Peter J. Norton’s research while affiliated with Cairnmillar Institute and other places

The objective of the study was to adapt the Courage Scale and estimate validity evidence based on content and internal structure. The study included 510 young people, between 14 and 19 years old. The results of the content validity coefficient suggested the adequacy of the content. Confirmatory factor analysis (CFA) was used to test three factor models, namely one-factor, two-factor, and the random intercept model. The results indicated that it is possible to measure courage through a factor, when the acquiescent response style is controlled, corroborating the theoretical perspective, given that the random intercept model adjusted well to the sample data. In other words, the findings indicate that the scale is capable of measuring courage in the Brazilian context and that acquiescence control is an important method in evaluating the construct.

Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.

Aim: To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. Methods: Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. Results: The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of$6,642/QALY. The probability at a WTP threshold of $20,000 and$40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. Conclusion: tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.

Background Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU). Methods This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed. Results Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. Conclusions The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination. Trial registration ClinicalTrials.gov: NCT02811458, 23/06/2016

Sudden gains, incidences of unexpectedly large and stable session to session symptom reductions during psychotherapy, have been shown in samples of individuals receiving treatment for both anxiety and depressive disorders, although seemingly more frequently in sample receiving treatment for depressive disorders. This may suggest that sudden gains are a function of depression, but the high comorbidity between anxiety and depressive disorders makes this difficult to assess. Study One utilised a sample of 117 adults undergoing CBT for a principal anxiety disorder to explore the effect of comorbid depression on sudden gain prevalence. Results indicated that sudden gains were not more prevalent in the comorbid depression group; however, the frequency of sudden gains was significantly related to comorbid depressive disorder severity. Study Two involved a meta-analysis of 48 studies to compare sudden gain prevalence between trials of CBT for depressive disorders versus anxiety-related disorders. The results of the meta-analysis indicated significantly higher rates of sudden gains in samples with a principal depressive disorder diagnosis, compared to a principal anxiety disorder diagnosis. Sudden gains may therefore be driven by depression, but only at the more severe level.

Introduction: Anxiety disorders are the most prevalent among the mental health disorders and have a negative impact on an individual's life. Cognitive behaviour therapy (CBT) is documented as the most effective treatment for anxiety disorders. However, challenges associated with implementing diagnosis-specific CBT have led to transdiagnostic approaches of CBT (tCBT). tCBT uses a single protocol with core elements of CBT for treatment of anxiety disorders broadly. The aim of the current study is to examine whether participants with different principal anxiety diagnoses demonstrate similar anxiety reduction. Methods: The current study involved a secondary analysis of 117 participants randomly allocated to receive tCBT for anxiety disorders in a pragmatic randomised effectiveness trial. Beck Anxiety Inventory (BAI) and Clinician Severity Ratings (CSR) scales were administered at pre- and post-treatment and one-year follow-up, while the Anxiety Disorder Diagnostic Questionnaire - Weekly (ADDQ-W) was administered each session. Results: Mixed-factorial analyses of variance (ANOVAs) indicated that participants with GAD, SAD and PD/A improved to post-treatment and maintained to follow-up, with no differential improvement across principal diagnoses. Mixed effect regression modelling of session by session measures indicated non-differential negative slopes across principal diagnoses of GAD, SAD and PD/A. Conclusion: Overall, results indicate that group tCBT for anxiety disorders shows equal effectiveness for GAD, PD/A, and SAD in real-world conditions.

Background This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone. Methods This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included. Results Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89 Conclusions From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.

Haemopoietic stem-cell transplantation (HSCT) can be a highly distressing procedure that negatively impacts quality of life (QoL). Self-help interventions can help improve psychopathology and wellbeing in patients with physical illness, but have rarely been trialled with HSCT recipients. This study aimed to pilot the utility of a self-help manual intervention during the acute phase of HSCT. Forty autologous and allogeneic HSCT candidates were randomly assigned to a self-help manual intervention or treatment as usual (TAU). Psychological distress (BSI-18) and QoL (FACT-BMT-Vs4) were measured pre-, 2–3 weeks and 3 months post-HSCT. Linear mixed-effects analyses showed no significant group-time interaction for global QoL (p = .199) or global distress (p = .624). However, highlighting a protective role during admission, manual participants showed minimal QoL or somatic distress change at 2–3 weeks post-transplant compared with moderate-large effects for reduced QoL (d = 0.62) and increased somatic distress (d = − 0.81) for TAU patients. Thematic analysis suggests the manual helped prepare patients for transplant and provided strategies to improve distress and QoL. This pilot provides preliminary evidence for the benefit of a self-help manual during hospitalisation for a HSCT. More intensive, recovery-focussed care, however, may be needed to improve psychological health in the post-hospital period. Retrospectively registered trial (ANZCTR No. 12620001165976, 6th November 2020).

La thérapie cognitivo-comportementale (TCC) est un traitement des troubles anxieux basé sur des données probantes. Au moment d’initier une TCC, il n’est pas rare que les patients utilisent un traitement pharmacologique, généralement des antidépresseurs. Les benzodiazépines sont également couramment utilisées, bien qu’elles soient recommandées comme traitement d’appoint et à court terme en raison de leurs effets secondaires. Cette étude, reposant sur une méthodologie mixte imbriquée à un essai contrôlé randomisé d’une intervention de TCC transdiagnostique de groupe (TCCt), visait à explorer l’effet de la prise de benzodiazépines avant la TCCt ainsi que l’expérience des participants quant à leur utilisation de cette médication avant, pendant et après la psychothérapie. Le groupe expérimental a reçu la TCCt et les soins usuels (SU; n = 117) durant 12 semaines; le groupe témoin a reçu les SU (n = 114). Les symptômes d’anxiété ont été évalués par l’Inventaire d’anxiété de Beck (IAB). Les différences pré- et post- IAB avec la prise de benzodiazépines au cours des 12 derniers mois, la TCCt ainsi que leur interaction ont été examinées au moyen d’une analyse de régression linéaire multiple. Des entretiens semi-structurés ont été menés auprès de 13 participants ayant déclaré avoir utilisé des benzodiazépines 12 mois avant le début du traitement. Le contenu des entretiens a été analysé au moyen d’une approche descriptive interprétative. Les résultats quantitatifs suggèrent que la TCCt a influencé significativement la diminution des symptômes anxieux, mais que cet effet était non différentiel quant à la prise de benzodiazépines 12 mois avant la TCCt. Les résultats qualitatifs ont nuancé l’utilité perçue des benzodiazépines. Les participants ont rapporté que l’usage de benzodiazépines avait facilité le partage durant la thérapie de groupe et la réalisation d’exercices d’exposition. Malgré certains avantages, des participants ont perçu que les benzodiazépines avaient pu nuire à l’efficacité des exercices d’exposition et à l’acquisition de concepts en raison de leur effet sédatif. Cette étude met en lumière l’importance de sensibiliser les thérapeutes et les patients aux effets potentiels des benzodiazépines dans le cadre d’une TCCt.

Introduction Cognitive-behavioral therapy (CBT) is recognized as an effective treatment for anxiety disorders. Transdiagnostic group CBT (tCBT) targets cognitive and behavioural intervention strategies common to anxiety disorders. tCBT allows the treatment of a larger number of patients simultaneously and therapists only need to master a single intervention protocol. However, tCBT may present several challenges for therapists, particularly regarding group management. Objectives To explore therapists’ perceptions and experience of group management during tCBT for mixed anxiety disorders. Methods A qualitative study embedded in a randomized controlled trial of group tCBT (Roberge & Provencher; CIHR, 2015-2021). Semi-structured interviews were conducted with 18 of the 21 therapists to document their perceptions and to identify improvements for tCBT delivery. The data were analyzed using a deductive approach and based on the interactive cyclical process of data reduction, display and conclusion drawing. Results Therapists raised the challenge of the heterogeneous characteristics of participants’ anxious profile, since they had to be creative to provide exercises that were suitable for a whole group. Exposure exercises, a key component of tCBT, were particularly affected by the composition of the groups. Previous group animation experience and the ability to establish a therapeutic alliance from a group perspective were important facilitators. Co-therapy also facilitated the intervention, since it allowed the therapists to be more vigilant to group dynamics and favored the organization of tCBT. Conclusions This study highlights the importance of exploring therapists’ perceptions and experience about group management in order to identify facilitators and barriers of group tCBT in community-based care. Disclosure No significant relationships.