI), age, illness duration, protocol duration of therapy, dropout). Searches (SCOPUS, PsycINFO, MEDLINE, grey literature) identified 26 studies reporting pre- to post-treatment outcomes for at least one primary measure (weight, eating disorder symptoms). Studies were medium to high quality. Secondary outcome data (depression, anxiety, quality of life) were also extracted. Meta-analyses (26 studies) found medium to large post-treatment effect sizes for weight (g = 0.87; 95% CI 0.67-1.08) and eating disorder symptoms (g = -0.74; 95% CI -0.93 - -0.54), with change starting early and increasing to follow-up. Effect sizes for secondary outcome measures were medium to large. Pre-treatment BMI moderated weight gain. This review was constrained by excluding non-English language papers and the limited number of papers reporting minimum data for inclusion. Overall, results suggest an optimistic picture for patients with anorexia nervosa treated with outpatient CBT. Clinicians can expect good outcomes using CBT, regardless of patients' starting weight, age, or illness duration.
... How these are treated through the networks (interactions) between various features like feelings, thoughts and physicalsensations. (Williams and Garland, 2002) The society and cultures and way too vast and every individual have different experiences, by the help of this model we tried to explain the part that Instagram and social comparison might play simultaneously in mental-health related issues. The increased Instagram usage, lowered self-esteem and depression these three terms are interconnected and correlated. ...
Instagram has a very high number of monthly-active users that is more than 400 million, the number of shared faces is around 80 million and nearly about 3.5 likes daily. A high percentage of people post their lives on Instagram so that they can be viewed, seen and admired. This causes people to judge, comment and at times try to copy what they see on Instagram. Thus this comparing causes "mental health issues, anxiety, depression, lowered self-esteem and social-comparison". As social media, Instagram, has become most important part of every individual especially among youth. It is important to study and analyze the impact that it brings among youth and culture it imparts. Instagram have grown rapidly in past few years. Its effects are yet unclear whether it is creating a sense of social-comparison among people and leading to mental health issues. The main idea of carrying out this study is to look for the effect of Instagram usage among individual, social depression/anxiety and comparing themselves with others. We have used the basics of social-comparison theory and Five-system model. We carried out a online-survey for this study (N=404). The whole set of data was transferred to SPSS software of Instagram users. The recent studies affirms and proves that the high usage of social platforms has major consequences as it leads to anxiety, stress and various health related issues. To lower the bad effects the research shows the role that self-esteem and social-comparison can play. The people with high self-esteem and tends to be less effected by social media usage. Thus proposes that to higher self-esteem could be used improve the social-comparison developed among youth. The research is aimed to find whether Instagram usage is leading youth towards social comparisons and to identify the correlation between factors, i.e. mental health and social comparison caused by Instagram usage. Also, it has been observed that social-comparison can cause mental health issues and colorism. As per studies nearly 88% of youth are engaged in social comparisons caused by Instagram and most of these are suffering with upward-comparison. Moreover, this research study suggests that there is a strong relation between Instagram usage and social comparison, causing mental health issues i.e social anxiety and depression. Instagram usage appeared to influence the psychological health of individual, the individuals with more usage faced higher mental issues and with high self-esteem the social comparison effect showed a change. The relationship between Instagram usage and social-comparison was studied and it regulated to extent as it created the direct relation among the users."
... Although it is time-consuming, requires attention to detail, more efforts and special equipment in the dental office, the current data obtained show promising opportunities in the treatment of anxious patients of the investigated age group. The simultaneous influence on several areas of the so-called Five Areas model of Cognitive Behavioural Therapy explains how the highest efficiency of the combined use of the Er:YAG laser and the Latent inhibition technique in the reduction of dental anxiety is probably achieved [20]. ...
This study aimed to evaluate the anxiety in paediatric patients during caries treatment, with Er:YAG laser and conventional rotary instruments, in combination with child-management technique Latent inhibition. A group of 126 6–12-year-old children with one or more untreated dentine carious lesions (ICDAS code 05) on the occlusal surface of a primary molar was divided into four equal treatment subgroups. A standardized caries treatment was performed with Erbium:YAG laser or conventional rotary instruments. In the intervention groups, Latent inhibition was used as an anxiety-management technique. During the procedure, objective and subjective stress parameters were recorded. Statistically significant reduction in mean heart rate and self-anxiety scores was seen in the combination of Er:YAG laser caries removal and child-management technique (p < 0.05). The use of laser cavity preparation in combination with the child-management technique Latent inhibition is the most effective method during the dental treatment of children. Er:YAG laser alone showed an advantage over the conventional method and equivalent effect to the combined use of conventional rotary instruments and behaviour management technique.
... What I mean is, CBT by dealing with time"s unknown constraints may be found in the position of individuals" continuous relapses, not because they haven"t done their homework or didn"t practice interventions agreed, but because the problem was "treated inwardly", and not in relation to the time needed in an analogous proportion to the time lasted (Lynch et al., 2010). What it is suggested, instead, is the "treatment time" in CBT to be analogous to the number of sessions needed (Williams & Garland, 2002), and not analogous to the time an individual has suffered (Grazebrook & Garland, 2005). ...
The present paper is a proposal to a new model, the theorization of which is set in this article. It presents and discusses the importance of context specificity of eventful experiences in terms of cognitive, emotional and behavioural choices. Cognitive, emotional and behavioural choices are approached as depending on contextual changes due to environmental contingencies. Environmental contingencies (triggers) are regarded as precursors to core beliefs and rules for living in cognitive-behavioural therapy. The aim of this paper is to consider contextual changes as bringing upon changes to personality traits, which in turn influence cognitive, emotional and behavioural domains of human psyche. The main topic of discussion is centred around the premise that, teaching cognitive-behavioural therapy in line with changes occurring within the person, needs to be re-focused on the contextual changes taking place outside the person, as provoking internal changes not only in personality traits, but to the person"s cognitive appraisals and choices related to given environments.
... The transformation of irrational thinking depends on the understanding that faulty appraisals beget cognitive uneasiness to one's mind. By faulty appraisals are meant thinking errors, some of which are black-and-white thinking, filtering, mind-reading, catastrophising and overgeneralising (Clark, 2007;Williams & Garland, 2002a). The b. ...
This paper discusses ways of transforming personal appraisals of religious origin through the use of cognitive behavioural therapeutic approaches. In the introduction, an account is presented of the theoretical background of cognitive behavioural therapy together with the main aspects underlining it, such as: how an event can induce irrational thinking in one's reasoning, how irrational thinking can affect physical and emotional sensations and what follows, in terms of behaviours, after one has been emotionally influenced by irrational thinking. Appraisals of religious origin are presented and discussed in the main part of this chapter, followed by cognitive behavioural explanations which explore how these can be transformed from negative to positive ones. Before completing the main part of the chapter, a new topic is discussed, titled Cognitive Behavioural Psychology of Religion and ways of its contributing to new theoretical and empirical approaches for both psychology and religion. Finally, a summary of the main points of what has been discussed concludes the paper.
... Mohammadi (2013) development of the measure, seeks to provide clinicians and patients with valuable information regarding the specific factors that can be addressed to alleviate anxiety (Williams & Garland, 2002). ...
Objective
The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9‒16.
Methods
The CEDAM was translated into Persian following the guidelines of the IQOLA project. A sample of children completed the measure in a clinical setting, with a subgroup completing it again to assess test–retest reliability. Concurrent criterion validity was evaluated by having all participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the CEDAM. Construct validity was examined using exploratory and confirmatory factor analyses.
Results
The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test–retest reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and positive correlation between CEDAM and MCDAS scores ( ρ = 0.72, p < .01). Exploratory factor analysis identified two factors, and confirmatory factor analysis confirmed that the instrument aligned well with the factor structure obtained from the exploratory analysis.
Conclusion
This study provides evidence supporting the validity and reliability of the Iranian version of CEDAM as a valuable tool for evaluating dental anxiety in Persian‐speaking children between the ages of 9 and 16.
... The CBT sessions were structured on the basis of formulations developed between the therapist and patient to identify patterns of behavior which potentially had an impact on recovery and symptom management. CBT models within a biopsychosocial framework (Five Areas Approach) [37] were used to challenge unhelpful beliefs and thinking styles, with a focus on responses to stressful situations. These sessions considered individual predisposing, precipitating and perpetuating factors. ...
Objectives
We report routinely collected outcome data from an 8-week outpatient rehabilitative therapy program. The aims of the intervention were to (1) reduce symptom severity and (2) improve functional mobility in adults with functional neurological disorder (FND).
Methods
The program delivered individual physiotherapy, cognitive behavioral therapy (CBT) and self-management sessions, group physiotherapy, and psychoeducation. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Work and Social Adjustment Scale (WSAS), 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Data were analyzed retrospectively in accordance with routine service evaluation. Wilcoxon signed-rank tests assessed changes in outcomes between weeks 1 and 8 for all patients completing treatment (n = 45). For patients who attended the 3-month follow-up (n = 31), Friedman’s ANOVA assessed overall change in outcomes over time. Post hoc Wilcoxon signed-rank tests compared pairs of time-points (Weeks 1, 8, and 3-month follow-up).
Results
Analyses of patients completing the program revealed significant improvements in scores between week 1 and week 8. Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up.
Discussion
This outpatient therapy program provided effective treatment for FND. Patients reported reduced anxiety, depression, and functional impairment, as well as improved performance on most physiotherapy measures.
... Cognitions to do that is via facial expressions and/or postures. In CBT terms, negative automated thinking is a kind of vicious circle between faulty appraisals and emotions leading to avoidant behaviours and the consequences of them (Williams & Garland, 2002). Not all incidents and/or events are regarded as triggers in CBT. ...
This case study is a partial replication of an original experiment by Strack et al. (1988). It examines the understanding of the facial feedback hypothesis. For this experiment, participants were asked to rate the funniness of a cartoon after completing tasks using only their lips or teeth to hold a pen, thereby facilitating a smile or a frown. In addition to that, there have been discussed cognitive-behavioural therapy elements on the presentation of emotions following physical reactions. It was a between-participants design in which respondents were asked to complete a questionnaire in the lips or teeth condition to generate emotional states of physical reaction required to underline cognitive precipitants. In this study, a within-participants correlational design was also conducted between extraversion and altruism to consider the possibility whether these two variables could relate to funniness or not. To test that, participants were asked to rate the humour of a far side cartoon. The results did not confirm the hypothesis that those in the teeth condition rated the cartoon funnier than those in the lips condition meaning that facial reaction does not necessarily imply respective emotional states due to cognitive elements, such as awareness and attention, which posit reason as a more important factor than emotions. Discussion of the results in line with physiological and cognitive aspects and their implications to future research had also been carried out.
... The soft part of the carious lesion is removed manually by a special set of hand instruments, called excavators, for removal of only the infected dentin (unable to undergo remineralization) until reaching firmer and light brown, affected dentin. Williams et al. point out the `atraumatic` component of the technique concerning the patient`s comfort, as the noise and vibration related to the bur are absent [15]. This effect is further enhanced by the fact that local anesthesia is rarely used [11]. ...
Dental caries is the most common chronic dental disease in the world. It is defined as a multifactorial microbial infectious disease characterized by demineralization of the inorganic and destruction of the organic substance of the tooth. Conventional treatments for caries removal are often associated with pain and fear. Minimally invasive treatment offers an attractive alternative to managing carious lesions in a more conservative and effective manner, resulting in enhanced preservation of tooth structure. The aim of this review article is to analyze the scientific literature regarding the alternative therapeutic approach to the caries lesion management. A search was performed to summarize the evidence behind the alternative methods for caries removal, including the use of air abrasion, lasers, ultrasonic devices, polymer burs, At-raumatic restorative technique, chemo-mechanical caries removal, and their advantages and disadvantages to be discussed. The findings of the literature review give grounds to undertake studies investigating the efficiency of the different methods for caries removal. Future explorations will be interesting as the profession begins adopting the alternative caries management strategies that may decrease the use of behaviour management techniques in the treatment of paediatric dental patients.
... The affective component involves a vicarious emotional response to the perceived feelings and emotions of another (Eisenberg and Strayer, 1987), e.g., "I feel your pain as you attempt to make friends and get resettled." A person's emotions and feelingsor empathic concernare understood to be related more directly to overt behavior than are thoughts (Konrath et al., 2011;Williams and Garland, 2002). Therefore, in the present study, we focused on the affective component of empathyempathic concern. ...
Empathy is an essential component of positive human interaction driven in part by parenting. Most research on parents’ role in empathy focuses on child and adolescent samples. Thus, the present study examined the relations between current maternal behaviors (warmth and behavioral control) and empathic concern of European-American and Asian-American college-going emerging adults residing in the U.S. Gender (male/female) was explored as a moderator. Participants included 606 (69.6% women, 79.5% European American) undergraduate students ages 18–29. Gender and ethnic differences were observed: (a) emerging-adult women reported greater levels of empathy than did emerging-adult men, and (b) European Americans reported greater levels of empathy than did Asian Americans. Maternal warmth was related positively to empathy, maternal behavioral control was related negatively to empathy, and Maternal Warmth x Gender was significant with the maternal warmth-empathy relation being stronger for men than women. Implications and future directions are discussed.
... During the second and third counseling sessions at the outpatient clinic Healthy Pregnancy, a functional analysis of behavior will be carried out using a situation-organism-reaction-consequences scheme, relaxation techniques will be educated, the automatic thoughts worksheet will be filled out, and the five-factor model will be discussed (Multimedia Appendices 1-3) [25][26][27]. These components of cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness will teach the women and their partner skills to achieve and maintain long-term lifestyle change. ...
Background:
Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions.
Objective:
The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI≥25 and who are contemplating pregnancy or are already pregnant (≤12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome.
Methods:
The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI≥25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications.
Results:
The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023.
Conclusions:
This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI≥25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies.
Trial registration:
Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264.
International registered report identifier (irrid):
PRR1-10.2196/28600.
... A recent computerized big data text analysis conducted by Al-Mosaiwi and Johnstone (2018) examined the use of absolutist words, such as "always", "nothing" or "completely", and found that absolutist words were even better markers for mental health forums than negative emotion words. This was interpreted in relation to so-called "absolutist thinking", which has been suggested to underlie anxiety and depression (Beck, 1979;Burns, 1989;Williams and Garland, 2002). In addition, dichotomous thinking, cognitive rigidity, and problem-solving deficits have been repeatedly found to co-occur in suicidal individuals (see Ellis and Rutherford, 2008 for a review). ...
Dyads with a depressed and a non-depressed participant ( N = 15) and two non-depressed participants ( N = 15) discussed a moral dilemma, during which the participants’ gaze direction and skin conductance (SC) were measured. Partner gazing occurred most frequently when a speaker took a strong stance toward saving a person in the dilemma, depressed participants however looking at their co-participants less often than non-depressed participants. The participants’ SC response rates were higher during responsive utterances expressing disagreement (vs. agreement) with co-participant ideas or suggesting that a person be sacrificed (vs. saved). We argue that a better understanding of the affective corollaries of human social interaction necessitates a balanced consideration of both contents of talk and behavioral patterns.
... In the treatment of anxiety disorders, the aim of cognitive behavioural therapy (CBT) is to reduce anxious feelings by undoing prior learning or by providing new, more adaptive learning experiences and changing cognitive and behavioural responses to anxiety (Williams & Garland 2002). Increasing an individual's awareness of unwanted emotions and behaviours is thought to generate a number of alternative responses. ...
Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.
Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.
Results: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.
Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
... In the treatment of anxiety disorders, the aim of cognitive behavioural therapy (CBT) is to reduce anxious feelings by undoing prior learning or by providing new, more adaptive learning experiences and changing cognitive and behavioural responses to anxiety (Williams & Garland 2002). Increasing an individual's awareness of unwanted emotions and behaviours is thought to generate a number of alternative responses. ...
Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.
Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.
Results: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.
Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
... In the treatment of anxiety disorders, the aim of cognitive behavioural therapy (CBT) is to reduce anxious feelings by undoing prior learning or by providing new, more adaptive learning experiences and changing cognitive and behavioural responses to anxiety [84]. Increasing an individual's awareness of unwanted emotions and behaviours is thought to generate a number of alternative responses. ...
Background
To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.
Methods
The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.
Results
The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.
Conclusion
The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
... In the treatment of anxiety disorders, the aim of cognitive behavioural therapy (CBT) is to reduce anxious feelings by undoing prior learning or by providing new, more adaptive learning experiences and changing cognitive and behavioural responses to anxiety (Williams & Garland 2002). Increasing an individual's awareness of unwanted emotions and behaviours is thought to generate a number of alternative responses. ...
Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.
Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.
Discussion: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.
Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
... In the treatment of anxiety disorders, the aim of CBT is to reduce anxious feelings by undoing prior learning or by providing new, more adaptive learning experiences, changing cognitive and behavioural responses to anxiety (Williams & Garland 2002). Increasing an individual's awareness of unwanted emotions and behaviours is thought to generate a number of alternative responses. ...
Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.
Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.
Discussion: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.
Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
... This may in turn lead to poor decision making regarding treatment goals and less favourable clinical outcomes [17,18]. We were unable to determine whether this was the case in the present study, however, cognitive behaviour therapists working in multidisciplinary teams may benefit from adopting clearer and less jargon-laden terminology when communicating with colleagues, such as terms from Five Areas model of CBT [19]. ...
Effective communication between clinicians is essential for the success of mental health interventions in multidisciplinary contexts. This relies on a shared understanding of concepts, diagnoses and treatments. A major assumption of clinicians when discussing psychological treatments with each other is that both parties have a shared understanding of the theory, rationale and application of the respective technique. We aimed to determine to what extent there is inter-rater agreement between clinicians in describing the content of group therapy sessions. Pairs of clinicians, drawn from a large multidisciplinary team (13), were asked to provide ratings of the therapeutic content and emphasis of N = 154 group therapy sessions conducted during an intensive residential treatment program for post-traumatic stress disorder (PTSD). In most therapeutic content domains there was a moderate level of agreement between clinicians regarding session content (Cohen’s Kappa 0.4 to 0.6), suggesting that clinicians have a broad shared understanding of therapeutic content, but that there are also frequent discordant understandings. The implications of these findings on multidisciplinary team communication, patient care and clinical handovers are discussed and directions for further research are outlined.
... In the treatment of anxiety disorders, the aim of CBT is to reduce anxious feelings by undoing prior learning or by providing new, more adaptive learning experiences, changing cognitive and behavioural responses to anxiety (Williams & Garland 2002). Increasing an individual's awareness of unwanted emotions and behaviours is thought to generate a number of alternative responses. ...
Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.
Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.
Discussion: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.
Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
... 40 Simplified CBT can be useful in everyday clinical practice, which can be useful for less severe cases. 41 Psychotropic should also be considered, depending on the severity of the psychopathology (anxiety, depression) linked with the dermatosis or the skin symptoms. A benzodiazepine or hydroxyzine can be started in the setting of acute anxiety, while an antidepressant, particularly a selective serotonin reuptake inhibitor (SSRI), is an option for chronic anxiety and depression. 1 Increasing evidence also suggests the interest of psychobiotics, namely Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum, in the management of psychophysiological disorders, due to the antidepressant and anxiolytic effect. ...
Psychodermatology is a growing specialty which is gaining momentum in different parts of the world. It focuses on the connection between skin and psyche. Psychocutaneous conditions are characterized by those disorders where stress is the key element in exacerbating skin conditions or flare ups of dermatoses like psoriasis and atopic dermatitis. There is a direct relationship of stress with the course, and prognosis of the skin disease. In some situations, there is no skin condition but the lesions are self‐inflicted and such disorders are always associated with underlying psychopathology or psychological conflicts. Sometimes emotional problems are more prominent as a result of having skin disease and the psychological consequences may be more severe than the physical symptoms. Management of these conditions require a combination of psychpharmacology, psychotherapy and liaison clinics of psychiatry and dermatology. This review focuses on the common management approach which can be adopted by deramtologists in treating patients with psychodermatological disorders, improving doctor‐patient relationship and therapeutic bond.
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... Pri postavljanju ciljev obravnave si lahko pomagamo s tako imenovanim modelom petih področij (angl. five areas model) (Williams in Garland, 2002), pri katerem posameznika povprašamo po tem, katere so spremembe na področju njegovih medosebnih odnosov, življenjske situacije, na področju njegovega mišljenja (večkrat razmišlja o bolečini, o tem, kako ne more nečesa početi itd.), vedenja (več počiva oziroma je manj aktiven, manj družaben ipd.), čustvovanja (večkrat je žalosten, jezen ipd.) in telesnega doživljanja (manjkrat je sproščen, ima manj kondicije ipd.), ki so se pojavile s kronično bolečino. Nato posameznik pove, kaj od naštetega bi najraje spremenil, iz česar skupaj oblikujemo cilje obravnave. ...
Chronic or recurrent pain in childhood is a common phenomenon, which psychologists encounter in their work within a multidisciplinary care team. In this article, we try to shed some light on the theoretical background and practical guidelines when dealing with chronic pain in children and adolescents. To understand chronic pain properly, biological/physiological, cognitive, emotional, behavioural and social factors need to be taken into consideration. In the first part of the article, we try to summarize the results of recent studies on the connection between these factors and the development of chronic pain. We highlight the theory of understanding and treating chronic pain in children and adolescents based on cognitive-behavioural theory. The second part of the article deals with the methods of cognitive-behavioural therapy for assessing and monitoring pain, psychoeducation, and specific cognitive and behavioural techniques in a systematic and practical fashion.
Background: Dental anxiety is a common phenomenon experienced by children in the dental setting. Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions. Though research has been done on CBT to allay dental anxiety but still its clinical applicability is less explored in dentistry. Aim: To assess and evaluate the impact of a cognitive-behavioral intervention on dental anxiety in children. Materials and methods: A total of thirty children, aged 7-10 years were included. The pre assessment anxiety and cooperation levels of the children were determined by using the Modified Child Dental Anxiety Scale (MCDAS), Venham child cooperation scale (VCCS), and Deepak-Parimala Children Perception. The intervention group (group 1) (N=15) received twenty-minute session of cognitive behavioral therapy while control group (group 2) didn’t receive any CBT intervention. After CBT in group 1, Local anesthesia was administered in both the groups. Then, the respective measuring scales were again applied. Results: There was a statistically significant difference in anxiety and cooperation levels measured by MCDAS scale, VCCS scale and Deepak-Parimala anxiety scale in intervention group as compared to control group. Conclusion: Findings of our study suggests that CBT is an effective intervention for managing dental anxiety in paediatric patients during dental procedures.
Aim
To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self‐help cognitive behavioural therapy (CBT) intervention, ‘Your teeth, you are in control’ (YTYAIC), in the CALM trial.
Methods
Semi‐structured interviews were conducted as part of this qualitative component of the process evaluation, and data were analysed using a framework approach based on the Consolidated Framework for Implementation Research (CFIR) and the Five Areas Model of CBT.
Results
Thirty‐seven participants were recruited. Potential mechanisms of action were identified using the Five Areas Model of CBT. Participants felt the intervention may exert change through targeting unhelpful thoughts and feelings (e.g., building trust and perceptions of control) and behaviours (e.g., encouraging effective communication and coping strategies) and facilitating a more positive situational context (e.g., developing more supportive relationships). Enablers (e.g., adaptability, design and delivery) and barriers (e.g., time/resource constraints, cost) to implementation were identified using the CFIR.
Conclusions
This study revealed multiple potential mechanisms of action which could reduce dental anxiety and examined how implementation and contextual factors may influence this change process. The results of the research revealed that the intervention could be implemented in primary dental care and identified the potential barriers which should be addressed to aid successful implementation of the intervention in real world contexts.
Trial Registration
This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420)
Background
Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent.
Objective
This study aims to examine engagement with a mobile phone app to support worry management with specific attention directed toward interaction with specific LICBT techniques and examine the potential to reduce symptoms of anxiety.
Methods
Log data were examined with respect to a sample of “engaged” users who had completed at least 1 lesson related to the Worry Time and Problem Solving in-app modules that represented the “minimum dose.” Paired sample 2-tailed t tests were undertaken to examine the potential for IMWW to reduce worry and anxiety, with multivariate linear regressions examining the extent to which completion of each of the techniques led to reductions in worry and anxiety.
Results
There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the cognitive behavioral therapy model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully used to support the user with lower levels of engagement. Several users engaged with Worry Time outside of the app. Forgetting to use the app was the most common reason for lack of engagement, with features of the app such as completion of routine outcome measures and weekly reflections having lower levels of engagement. Despite difficulties in the collection of end point data, there was a significant reduction in severity for both anxiety (t53=5.5; P<.001; 95% CI 2.4-5.2) and low mood (t53=2.3; P=.03; 95% CI 0.2-3.3). A statistically significant linear model was also fitted to the Generalized Anxiety Disorder–7 (F2,51=6.73; P<.001), while the model predicting changes in the Patient Health Questionnaire–8 did not reach significance (F2,51=2.33; P=.11). This indicates that the reduction in these measures was affected by in-app engagement with Worry Time and Problem Solving.
Conclusions
Engaged users were able to successfully interact with the LICBT-specific techniques informed by an evidence-based protocol although there were lower completion rates of routine outcome measures and weekly reflections. Successful interaction with the specific techniques potentially contributes to promising data, indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of log data to inform future developments. However, attention needs to be directed toward enhancing interaction with wider features of the app given that larger improvements were associated with greater engagement.
In this chapter, the authors draw on their expertise in child developmental psychology, anxiety management and paediatric dentistry practice to provide a theoretical basis and practical guide for the management of children in the dental setting.The first part gives an overview of the central aspects of children’s psychosocial, emotional and cognitive development before offering some practical and evidence-based approaches for providing dental care to children of different age groups.The final section provides a more detailed insight into the experiences and needs of dentally-anxious children and explains how guided self-help cognitive behavioural therapy can offer support for these young patients.KeywordsPaediatric dentistryChild psychologyAttachmentCognitive behavioural therapy
Background
Methamphetamine use can be associated with involvement with correctional services and incarceration. Traditionally, treatments for methamphetamine use have been delivered in-person – however, lockdowns initiated during the COVID-19 pandemic significantly reduced access to such in-person support in prisons. Therefore, in May 2020 a digital cognitive-behavioral therapy (CBT) program for substance use disorders - 'Breaking Free from Substance Abuse' - was made available across prisons in Ohio in order to meet this treatment gap. This represents the first time this digital CBT intervention has been made widely available to incarcerated people residing in prisons or jails in the United States (US). This was a within-subjects study using data from 2187 Ohio prison residents who engaged with this digital CBT program to address their methamphetamine use.
Results
Participants reported multiple psychosocial risk factors, including moderate to severe substance dependence, depression and anxiety; interpersonal conflict; aggressive behavior; paranoia; and difficulties with work, education and accommodation. Significant reductions in substance dependence, depression/anxiety and biopsychosocial impairment, and improvements in quality of life, were identified in the sample. Risk factors were associated with less positive outcomes, specifically interpersonal conflict and poor mental health. Completion of specific components of the program were associated with more positive outcomes – a dose response was also identified.
Conclusions
Digital CBT can be delivered in secure US correctional settings and may help to fill unmet needs for in-person treatment. Specifically, this digital CBT program may support incarcerated individuals to address methamphetamine use, with outcomes being associated with psychosocial risk factors and program engagement.
Background:
Schizophrenia is a disabling psychotic disorder characterised by positive symptoms of delusions, hallucinations, disorganised speech and behaviour; and negative symptoms such as affective flattening and lack of motivation. Cognitive behavioural therapy (CBT) is a psychological intervention that aims to change the way in which a person interprets and evaluates their experiences, helping them to identify and link feelings and patterns of thinking that underpin distress. CBT models targeting symptoms of psychosis (CBTp) have been developed for many mental health conditions including schizophrenia. CBTp has been suggested as a useful add-on therapy to medication for people with schizophrenia. While CBT for people with schizophrenia was mainly developed as an individual treatment, it is expensive and a group approach may be more cost-effective. Group CBTp can be defined as a group intervention targeting psychotic symptoms, based on the cognitive behavioural model. In group CBTp, people work collaboratively on coping with distressing hallucinations, analysing evidence for their delusions, and developing problem-solving and social skills. However, the evidence for effectiveness is far from conclusive.
Objectives:
To investigate efficacy and acceptability of group CBT applied to psychosis compared with standard care or other psychosocial interventions, for people with schizophrenia or schizoaffective disorder.
Search methods:
On 10 February 2021, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, four other databases and two trials registries. We handsearched the reference lists of relevant papers and previous systematic reviews and contacted experts in the field for supplemental data.
Selection criteria:
We selected randomised controlled trials allocating adults with schizophrenia to receive either group CBT for schizophrenia, compared with standard care, or any other psychosocial intervention (group or individual).
Data collection and analysis:
We complied with Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated risk ratio (RR) and 95% confidence interval (CI) for binary data and mean difference (MD) and 95% CI for continuous data. We used a random-effects model for analyses. We assessed risk of bias for included studies and created a summary of findings table using GRADE.
Main results:
The review includes 24 studies (1900 participants). All studies compared group CBTp with treatments that a person with schizophrenia would normally receive in a standard mental health service (standard care) or any other psychosocial intervention (group or individual). None of the studies compared group CBTp with individual CBTp. Overall risk of bias within the trials was moderate to low. We found no studies reporting data for our primary outcome of clinically important change. With regard to numbers of participants leaving the study early, group CBTp has little or no effect compared to standard care or other psychosocial interventions (RR 1.22, 95% CI 0.94 to 1.59; studies = 13, participants = 1267; I2 = 9%; low-certainty evidence). Group CBTp may have some advantage over standard care or other psychosocial interventions for overall mental state at the end of treatment for endpoint scores on the Positive and Negative Syndrome Scale (PANSS) total (MD -3.73, 95% CI -4.63 to -2.83; studies = 12, participants = 1036; I2 = 5%; low-certainty evidence). Group CBTp seems to have little or no effect on PANSS positive symptoms (MD -0.45, 95% CI -1.30 to 0.40; studies =8, participants = 539; I2 = 0%) and on PANSS negative symptoms scores at the end of treatment (MD -0.73, 95% CI -1.68 to 0.21; studies = 9, participants = 768; I2 = 65%). Group CBTp seems to have an advantage over standard care or other psychosocial interventions on global functioning measured by Global Assessment of Functioning (GAF; MD -3.61, 95% CI -6.37 to -0.84; studies = 5, participants = 254; I2 = 0%; moderate-certainty evidence), Personal and Social Performance Scale (PSP; MD 3.30, 95% CI 2.00 to 4.60; studies = 1, participants = 100), and Social Disability Screening Schedule (SDSS; MD -1.27, 95% CI -2.46 to -0.08; studies = 1, participants = 116). Service use data were equivocal with no real differences between treatment groups for number of participants hospitalised (RR 0.78, 95% CI 0.38 to 1.60; studies = 3, participants = 235; I2 = 34%). There was no clear difference between group CBTp and standard care or other psychosocial interventions endpoint scores on depression and quality of life outcomes, except for quality of life measured by World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF) Psychological domain subscale (MD -4.64, 95% CI -9.04 to -0.24; studies = 2, participants = 132; I2 = 77%). The studies did not report relapse or adverse effects.
Authors' conclusions:
Group CBTp appears to be no better or worse than standard care or other psychosocial interventions for people with schizophrenia in terms of leaving the study early, service use and general quality of life. Group CBTp seems to be more effective than standard care or other psychosocial interventions on overall mental state and global functioning scores. These results may not be widely applicable as each study had a low sample size. Therefore, no firm conclusions concerning the efficacy of group CBTp for people with schizophrenia can currently be made. More high-quality research, reporting useable and relevant data is needed.
Background:
Stigma is a common psychological consequence for stroke survivors that aggravates their physical and psychological burden and hinders their rehabilitation. Currently, there are few interventions targeted at the stigma of stroke survivors.
Objectives:
This study reports on the development of a self-help cognitive behavioral therapy (CBT) programme driven by a logical model of stigma in stroke survivors, CBT and the advice of multidomain experts.
Methods:
A logical model of stigma in stroke survivors was derived from a systematic search of the literature and semistructured interviews with 21 patients to identify factors influencing stigma. The item content of the programme was generated based on this logical model in combination with CBT. A modified Delphi process with an expert panel of multidomain experts was used to evaluate and refine the content of the programme. SPSS 20.0 was used for data analysis.
Results:
Seventeen experts accepted the invitation to participate, and all completed two rounds of the Delphi survey. Six sections and 26 items were identified. Consensus was reached among experts that the self-help CBT programme included the following six sections: health education, understanding stigma, cognition change, skills training and self-care, self-acceptance and relapse prevention.
Conclusions:
The self-help CBT programme includes health education and psychological education. This study extends the limited body of research on stroke-related stigma interventions, and the next step is to evaluate its efficacy in trials.
In this article, we will seek to provide an overview of dental anxiety and fear, including its most extreme manifestation, dental phobia. We will explore the prevalence of different levels of dental anxiety and outline some broad principles for the management of dental anxiety based on an approach that suggests that management should be proportionate to the level of anxiety.
Many individuals struggling with debt will experience associated psychological stress that negatively impacts both their physical and psychological health. People in debt may be too ashamed to participate in support groups or to seek face-to-face therapy but may welcome the more anonymous help that can be made available through an internet-based therapeutic intervention. The Ostrich community internet-cognitive behavioural therapy program was specifically designed to assist individuals with distress related to carrying debt, facilitating them to move out of denial of their financial problems to managing stress symptoms and mobilizing them to be able to cope more effectively with the financial problems. Preliminary outcome studies have demonstrated the feasibility of this approach and its effectiveness.
Introduction: Cases of pneumothorax have been reported by various authors in patients with COVID-19. The association between these two diseases, as well as its frequency, have not yet been well studied. Aim: To present the first three cases of spontaneous pneumothorax associated with COVID-19 registered in the University Hospital “Sveti Georgi” Plovdiv. Clinical cases: Three cases of pneumothorax associated with COVID-19 were presented in two men aged 76 and 33 years and one woman aged 72 years. All three patients were on mechanical ventilation. They underwent thoracentesis with the placement of a chest drain. Due to the worsening of the underlying disease, all three patients died. Discussion: Pneumothorax
associated with COVID-19 has been reported in 1% of patients requiring hospitalization. Association between barotrauma and pneumothorax is observed in the intubated patients in ICU. Another pathogenetic mechanism is the diffuse alveolar damage caused by the virus with the formation of interstitial emphysema and pneumatocele. The surgical method of choice is thoracentesis. The outcome in patients with COVID-19 and pneumothorax depends on the severity of the underlying lung injury. Conclusion:
Pneumothorax is a rare but serious complication of COVID-19. It is often associated with poor outcome, especially in patients on mechanical ventilation.
Background
Despite the increasing evidence base for the use of cognitive behavioural interventions in nursing, the extent to which therapeutic interventions and their components are included in the undergraduate curriculum in Australia remains unclear.
Objectives
To explore if and how cognitive behavioural components are being taught to undergraduate nursing students. to deliver outcome benefits to students and patients.
Design
An integrative literature review reporting links between CBT components and methods taught in pre-registration nurse education.
Findings and Conclusion
Based on an analysis of current literature, it is suggested that evidence-based cognitive behavioural components are being taught to undergraduate nursing students. The study reports that teaching cognitive behavioural components can bring clinical benefits to positive patient outcome, to student wellbeing and study performance. However, the teaching of cognitive behavioural conceptual models as a therapeutic skill was found to be limited. Recommendations to incorporate a simple, evidence based cognitive behavioural conceptual tool, highlights how nurse educators can address the requirement to teach from the current evidence base.
This chapter focuses on helping residents increase their awareness of cognitive factors that influence emotional experience, which can contribute to either the development and maintenance of resilience or to an increased risk of burn-out. It highlights that thinking patterns develop and are maintained through experience and influence attributions and expectations that are important determinants of how one interprets experiences and interpersonal interactions. Incorporating mindfulness to increase tolerance of emotional experiences that cannot be shifted by changing cognition is discussed as a complementary approach to building resilience.
In this chapter, we present general concepts linked with the prescription of psychotropic treatments in psychodermatology, emphasizing the antidepressants, the antiepileptics, the antihistamines, the benzodiazepines and the psychobiotics, with basic principles applied to the main groups of psychodermatologic disorders. The management in psychodermatology is multifaceted, also including the skin care, depending on the type of dermatosis or skin illness. Complementary treatments, particularly, psychotherapy should be considered, depending on the psychopathology and its severity.
We report an extensive study which compares cognitive therapy, antidepressant drugs and a combination of these two, in depressed patients seen either in general practice or an out-patient department. One-hundred and forty patients were screened for primary major depression and 64 patients completed the trial. All were rated on seven measures of mood, including independent observer-rated and self-rated depression and scales of anxiety and irritability. Patients were randomly assigned to cognitive therapy, antidepressants or a combination of the two. The antidepressant drug group did less well in both hospital and general practice and combination treatment was superior to drug treatment in both hospital and general practice. In general practice, cognitive therapy was superior to drug treatment. The presence of endogenous features did not affect response to treatment. The results are discussed in terms of Beck's cognitive theory of depression and factors of presumed causal importance of depression in general practice.
Previous studies indicate that depressed patients with partial remission and residual symptoms following antidepressant treatment are common and have high rates of relapse. There is evidence that cognitive therapy may reduce relapse rates in depression.
One hundred fifty-eight patients with recent major depression, partially remitted with antidepressant treatment (mean daily doses equivalent to 185 mg of amitriptyline or 33 mg of fluoxetine) but with residual symptoms of 2 to 18 months' duration, were included in a controlled trial. Subjects were randomized to receive clinical management alone or clinical management plus cognitive therapy for 16 sessions during 20 weeks, with 2 subsequent booster sessions. Subjects were assessed regularly throughout the 20 weeks' treatment and for a further year. They received continuation and maintenance antidepressants at the same dose throughout.
Cognitive therapy reduced relapse rates for acute major depression and persistent severe residual symptoms, in both intention to treat and treated per protocol samples. The cumulative relapse rate at 68 weeks was reduced significantly, from 47% in the clinical management control group to 29% with cognitive therapy (hazard ratio 0.54; 95% confidence interval, 0.32-0.93; intention to treat analysis). Cognitive therapy also increased full remission rates at 20 weeks but did not significantly improve symptom ratings.
In this difficult-to-treat group of patients with residual depression who showed only partial response despite antidepressant treatment, cognitive therapy produced worthwhile benefit.
This study examined the cognitive mediation of relapse prevention by cognitive therapy (CT) in a trial of 158 patients with residual depression. Scores based on agreement with item content of 5 questionnaires of depression-related cognition provided no evidence for cognitive mediation. A measure of the form of response to those questionnaires, the number of times patients used extreme response categories ("totally agree" and "totally disagree"), showed significant and substantial prediction of relapse, differential response to CT, and conformity to mediational criteria. CT reduced relapse through reductions in absolutist. dichotomous thinking style. CT may prevent relapse by training patients to change the way that they process depression-related material rather than by changing belief in depressive thought content.
• Patients successfully treated during a 3-month period with either imipramine hydrochloride pharmacotherapy, cognitive therapy, or combined cognitive-pharmacotherapy were monitored during a 2-year posttreatment follow-up period. Half of the patients treated with pharmacotherapy alone continued to receive study medications for the first year of the follow-up. All other patients discontinued treatment at the end of the acute treatment phase. Patients treated with cognitive therapy (either alone or in combination with medication) evidenced less than half the rate of relapse shown by patients in the medication—on continuation condition, and their rate did not differ from that of patients provided with continuation medication. It appears that providing cognitive therapy during acute treatment prevents relapse. Whether this preventive effect extends to recurrence remains to be determined.
In the first three papers of this series (Williams & Garland, 2002 a, b ; Wright et al , 2002), we looked at the different areas of human experience that alter during times of mental illness. The Five Areas Assessment model (Williams, 2001; see Williams & Garland, 2002 a , Fig. 1) provides a clear summary of the range of problems and difficulties faced by individuals in each of the following domains: 1 life situation, relationships, practical problems
2 altered thinking
3 altered emotions (moods or feelings)
4 altered physical feelings/symptoms
5 altered behaviour or activity levels.
In the first article in this series (Williams & Garland, 2002) we encouraged readers to try out elements of the Five Areas model of cognitive–behavioural therapy (CBT) with some patients. Before we further discuss the model it might be of value to reflect on your experiences. If you did try, was it successful? Did it teach you anything about your clinical skills and the patients' problems? Can you build on this experience and use the Five Areas model more widely in your practice? If you did not try this out, why not? Were you prevented by internal factors (too busy, could not see the patient, thought you could not do it) or problems beyond your control (the patient failed to turn up)? How can you overcome these obstacles?
In the first two articles of this series (Williams & Garland, 2002; Wright et al, 2002), we looked at the different areas of human experience that alter during times of mental illness. The Five Areas Assessment model (Williams, 2001; see also Fig. 1 of Williams & Garland, 2002) provides a clear summary of the range of problems and difficulties faced by the individual in each of the following domains: 1 life situation, relationships, practical problems
2 altered thinking
3 altered emotions (moods or feelings)
4 altered physical feelings/symptoms
5 altered behaviour or activity levels.
This article reviews the cognitive therapy of depression. The psychotherapy based on this theory consists of behavioral and verbal techniques to change cognitions, beliefs, and errors in logic in the patient's thinking. A few of the various techniques are described and a case example is provided. Finally, the outcome studies testing the efficacy of this approach are reviewed.
Patients successfully treated during a 3-month period with either imipramine hydrochloride pharmacotherapy, cognitive therapy, or combined cognitive-pharmacotherapy were monitored during a 2-year posttreatment follow-up period. Half of the patients treated with pharmacotherapy alone continued to receive study medications for the first year of the follow-up. All other patients discontinued treatment at the end of the acute treatment phase. Patients treated with cognitive therapy (either alone or in combination with medication) evidenced less than half the rate of relapse shown by patients in the medication--no continuation condition, and their rate did not differ from that of patients provided with continuation medication. It appears that providing cognitive therapy during acute treatment prevents relapse. Whether this preventive effect extends to recurrence remains to be determined.
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