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Dalton B, Davies MR, Flynn M, Hutchings-Hay C, Potterton R, Breen O'Byrne E, Kilonzo C, Belli SR, Gallop L, Gordon G, Keeler J, Minnock I, Phillips M, Robinson L, Snashall E, Toloza C, Walo L, Cole J, Schmidt U. Virtually delivered guided self-help for binge eating disorder and bulimia nervosa: findings from a service evaluation. Behav Cogn Psychother 2024; 52:211-225. [PMID: 38263907 DOI: 10.1017/s1352465823000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Timely intervention is beneficial to the effectiveness of eating disorder (ED) treatment, but limited capacity within ED services means that these disorders are often not treated with sufficient speed. This service evaluation extends previous research into guided self-help (GSH) for adults with bulimic spectrum EDs by assessing the feasibility, acceptability, and preliminary effectiveness of virtually delivered GSH using videoconferencing. METHOD Patients with bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding and eating disorders (OSFED) waiting for treatment in a large specialist adult ED out-patient service were offered virtually delivered GSH. The programme used an evidence-based cognitive behavioural self-help book. Individuals were supported by non-expert coaches, who delivered the eight-session programme via videoconferencing. RESULTS One hundred and thirty patients were allocated to a GSH coach between 1 September 2020 and 30 September 2022; 106 (82%) started treatment and 78 (60%) completed treatment. Amongst completers, there were large reductions in ED behaviours and attitudinal symptoms, measured by the ED-15. The largest effect sizes for change between pre- and post-treatment were seen for binge eating episode frequency (d = -0.89) and concerns around eating (d = -1.72). Patients from minoritised ethnic groups were over-represented in the non-completer group. CONCLUSIONS Virtually delivered GSH is feasible, acceptable and effective in reducing ED symptoms amongst those with bulimic spectrum disorders. Implementing virtually delivered GSH reduced waiting times, offering a potential solution for long waiting times for ED treatment. Further research is needed to compare GSH to other brief therapies and investigate barriers for patients from culturally diverse groups.
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Affiliation(s)
- Bethan Dalton
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Molly R Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Chloe Hutchings-Hay
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Rachel Potterton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eleanor Breen O'Byrne
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Charmaine Kilonzo
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Stefano R Belli
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Lucy Gallop
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gemma Gordon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johanna Keeler
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Imelda Minnock
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Matthew Phillips
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lauren Robinson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emma Snashall
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Cindy Toloza
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Luiza Walo
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Jason Cole
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Ulrike Schmidt
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Li SX, Cheung FTW, Chan NY, Chan JWY, Zhang J, Li AM, Espie CA, Gradisar M, Wing YK. Effects of cognitive behavioural therapy and bright light therapy for insomnia in youths with eveningness: study protocol for a randomised controlled trial. Trials 2024; 25:246. [PMID: 38594725 PMCID: PMC11005158 DOI: 10.1186/s13063-024-08090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Insomnia and eveningness are common and often comorbid conditions in youths. While cognitive behavioural therapy for insomnia (CBT-I) has been suggested as a promising intervention, it remains unclear whether it is sufficient to also address circadian issues in youths. In addition, despite that light has been shown to be effective in phase-shifting one's circadian rhythm, there has been limited data on the effects of bright light therapy and its combination with CBT-I on sleep and circadian outcomes in youths. The current protocol outlines a randomised controlled trial that examines the efficacy of CBT-I and CBT-I plus bright light therapy (BLT) in reducing insomnia severity, improving mood symptoms and daytime functioning (e.g. sleepiness, fatigue, cognitive function), and improving subjective and objective sleep and circadian measures compared to a waitlist control group. METHODS We will carry out a randomised controlled trial (RCT) with 150 youths aged 12-24 who meet the criteria of insomnia and eveningness. Participants will be randomised into one of three groups: CBT-I with bright light therapy, CBT-I with placebo light, and waitlist control. Six sessions of CBT-I will be delivered in a group format, while participants will be currently asked to use a portable light device for 30 min daily immediately after awakening throughout the intervention period for bright light therapy. The CBT-I with light therapy group will receive bright constant green light (506 lx) while the CBT-I with placebo light group will receive the modified light device with the LEDs emitting less than 10 lx. All participants will be assessed at baseline and post-treatment, while the two active treatment groups will be additionally followed up at 1 month and 6 months post-intervention. The primary outcome will be insomnia severity, as measured by the Insomnia Severity Index. Secondary outcomes include self-reported mood, circadian, daytime functioning, and quality of life measures, as well as sleep parameters derived from actigraphy and sleep diary and neurocognitive assessments. Objective measures of the circadian phase using dim-light melatonin onset assessment and sleep parameters using polysomnography will also be included as the secondary outcomes. DISCUSSION This study will be the first RCT to directly compare the effects of CBT-I and BLT in youths with insomnia and eveningness. Findings from the study will provide evidence to inform the clinical management of insomnia problems and eveningness in youths. TRIAL REGISTRATION ClinicalTrials.gov NCT04256915. Registered on 5 February 2020.
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Affiliation(s)
- Shirley Xin Li
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
| | - Forrest Tin Wai Cheung
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medicine University, Guangzhou, Guangdong, China
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences and Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Tjokrowijoto P, Thomas S, Kneebone I, Ryan B, Stolwyk RJ. Aphasia, depression, and psychological therapy (ADaPT): A single case design evaluation of a modified cognitive behavioural therapy to treat depressive symptoms in stroke survivors with aphasia. Neuropsychol Rehabil 2024:1-45. [PMID: 38584439 DOI: 10.1080/09602011.2024.2331840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
Cognitive behavioural therapy (CBT) can effectively treat depression in the general population, but there is a lack of studies evaluating CBT tailored to specific cognitive and communication needs of individuals with post-stroke aphasia. We aimed to evaluate the feasibility and preliminary efficacy of a modified CBT intervention to ameliorate depressive symptoms. An ABA withdrawal/reversal single case design with concurrent multiple baselines (2.5, 4.5, or 6.5 weeks) was repeated across 10 participants (six male, four female) with post-stroke aphasia and self-reported depression. Participants completed 10 individual intervention sessions with a clinical neuropsychologist and a 4-week follow-up. The primary outcome was self-rated depression, and secondary outcomes included observer-rated symptoms of depression and anxiety. Data were analysed visually and statistically controlling for baseline trend. Feasibility was addressed by analysing recruitment and retention rates, treatment adaptations, and fidelity ratings. Three participants self-reported decreased depression levels during the intervention phase, which was sustained for two participants. Four additional participants improved during the follow-up phase. Close others reported sustained improvements in depressive symptoms (six participants) and anxiety symptoms (seven participants). Modified CBT appears feasible and potentially efficacious in reducing depressive symptoms in post-stroke aphasia. A randomized controlled trial is warranted, and should consider additional treatment sessions.
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Affiliation(s)
- Priscilla Tjokrowijoto
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Stroke and Telehealth Research, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | | | - Ian Kneebone
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Australia
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Brooke Ryan
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Australia
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Stroke and Telehealth Research, Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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Wannemueller A, Margraf J, Busch M, Jöhren HP, Suchan B. More than fear? Brain activation patterns of dental phobic patients before and after an exposure-based treatment. J Neural Transm (Vienna) 2024; 131:393-404. [PMID: 38424282 PMCID: PMC11016127 DOI: 10.1007/s00702-024-02754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Hyperactivation of brain networks conferring defensive mobilization is assumed to underlie inappropriate defensive-preparation in patients with Specific Phobia. However, studies targeting Dental Phobia (DP) yielded quite heterogeneous results and research concerning the effects of exposure treatments on phobic brain activation so far is missing. This functional Magnetic Resonance Imaging (fMRI) study aimed to investigate activation patterns in DP patients during exposure to phobia-related stimuli and the effects of an exposure-based fear treatment on phobia-related activation. Seventeen patients with DP and seventeen non-phobic, healthy controls participated in this fMRI experiment presenting dental-related and neutral auditory and visual stimuli. After completing a short exposure-based CBT program, patients were scanned a second time to illustrate treatment-related changes in brain activation patterns. Pre-treatment fMRI results demonstrate enhanced activation in DP-patients mainly in the precuneus and lateral parietal cortex. Moreover, a small activation focus was observed in the amygdala and anterior cingulate cortex (ACC) as parts of classically fear-related structures. Activation in all these clusters decreased significantly from pre- to post-treatment assessment and in the case of the ACC was correlated with dental fear reduction. Activation changes in the precuneus and lateral parietal cortex suggest a pronounced first-person perspective memory processing including a vivid recall of contextual information from an egocentric perspective triggered by exposure to phobia-related stimuli. Besides a treatment-sensitive hyperactivity of fear-sensitive structures, DP may also be characterized by a disturbed memory retrieval that can be reorganized by successful exposure treatment.
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Affiliation(s)
- André Wannemueller
- Center for the Study and Treatment of Mental Health, Ruhr University Bochum, Massenbergstr. 9-13, 44787, Bochum, Germany.
| | - Jürgen Margraf
- Center for the Study and Treatment of Mental Health, Ruhr University Bochum, Massenbergstr. 9-13, 44787, Bochum, Germany
| | - Martin Busch
- Grönemeyer-Institut for Microtherapy, Bochum, Germany
| | | | - Boris Suchan
- Clinical Neuropsychology, Neuropsychological Therapy Centre, Ruhr University, Bochum, Germany
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Eriksson-Liebon M, Westas M, Johansson P, Mourad G. Long-term effects and predictors of change of internet-delivered cognitive behavioural therapy on cardiac anxiety in patients with non-cardiac chest pain: a randomized controlled trial. BMC Psychiatry 2024; 24:216. [PMID: 38504157 PMCID: PMC10953164 DOI: 10.1186/s12888-024-05661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Approximately half of patients who seek care at Emergency Departments due to chest pain are diagnosed with Non-Cardiac Chest Pain (NCCP). Concerns for heart disease and misinterpretation of the symptoms increase cardiac anxiety and have a negative impact on patients' lives. Psychological interventions such as internet-delivered cognitive behavioral therapy (iCBT) are effective in treating psychological conditions such as anxiety, by helping patients to learn how to manage chest pain. AIMS To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and secondary outcomes, as bodily sensations, depressive symptoms, health-related quality of life and chest pain frequency in patients with NCCP at 6- and 12-month follow-up, and to explore predictors that can have impact on the effects of the iCBT program on psychological distress. METHODS A longitudinal study of a Randomized Controlled Trial (RCT) evaluating the long-term effects of an iCBT program (n = 54) in patients with NCCP, compared to psychoeducation (n = 55). The primary outcome, cardiac anxiety was measured using the Cardiac Anxiety Questionnaire (CAQ), and the secondary outcomes were measured with The Body Sensations Questionnaire (BSQ), Patient Health Questionnaire-9 (PHQ-9), The EuroQol Visual Analog Scale (EQ-VAS) and a self-developed question to measure chest pain frequency. All measurements were performed before and after the intervention, and 3, 6 and 12 months after the intervention. Linear mixed model was used to test between-group differences in primary and secondary outcomes and multiple regression analysis was used to explore factors that may have an impact on the treatment effect of iCBT on cardiac anxiety. RESULTS A total of 85% (n = 93/109) participants completed the 12-month follow-up. Mixed model analysis showed no statistically significant interaction effect of time and group between the iCBT and psychoeducation groups regarding cardiac anxiety over the 12-month follow-up. However, there was a statistically significant interaction effect of time and group (p = .009) regarding chest pain frequency favouring the iCBT group. In addition, we found a group effect in health-related quality of life (p = .03) favouring the iCBT group. The regression analysis showed that higher avoidance scores at baseline were associated with improvement in cardiac anxiety at 12-month follow-up. CONCLUSIONS Cardiac anxiety was reduced in patients with NCCP, but iCBT was not more effective than psychoeducation. Patients with a high tendency to avoid activities or situations that they believe could trigger cardiac symptoms may benefit more from psychological interventions targeting cardiac anxiety. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov NCT03336112 on 08/11/2017.
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Affiliation(s)
- Magda Eriksson-Liebon
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Department of Emergency Medicine in Norrköping, and, Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden.
| | - Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine in Norrköping, and, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Pan MR, Dong M, Zhang SY, Liu L, Li HM, Wang YF, Qian QJ. One-year follow-up of the effectiveness and mediators of cognitive behavioural therapy among adults with attention-deficit/hyperactivity disorder: secondary outcomes of a randomised controlled trial. BMC Psychiatry 2024; 24:207. [PMID: 38491411 PMCID: PMC10943890 DOI: 10.1186/s12888-024-05673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The long-term effectiveness of cognitive behavioural therapy (CBT) in medicated attention-deficit/hyperactivity disorder (ADHD) adults with residual symptoms needs to be verified across multiple dimensions, especially with respect to maladaptive cognitions and psychological quality of life (QoL). An exploration of the mechanisms underlying the additive benefits of CBT on QoL in clinical samples may be helpful for a better understanding of the CBT conceptual model and how CBT works in medicated ADHD. METHODS We conducted a secondary analysis of a randomised controlled trial including 98 medicated ADHD adults with residual symptoms who were randomly allocated to the CBT combined with medication (CBT + M) group or the medication (M)-only group. Outcomes included ADHD-core symptoms (ADHD Rating Scale), depression symptoms (Self-rating Depression Scale), maladaptive cognitions (Automatic Thoughts Questionnaire and Dysfunctional Attitude Scale), and psychological QoL (World Health Organization Quality of Life-Brief Version-psychological domain). Mixed linear models (MLMs) were used to analyse the long-term effectiveness at one-year follow-up, and structural equation modeling (SEM) was performed to explore the potential mechanisms of CBT on psychological QoL. RESULTS ADHD patients in the CBT + M group outperformed the M-only group in reduction of ADHD core symptoms (d = 0.491), depression symptoms (d = 0.570), a trend of reduction of maladaptive cognitions (d = 0.387 and 0.395, respectively), and improvement of psychological QoL (d = - 0.433). The changes in above dimensions correlated with each other (r = 0.201 ~ 0.636). The influence of CBT on QoL was mediated through the following four pathways: 1) changes in ADHD core symptoms; 2) changes in depressive symptoms; 3) changes in depressive symptoms and then maladaptive cognitions; and 4) changes firstly in depressive symptoms, maladaptive cognitions, and then ADHD core symptoms. CONCLUSIONS The long-term effectiveness of CBT in medicated ADHD adults with residual symptoms was further confirmed. The CBT conceptual model was verified in clinical samples, which would be helpful for a deeper understanding of how CBT works for a better psychological QoL outcome. TRIAL REGISTRATION ChiCTR1900021705 (2019-03-05).
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Affiliation(s)
- Mei-Rong Pan
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Min Dong
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Shi-Yu Zhang
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Lu Liu
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Hai-Mei Li
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Yu-Feng Wang
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Qiu-Jin Qian
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
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Gonda X, Balint S, Rethelyi JM, Dome P. Settling a distracted globe: An overview of psychosocial and psychotherapeutic treatment of attention-deficit/hyperactivity disorder. Eur Neuropsychopharmacol 2024; 83:1-8. [PMID: 38490015 DOI: 10.1016/j.euroneuro.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
While the currently prevailing theory of ADHD postulates a neurobiological background and core deficits of behavioural inhibition and executive functioning as the basis of ADHD symptoms, our current conceptualisation also acknowledges the essential contributory role of psychosocial, ecological, and cognitive factors. Considering the multifactorial background of ADHD, its treatment equally needs to be multifactorial involving, besides pharmacotherapy, skill development and psychotherapy as well, especially if we postulate the increasing contribution of social factors in the background of the increasing burden of ADHD. Pharmacotherapies, including stimulants and non-stimulant ADHD medications applied as first-line treatments have a positive effect on core behavioural symptoms, however, they often do not sufficiently remediate several other symptoms and comorbid disorders, which are consequences of ADHD, especially considering that ADHD persists into adulthood and is present over the whole life span. Furthermore, pharmacological treatment is not sufficient to substitute for the skills needed to manage symptoms and adapt well to the environment. As part of a multimodal treatment approach, psychological therapies for ADHD target, besides core ADHD symptoms, other associated features including emotional dysregulation, personality development, neurocognitive dysfunction, depression, anxiety, and sleep problems. Insufficiently treated ADHD may contribute to psychological and personality developmental problems in children, as well as increased health costs and decreased productivity warranting multimodal treatment to address the areas not sufficiently targeted by ADHD-specific pharmacotherapy.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Sara Balint
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
| | - Janos Miklos Rethelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
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Hards E, Hsu TC, Joshi G, Ellis J, Reynolds S. 'Who will I become?': possible selves and depression symptoms in adolescents - CORRIGENDUM. Behav Cogn Psychother 2024:1-2. [PMID: 38444244 DOI: 10.1017/s1352465824000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Lee R, McMillan D, Delgadillo J, Alexander R, Lucock M. Cognitive change before sudden gains in cognitive behavioural therapy for panic disorder. Behav Cogn Psychother 2024; 52:107-118. [PMID: 37821240 DOI: 10.1017/s1352465823000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Sudden gains occur in a range of disorders and treatments and are of clinical and theoretical significance if they can shed light on therapeutic change processes. This study investigated the relationship between sudden gains in panic symptoms and preceding cognitive change during cognitive behavioural therapy (CBT) for panic disorder. METHOD Participants with panic disorder completed in session measures of panic symptoms and catastrophic cognitions. Independent samples t-tests were used to compare the post-treatment score of those who met criteria for one or more sudden gain during treatment with those who did not, and to compare within-session cognitive change between pre-sudden gain sessions and the previous (control) session. RESULTS Twenty-two (42%) of 53 participants experienced a sudden gain during treatment. Participants demonstrating a sudden gain showed more improvement in panic symptoms from pre- to post-treatment than those without a sudden gain. The within-session cognitive change score in the pre-gain session was significantly greater than in the control session. CONCLUSIONS Sudden gains occurred in individual CBT for panic disorder and within-session cognitive change was associated with sudden gains. This is consistent with the cognitive model of panic disorder and highlights how sudden gains can help to identify key change processes.
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Affiliation(s)
- Rachel Lee
- South West Yorkshire Partnership NHS Foundation Trust, Fieldhead, Wakefield, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, Mental Health and Addiction Research Group, University of York, Heslington, York, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Rachael Alexander
- South West Yorkshire Partnership NHS Foundation Trust, Fieldhead, Wakefield, UK
| | - Mike Lucock
- University of Huddersfield, Huddersfield, UK
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Falshaw L, Clatworthy L. Cognitive behavioural therapy for depression and anxiety in a carer for two family members with dementia: a single case experimental design study. Behav Cogn Psychother 2024; 52:194-199. [PMID: 37994475 DOI: 10.1017/s135246582300053x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Evidence suggests that cognitive behavioural therapy (CBT) can be a helpful approach for older adults experiencing anxiety and depression. Some research has suggested this is also the case for those caring for a family member with dementia. Little research has been conducted into the impact of CBT for older adults juggling the demands of caring for multiple family members with dementia. AIMS This case study aimed to evaluate the application of CBT to 'Mrs P', a 68-year-old client experiencing anxiety and depression whilst caring for two family members with dementia. METHOD A single case experimental design study was conducted to assess the effectiveness of CBT formulation and intervention, including cognitive restructuring of unhelpful thoughts about caregiving and increasing engagement in pleasurable activities. RESULTS Mrs P's depression and anxiety scores improved significantly throughout treatment, and she met her goal of being able to manage when caregiving activities go wrong during daily life. CONCLUSIONS CBT may be a helpful approach to reducing anxiety and depression in dementia family caregivers.
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Affiliation(s)
- Lawson Falshaw
- The Oxford Institute of Clinical Psychology Training and Research, Oxford, UK
| | - Leah Clatworthy
- Central and Northwest London NHS Foundation Trust, London, UK
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Xu H, Cai J, Sawhney R, Jiang S, Buys N, Sun J. The Effectiveness of Cognitive-Behavioral Therapy in Helping People on Sick Leave to Return to Work: A Systematic Review and Meta-analysis. J Occup Rehabil 2024; 34:4-36. [PMID: 37067701 PMCID: PMC10899273 DOI: 10.1007/s10926-023-10116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Previous research has systematically studied the effectiveness of Cognitive Behavioral Therapy (CBT)-based interventions in managing both mental and physical symptoms of chronic disease including depression, stress-related mental disorders (SMD), and chronic pain that are common causes of sick leave. However, a systematic review focusing on the effectiveness of CBT in facilitating RTW is lacking. This study compiles research on utilizing CBT-based interventions for helping employees on sick leave return to work. METHODS Randomized controlled trials (RCT) published between 1 January 1990 and 27 June 2022 were searched in MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, Web of Science, and PubMed. The primary outcome variables included a return to work (RTW) measure and sickness absences. The secondary outcomes include psychological conditions (mental illness, stress, anxiety, and depression) and physical condition (working ability, fatigue, and physical function). RESULTS Thirty-four RCTs were included in the analysis. Fifteen RCTs with 1727 participants reported on sick leave. Results showed that participants who completed CBT intervention had reduced sick leave in days (mean reduction - 3.654; 95%CI - 5.253, - 2.046; p < 0.001) compared to the control group. Sixteen papers with 2298 participants reported that the intervention group RTW 1.5 days earlier (95%CI 1.019, 1.722; p < 0.05). CBT-based interventions were effective in managing fatigue, mental illness, and depression, and improving physical function while it showed no effects in managing stress, anxiety and working ability. CONCLUSIONS The findings indicate that CBT-based interventions are effective in reducing the length of sick leave and facilitating the RTW of employees in the intervention group.
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Affiliation(s)
- Huaying Xu
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Jinxuan Cai
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Rakshat Sawhney
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Stephen Jiang
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia
| | - Nicholas Buys
- Centre for Work, Organisation and Wellbing, Griffith University, Nathan, Q4215, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Nathan, Q4215, Australia.
- Institute for Integrated Intelligence and Systems, Griffith University, Nathan, Q4215, Australia.
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Wieland S, Melton S, Bastounis A, Carter T. The effectiveness of cognitive behavioural therapy for depression in women with breast cancer: a systematic review and meta-analysis. Behav Cogn Psychother 2024:1-20. [PMID: 38389281 DOI: 10.1017/s1352465824000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions. AIM To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer. METHOD Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck's protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures. RESULTS Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = -0.93 [95% CI -1.47, -0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer. CONCLUSION CBT aligned to Beck's protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck's CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly.
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Affiliation(s)
- Stephania Wieland
- Every Turn Services Ltd, Sir Bobby Robson Way, Newcastle upon Tyne, UK
| | - Sarah Melton
- Derbyshire NHS Foundation Trust, Kingsway Hospital, Derby, UK
| | - Anastasios Bastounis
- School of Health and Related Research (ScHARR), Regent Court, University of Sheffield, Sheffield, UK
| | - Tim Carter
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Seidel DH, Markes M, Grouven U, Messow CM, Sieben W, Knelangen M, Oelkers-Ax R, Grümer S, Kölsch H, Kromp M, von Pluto Prondzinski M. Systemic therapy in children and adolescents with mental disorders: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:125. [PMID: 38355466 PMCID: PMC10868021 DOI: 10.1186/s12888-024-05556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders. METHODS We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: "proof", "indication", or "hint" (or none of these categories). PRISMA standards were followed. RESULTS Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST. CONCLUSIONS Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders.
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Affiliation(s)
- David Henry Seidel
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany.
| | - Martina Markes
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Ulrich Grouven
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Claudia-Martina Messow
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Wiebke Sieben
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Marco Knelangen
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Rieke Oelkers-Ax
- Family Therapy Centre (Familientherapeutisches Zentrum gGmbH, FaTZ), Hermann-Walker-Straße 16, 69151, Neckargemünd, Germany
| | - Sebastian Grümer
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Heike Kölsch
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Mandy Kromp
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Markus von Pluto Prondzinski
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
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Henein A, Pascual-Sanchez A, Corciova S, Hodes M. Obsessive-compulsive disorder in treatment seeking children & adolescents during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2024; 33:629-632. [PMID: 36042061 PMCID: PMC9427161 DOI: 10.1007/s00787-022-02071-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have investigated the COVID-19 pandemic's effect on children and adolescents with obsessive-compulsive disorder (OCD). This study aims to investigate whether the pandemic is associated with increased referral of young people with OCD, any changes in their symptom severity and treatment offered. METHODS Service data were used to investigate 58 young people (8-17 years) referred and assessed in the Central and Northwest London NHS Foundation Trust Child and Adolescent Mental Health Service (CAMHS), before and during the COVID-19 pandemic (months March-October 2018-2020). Changes in symptom severity were measured using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). Patient records were reviewed to assess if COVID-19 had exacerbated symptoms. Type of treatment offered was compared. RESULTS 26 (5.62%) assessments to CAMHS related to OCD in 2020, compared to 12 (1.30%) and 20 (2.27%) assessments pre-pandemic (2018 and 2019), showing a significant increase in the proportion of OCD cases (X2 (1, N = 58) = 20.3, p < 0.001). There was no significant difference in any HoNOSCA dimensions on initial assessment. However, 69.2% of patients in 2020 showed symptom worsening over the COVID-period, versus 46.7% of cases first assessed pre-pandemic. Significantly more patients were discharged without being offered treatment pre-pandemic (X2 (2, N = 58) = 12.7, p = 0.002). In 2020, there was an 8.5% increase in the frequency of medication offered. DISCUSSION The proportion of OCD cases in CAMHS increased in 2020 despite the overall number of CAMHS referrals falling. Furthermore, many cases reportedly worsened during the pandemic, and services will need to address the increased burden of more severe cases. Further larger investigation of this subject is warranted.
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Affiliation(s)
- Anthony Henein
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Ana Pascual-Sanchez
- Division of Psychiatry, Imperial College London, 2nd Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | | | - Matthew Hodes
- Division of Psychiatry, Imperial College London, 2nd Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
- Westminster Child and Adolescent Mental Health Service, Central and North West, London NHS Foundation Trust, London, UK.
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15
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Bal Z, Uçar T. The effect of cognitive behavioural therapy and eye movement desensitization and reprocessing techniques on infertile women: a randomized controlled trial. Reprod Biomed Online 2024; 48:103612. [PMID: 38199076 DOI: 10.1016/j.rbmo.2023.103612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/09/2023] [Accepted: 10/09/2023] [Indexed: 01/12/2024]
Abstract
RESEARCH QUESTION What effects do training programmes based on cognitive behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) techniques applied to infertile women affected psychologically and emotionally by infertility have on post-traumatic stress disorder (PTSD) and psychological development? DESIGN This randomized controlled study was conducted between May 2021 and August 2022. The study population included 90 infertile women referred to the IVF unit of a hospital in a province in eastern Turkey: 30 in the CBT group, 30 in the EMDR group and 30 in the control group. Data were collected using a personal information form, the Subjective Units of Disturbance Scale (SUDS), the Validity of Cognition (VoC) scale, the Infertility Distress Scale (IDS), the Impact of Event Scale-Revised (IES-R) and the Post-traumatic Growth Inventory (PTGI). Women in the experimental groups (CBT and EMDR groups) received the intervention in six sessions over 3 weeks. Pre-tests were administered to both experimental groups and the control group, and post-tests were conducted 3 weeks after the intervention. RESULTS The mean scores on the SUDS, IDS and IES-R for women in the experimental groups were significantly lower compared with those for women in the control group following the interventions (P < 0.001). The mean scores on the VoC scale and PTGI for women in the experimental groups were significantly higher compared with those for women in the control group following the interventions (P < 0.001). CONCLUSION The use of CBT and EMDR techniques reduced the negative psychological and emotional effects of infertility among infertile women.
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Affiliation(s)
- Zeynep Bal
- Department of Midwifery, Faculty of Health Sciences, Gaziantep Islamic Science and Technology University, Gaziantep, Turkey.
| | - Tuba Uçar
- Department of Midwifery, Faculty of Health Sciences, Inonu University, Malatya, Turkey
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16
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Chung S, Cho IK, Kim J, Lee D, Cho E, Choi JM, Ha TK, Lee YJ, Kim JH, Choi JH. Efficacy and safety of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I): a pilot study. J Sleep Res 2024; 33:e14039. [PMID: 37704214 DOI: 10.1111/jsr.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
The aim of this study was to evaluate the safety and efficacy of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I) and compare them with those of digital application of Cognitive Behavioural Therapy for Insomnia (dCBT-I). This randomised prospective pilot study was conducted at the Asan Medical Center. A total of 50 patients with insomnia were recruited between December 2022 and January 2023 and randomly allocated to the dSIBT-I or dCBT-I group. The study was carried out for one month. The primary outcome was the significant reduction in Insomnia Severity Index score at Week 4 compared to baseline, while the secondary outcome was proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4. We performed linear mixed model and generalised estimating equation analyses. Both dSIBT-I and dCBT-I groups showed significant improvements in Insomnia Severity Index scores at Week 4. There was no significant difference between two groups in terms of Insomnia Severity Index scores at Week 4 (group × time effect, F = 1.07, p = 0.382) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4 (group × time effects, F = 1.80, p = 0.615). However, at Week 2, the dSIBT-I group showed better results than the dCBT-I group in terms of both Insomnia Severity Index scores (p = 0.044) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 (82.6% vs. 48.0%, p = 0.017). No treatment-emergent adverse events were reported in either group. The dSIBT-I is a safe and effective therapy for insomnia, with rapid treatment effects.
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Affiliation(s)
- Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Inn-Kyu Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jiyoung Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dongin Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eulah Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Mun Choi
- Department of Literature and Art Therapy, Graduate School of Konkuk University, Seoul, South Korea
| | - Tae Kyoung Ha
- Honeynaps Research and Development Center, Honeynaps Co. Ltd, Seoul, South Korea
| | - Young Jun Lee
- Honeynaps Research and Development Center, Honeynaps Co. Ltd, Seoul, South Korea
| | - Ji Hyun Kim
- Honeynaps Research and Development Center, Honeynaps Co. Ltd, Seoul, South Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
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17
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Malivoire BL, Stewart KE, Cameron D, Rowa K, McCabe RE. Effectiveness and predictors of group cognitive behaviour therapy outcome for generalised anxiety disorder in an out-patient hospital setting. Behav Cogn Psychother 2024:1-16. [PMID: 38291658 DOI: 10.1017/s1352465823000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is an empirically supported treatment for generalized anxiety disorder (GAD). Little is known about the effectiveness of CBT for GAD in real-world treatment settings. AIM This study investigated the effectiveness of group CBT and predictors of treatment response in an out-patient hospital clinic. METHOD Participants (n = 386) with GAD participated in 12 sessions of group CBT at an out-patient clinic. Of those who provided at least partial data (n = 326), 84.5% completed treatment. Most questionnaires were completed at pre- and post-treatment; worry severity was assessed weekly. RESULTS Group CBT led to improvements in chronic worry (d = -0.91, n = 118), depressive symptoms (d = -1.22, n = 172), GAD symptom severity (d = -0.65, n = 171), intolerance of uncertainty (IU; d = -0.46, n = 174) and level of functional impairment (d = -0.35, n = 169). Greater pre-treatment GAD symptom severity (d = -0.17, n = 293), chronic worry (d = -0.20, n = 185), functional impairment (d = -0.12, n = 292), and number of comorbid diagnoses (d = -0.13, n = 299) predicted greater improvement in past week worry over treatment. Biological sex, age, depression symptom severity, number of treatment sessions attended, and IU did not predict change in past week worry over time. DISCUSSION These findings provide support for the effectiveness of group CBT for GAD and suggest the outcomes are robust and are either not impacted or are slightly positively impacted by several demographic and clinical factors.
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Affiliation(s)
- B L Malivoire
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - K E Stewart
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - D Cameron
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - K Rowa
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - R E McCabe
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Hards E, Hsu TC, Joshi G, Ellis J, Reynolds S. 'Who will I become?': possible selves and depression symptoms in adolescents. Behav Cogn Psychother 2024:1-12. [PMID: 38284269 DOI: 10.1017/s1352465823000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Adolescence is an important period for the development of the possible self. It is also a time when depression is prevalent. The cognitive theory of depression proposes that a negative view of the future is a key feature of depression. Targeting these negative thoughts about the future during cognitive behavioural therapy may be helpful in depression. However, little is known about how adolescents envisage their future (i.e. possible) self, or if the content is associated with affect. The aim of this quantitative study is to describe how adolescents describe their 'possible self' and examine the relationship between the valence of the possible self and depression in adolescents. METHOD Adolescents (n = 584) aged 13-18 years were recruited via opportunity sampling via their schools and completed measures of depression symptoms (the Mood and Feelings Questionnaire) and the 'possible self' (a variant of the 'I Will Be' task). Possible selves were coded for content and valence. RESULTS Despite depression severity, the most common possible selves generated by adolescents were positive and described interpersonal roles. The valence of the possible self was associated with depression severity but only accounted for 3.4% of the variance in severity. CONCLUSION The results support the cognitive model of depression. However, adolescents with elevated symptoms of depression were able to generate positive, possible selves and therefore may remain somewhat 'hopeful' about their future despite clinically significant depression symptoms. Future-oriented treatment approaches such as cognitive behavioural therapy that focus on changing unhelpful negative future thinking may not be appropriate for this population.
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Affiliation(s)
- Emily Hards
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Ting-Chen Hsu
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Gauri Joshi
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Judi Ellis
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Reading, UK
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Bennebroek Evertsz' F, Bockting CL, Braamse A, van Dissel MNM, Duijvestein M, Kager LM, Kool M, Löwenberg M, Mares W, Nieuwkerk P, Sipkema HA, Young Z, Knoop H. Implementation of 'IBD-Specific Cognitive Behavioural Therapy' for Patients with Inflammatory Bowel Diseases with Poor Mental Quality of Life, Anxiety and Depression. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09996-8. [PMID: 38281306 DOI: 10.1007/s10880-023-09996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
This paper describes the implementation of inflammatory bowel disease (IBD)-specific cognitive behavioural therapy (CBT) for IBD patients with poor quality of life (QoL), anxiety and depression, in four hospitals in the Netherlands. Treatment outcomes were compared with those of a previously published randomized control trial (RCT) of 'IBD-specific CBT', following a benchmark strategy. Primary outcome was IBD-specific QoL (IBDQ) completed before and after CBT, secondary outcomes were anxiety and depressive symptoms (HADS, CES-D). Semi-structured interviews were conducted among a pilot of gastroenterologists, nurse specialists and psychologists to evaluate 'IBD-specific CBT'. 94 patients started treatment (280 screened). At follow-up, 63 participants (67% compared to 81% in the RCT benchmark) completed the IBDQ. Treatment effect sizes of the implementation study were comparable and slightly larger than those of RCT benchmark. Gastroenterologists, IBD nurses and psychologists found CBT necessary for IBD patients with poor QoL, depression and/or anxiety disorders. 'IBD-specific CBT' can be successfully implemented. Regular supervision of psychologists performing 'IBD-specific CBT' treatment is needed.
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Affiliation(s)
- Floor Bennebroek Evertsz'
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Mafalda N M van Dissel
- Medicine Master's Student, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth M Kager
- Department of Gastroenterology and Hepatology, Noord-West Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Marianne Kool
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Wout Mares
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Houkje A Sipkema
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands
| | - Zwanet Young
- Brain and Cognitive Sciences Master's Student, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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20
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Nagel LC, Tesky VA, Schall A, Müller T, König J, Pantel J, Stangier U. Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study. Heliyon 2024; 10:e23379. [PMID: 38148800 PMCID: PMC10750160 DOI: 10.1016/j.heliyon.2023.e23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Objectives Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified. Methods Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral. Results Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008). Conclusion Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.
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Affiliation(s)
| | | | - Arthur Schall
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Tanja Müller
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Jochem König
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Johannes Pantel
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology, Goethe University, Frankfurt, Germany
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21
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Kolnes LJ, Stensrud T, Andersen OK. A multidimensional strategy to managing dysfunctional breathing and exercise-induced laryngeal obstruction in adolescent athletes. BMC Sports Sci Med Rehabil 2024; 16:13. [PMID: 38212851 PMCID: PMC10782679 DOI: 10.1186/s13102-023-00804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Exercise induced laryngeal obstruction (EILO) causes inspiratory distress in the upper airway in many adolescent athletes. The nature of EILO is not fully understood, and effective management strategies are lacking. This study aimed to assess the effectiveness of a multidimensional individually tailored intervention, including Norwegian Psychomotor Physiotherapy (NPMP), elements of cognitive behavioural therapy and a rehabilitation plan, in reducing inspiratory distress and dysfunctional breathing in adolescent athletes with EILO. METHODS A mixed methods design, which combined qualitative and quantitative research, was used. Data, including subjective experiences of respiratory distress, findings from body examinations and objective measurements of lung function and aerobic capacity were gathered before and after a five month intervention involving 18 participants. RESULTS Following the intervention, the participants showed a reduction in respiratory distress and anxiousness associated with their breathing difficulties. Furthermore, the participants reported to be more in control of their breathing. The body assessments revealed a more functional breathing motion and improved posture, which imply that the breathing was less thoracic and more diaphragmatic in rest and exercise in all participants after the intervention. CONCLUSIONS Our results suggest that a multidimensional individually tailored intervention, including NPMP based physiotherapy, cognitive behavioural therapy elements, and a rehabilitation plan may reduce inspiratory distress and dysfunctional breathing in athletes with EILO. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration and Results system NCT06033755, date of registration: September12, 2023. Retrospectively registered.
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Affiliation(s)
- Liv-Jorunn Kolnes
- Faculty of Health, VID Specialized University, Diakonveien 12-18, 0370, Oslo, Norway.
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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22
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Henderson RR, Nielsen AM, Fernandez AMP, Downing ST, McCarty RJ, Strekalova YA, Cobite-Njoh J, Mirhosseini T, Guzick AG, McNamara JPH, Mathews CA. Expectations and perspectives of cognitive behavioural therapy for childhood anxiety and related disorders. Behav Cogn Psychother 2024; 52:65-77. [PMID: 37699703 DOI: 10.1017/s1352465823000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Anxiety disorders are the most frequently diagnosed psychiatric conditions in children and adolescents. Cognitive behavioural therapy (CBT) is a well-established and effective treatment for anxiety and related disorders across the lifespan. Expectations of psychotherapy have been demonstrated to affect outcomes, yet there is sparse existing literature on adolescent patient and parent perspectives of CBT prior to engagement with treatment. AIMS This study aimed to qualitatively explore the expectations and perceptions of CBT for anxiety and related disorders among adolescent patients and parents. METHOD Fourteen adolescent patients and 16 parents participated in semi-structured individual interviews or focus groups consisting of 2-3 participants. Interview transcripts were analysed using inductive analysis. RESULTS Three themes were identified: worries about CBT, expectations and knowledge of the CBT process, and the role of parents and families. Overall, we found that adolescents and parents had generally positive views of CBT. The outset of CBT saw adolescents and parents express concern about stigma as well as the ambiguity of CBT. Parents continued to express a lack of understanding of what CBT entailed during their child's treatment course. CONCLUSION These results suggest that both adolescents and parents would benefit from early discussion and reinforcement of expectations for CBT treatment. Further research efforts are warranted and should be directed towards determining appropriate expectations for parental involvement in a child's CBT course and effective communication of treatment expectations to both adolescents and parents.
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Affiliation(s)
| | - Alyssa M Nielsen
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Seth T Downing
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Ryan J McCarty
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Yulia A Strekalova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Journa Cobite-Njoh
- Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | | | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
- Center for OCD, Anxiety, and Related Disorders, University of Florida, Gainesville, FL, USA
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23
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Berendsen S, Berendse S, van der Torren J, Vermeulen J, de Haan L. Cognitive behavioural therapy for the treatment of schizophrenia spectrum disorders: an umbrella review of meta-analyses of randomised controlled trials. EClinicalMedicine 2024; 67:102392. [PMID: 38274116 PMCID: PMC10809079 DOI: 10.1016/j.eclinm.2023.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
Background Cognitive behavioural therapy (CBT) forms the standard psychotherapy for schizophrenia spectrum disorders (SSD). We aimed to summarize and evaluate the evidence on the effectiveness of CBT for SSD. Methods In this umbrella review, we searched PubMed, Embase, Cochrane Database, and PsychInfo, for meta-analyses of randomised controlled trials (RCTs) of CBT in SSD published between database inception up to Aug 18, 2023. Inclusion criteria were RCTs investigating individually provided CBT in a population of patients with SSD, compared to either standard care, treatment as usually, or any other psychosocial therapies. No restrictions concerning follow-up or language were applied. We used the "assessment of multiple systematic reviews" (AMSTAR-2) appraisal checklist for the evaluation of methodological quality of meta-analysis. We extracted summary metrics from eligible studies in duplicate. The strength of evidence was classified by the sample size, p-value, excess significance bias, prediction intervals, significance of largest study, and heterogeneity. The strength of evidence was ranked according to established criteria as: convincing, highly suggestive, suggestive, weak, or not significant. Primary outcomes were general psychopathology, positive and negative symptoms. This study is registered in PROSPERO, CRD42022334671. Findings We found 26 eligible meta-analyses, of which 16 meta-analyses provided sufficient data. Using the AMSTAR-2, we found limitations in details concerning the selection of study design, quality of the search and reporting of funding in included meta-analyses. A minority of 42.9% of the comparisons showed a significant result in favor of CBT; 57.1% were non-significant with no convincing or highly suggestive evidence. Suggestive evidence was found in favor of CBT for general psychopathology (6.2%, N = 34 RCTs, effect size (ES) = -0.33 (-0.47; -0.19), I2 = 67.93), delusions (16.7%, N = 27, ES = 0.36 (0.22; 0.51), I2 = 50.47), and hallucinations (33.3%, N = 28, ES = 0.32 (0.19; 0.46), I2 = 45.14) at the end of treatment (EoT). Weak (N = 34 RCTs, ES = -0.13 (-0.24; -0.02), I2 = 51.28), or non-significant evidence (N = 28 RCTs, ES = 0.12 (-0.03; 0.27) I2 = 64.63) was found for negative symptoms at EoT. At longer follow-up, evidence became weak or non-significant. Interpretation Findings suggest that the effectiveness of CBT on general and positive symptoms in SSD at EoT was small to medium, while we found inconsistent evidence for a sustainable effect. CBT has no convincing impact on other relevant outcomes. Guidelines may use these results to specify their recommendations. Funding None.
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Affiliation(s)
- Steven Berendsen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
- Dimence Mental Health Care, Deventer, the Netherlands
| | - Silke Berendse
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Jeanne van der Torren
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
- Arkin Mental Health Care, Amsterdam, the Netherlands
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24
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You XR, Gong XR, Guo MR, Ma BX. Cognitive behavioural therapy to improve social skills in children and adolescents with autism spectrum disorder: A meta-analysis of randomised controlled trials. J Affect Disord 2024; 344:8-17. [PMID: 37802322 DOI: 10.1016/j.jad.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is effective in treating various neurological and psychiatric diseases. It improves anxiety symptoms in children with autism spectrum disorder, gaining considerable empirical support. However, social skills results are mixed, leading to debate over its effectiveness, highlighting the need for further development. While the Social Responsiveness Scale (SRS) is a secondary indicator to measure anxiety symptoms, it primarily evaluates social skills, which are essential for rehabilitating children with autism. Therefore, evaluating social disorder improvement in children with autism is imperative. Social impairment is a core autism symptom. Therefore, we conducted a systematic review of randomised controlled trials assessing the effects of CBT on social skills in this population. METHODS We reviewed articles published in several databases through October 2022 and relevant reference lists. We used the standardised mean difference (SMD) as the main effect size indicator and focused on SRS metrics from baseline to endpoint. We analysed subgroups, heterogeneity, bias risk, and publication bias. RESULTS Our meta-analysis included 214 children from seven randomised controlled trials with nine datasets. Forest plot analysis shows CBT improved social skills in children with autism compared to controls. Subgroup analysis revealed parents' and teachers' SRS scores for children, SRS scores of CBT versus waitlist controls, and those of CBT versus non-waiting-list controls. LIMITATIONS Most randomised controlled CBT trials for children with autism have explored anxiety symptom improvement. Further, social skill assessment was a secondary outcome or not assessed. Thus, social skills data are insufficient. CONCLUSIONS CBT is effective in improving social impairment in children with autism. REGISTRATION This meta-analysis was registered with the International Prospective Register of Systematic Reviews (CRD42022363423).
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Affiliation(s)
- Xiao-Rui You
- Hebei University of Chinese Medicine, Hebei Province, Shijiazhuang, China
| | - Xing-Ruo Gong
- Hebei University of Chinese Medicine, Hebei Province, Shijiazhuang, China
| | - Mei-Ran Guo
- Hebei University of Chinese Medicine, Hebei Province, Shijiazhuang, China
| | - Bing-Xiang Ma
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Province, Zhengzhou, China.
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25
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Soo CA, Tate RL, Catroppa C, Benson S, McDonald S, Rapee RM, Anderson V. A randomized controlled trial of cognitive behavioural therapy for managing anxiety in adolescents with acquired brain injury. Neuropsychol Rehabil 2024; 34:74-102. [PMID: 36534593 DOI: 10.1080/09602011.2022.2154811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12-19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or a wait-list control group (n = 17). The primary outcome was participants' anxiety and secondary outcomes were participants' depression, self-perception, and participation in daily activities, and parental stress, measured at (i) pre-intervention, (ii) immediately post-intervention, (iii) 2 months post-intervention and (iv) 6 months post-intervention. Repeated measures ANOVAs revealed significant treatment effects with the intervention group demonstrating greater improvements in self-reported anxiety, as well as self- and parent-reported depression from pre- to immediately post-treatment, compared to wait-list controls. Little evidence of treatment effects was found for the remaining outcomes (parent-reported anxiety, self-perception, daily participation, and parental stress). Significant improvement in self-reported anxiety found immediately post-treatment was maintained at two- and six-month follow-up. Findings provide support for adapted CBT as an effective means of reducing anxious and depressive symptomatology in adolescents with ABI compared to waitlist controls, and offer support for the use of these techniques to manage anxiety in this population.
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Affiliation(s)
- Cheryl A Soo
- Brain and Mind, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Robyn L Tate
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, Australia
| | - Cathy Catroppa
- Brain and Mind, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Suzanne Benson
- Rehabilitation Department, Children's Hospital at Westmead, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of NSW, Sydney, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Vicki Anderson
- Brain and Mind, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Psychology, Royal Children's Hospital, Melbourne, Australia
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26
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Verma S, Varma P, Brown A, Bei B, Gibson R, Valenta T, Pietsch A, Cavuoto M, Woodward M, McCurry S, Jackson ML. Multi-modal sleep intervention for community-dwelling people living with dementia and primary caregiver dyads with sleep disturbance: protocol of a single-arm feasibility trial. PeerJ 2023; 11:e16543. [PMID: 38107589 PMCID: PMC10725664 DOI: 10.7717/peerj.16543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Background Disturbed sleep is common among people living with dementia and their informal caregivers, and is associated with negative health outcomes. Dyadic, multi-modal interventions targeting caregiver and care-recipient sleep have been recommended yet remain limited. This protocol details the development of a single-arm feasibility trial of a multi-modal, therapist-led, six-week intervention targeting sleep disturbance in dyads of people living with dementia and their primary caregiver. Methods We aim to recruit 24 co-residing, community-dwelling dyads of people living with dementia and their primary informal caregiver (n = 48) with sleep concerns (Pittsburgh Sleep Quality Index ≥5 for caregivers, and caregiver-endorsed sleep concerns for the person living with dementia). People who live in residential care settings, are employed in night shift work, or are diagnosed with current, severe mental health conditions or narcolepsy, will be excluded. Participants will wear an actigraph and complete sleep diaries for two weeks prior, and during the last two weeks, of active intervention. The intervention is therapist-led and includes a mix of weekly small group video sessions and personalised, dyadic sessions (up to 90 min each) over six weeks. Sessions are supported by a 37-page workbook offering strategies and spaces for reflections/notes. Primary feasibility outcomes are caregiver: session attendance, attrition, and self-reported project satisfaction. Secondary outcomes include dyadic self-reported and objectively-assessed sleep, depression and anxiety symptoms, quality of life, and social support. Self-report outcomes will be assessed at pre- and post-intervention. Discussion If feasible, this intervention could be tested in a larger randomised controlled trial to investigate its efficacy, and, upon further testing, may potentially represent a non-pharmacological approach to reduce sleep disturbance among people living with dementia and their caregivers. ANZCTR Trial registration ACTRN12622000144718: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382960&showOriginal=true&isReview=true.
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Affiliation(s)
| | | | - Aimee Brown
- Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Centre, Richmond, Victoria, Australia
| | - Bei Bei
- Monash University, Clayton, Victoria, Australia
| | - Rosemary Gibson
- Health and Ageing Research Team, School of Psychology, Massey University, Palmerston North, New Zealand
| | - Tom Valenta
- Independent Researcher, Melbourne, Victoria, Australia
| | - Ann Pietsch
- Independent Researcher, Adelaide, South Australia, Australia
| | | | - Michael Woodward
- Aged and Continuing Care Services, Austin Health, Heidelberg, Victoria, Australia
| | - Susan McCurry
- School of Nursing, University of Washington, Washington, United States of America
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27
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Bøhn S, Oldervoll LM, Reinertsen KV, Seland M, Fosså A, Kiserud C, Skaali T, Nilsen TS, Blomhoff R, Henriksen HB, Lie HC, Berge T, Fjerstad E, Wisløff T, Slott M, Zajmovic I, Thorsen L. The feasibility of a multidimensional intervention in lymphoma survivors with chronic fatigue. Support Care Cancer 2023; 32:22. [PMID: 38095797 PMCID: PMC10721709 DOI: 10.1007/s00520-023-08204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Chronic fatigue (CF) affects 25-30% of lymphoma survivors, but interventions designed to reduce fatigue are lacking. The main aim of this study was to test the feasibility of a multidimensional intervention study in lymphoma survivors with CF. Secondary aims were to describe individual changes in fatigue, quality of life (QoL) and physical performance from pre (T0) to post (T1) intervention. METHODS This feasibility study was as a one-armed intervention study performed in 2021. Hodgkin or aggressive non-Hodgkin lymphoma survivors received mailed study information and Chalder Fatigue Questionnaire and were asked to respond if they suffered from fatigue. The 12-week intervention included patient education, physical exercise, a cognitive behavioural therapy (CBT)-based group program and nutritional counselling. Feasibility data included patient recruitment, completion of assessments, adherence to the intervention and patient-reported experience measures. Participants responded to questionnaires and underwent physical tests at T0 and T1. RESULTS Seven lymphoma survivors with CF were included. Of all assessments, 91% and 83% were completed at T0 and T1, respectively. Adherence to the interventional components varied from 69% to 91%. At T1, all participants rated exercise as useful, of whom five rated the CBT-based program and five rated individual nutritional counselling as useful. Five participants reported improved fatigue, QoL and physical performance. CONCLUSION Lymphoma survivors with CF participating in a multidimensional intervention designed to reduce the level of fatigue showed high assessment completion rate and intervention adherence rate. Most of the participants evaluated the program as useful and improved their level of fatigue, QoL and physical performance after the intervention. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT04931407. Registered 16. April 2021-Retrospectively registered. https://www. CLINICALTRIALS gov/ct2/show/NCT04931407.
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Affiliation(s)
- Skh Bøhn
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.
| | - L M Oldervoll
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - K V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - M Seland
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - A Fosså
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - C Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - T Skaali
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - T S Nilsen
- Institute of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - R Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - H B Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - H C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Berge
- Diakonhjemmet Hospital, Oslo, Norway
| | | | - T Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - M Slott
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - I Zajmovic
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - L Thorsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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28
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Käll A, Andersson G. Knowledge acquisition following internet-based cognitive behavioural therapy for loneliness - A secondary analysis of a randomised controlled trial. J Behav Ther Exp Psychiatry 2023; 81:101872. [PMID: 37209636 DOI: 10.1016/j.jbtep.2023.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/21/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Knowledge about a condition and how to treat it is part of most cognitive behavioural therapies. This is particularly relevant for self-help treatments such as internet-based CBT, which is commonly delivered in the form of didactic materials. The role of knowledge acquisition in treatment outcomes is an understudied area. The present study sought to investigate knowledge acquisition as part of an ICBT trial targeting loneliness and discern its role in the outcome of treatment. METHODS We used secondary data from a randomised controlled trial of ICBT targeting loneliness with 73 participants. A knowledge test including certainty ratings was constructed and used to investigate whether knowledge increased for the treatment group in comparison to the control group, whether changes in knowledge predicted changes in loneliness during the treatment phase, and how the acquired knowledge related to outcomes at a two-year follow-up. Multiple linear regression models were used to analyse the data. RESULTS The treatment group had significantly higher knowledge scores compared to the waitlist group at posttreatment, both in terms of correct answers (Cohen's d = 0.73) and certainty-weighted sum scores (Cohen's d = 1.20). Acquired knowledge did not predict reductions in loneliness in the short-term, and neither loneliness ratings nor use of treatment techniques in the long-term. LIMITATIONS The sample size was relatively small, which limits the statistical inferences. CONCLUSIONS Knowledge of treatment relevant principles increase as part of the treatment in ICBT for loneliness. This increase was not related to other short- and long-term outcomes.
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Affiliation(s)
- Anton Käll
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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29
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Law M, Pickering I, Bartlett E, Sebaratnam G, Varghese C, Gharibans A, O'Grady G, Andrews CN, Calder S. Cognitive behavioural therapy-based interventions for gastroduodenal disorders of gut-brain interaction: A systematic review. J Psychosom Res 2023; 175:111516. [PMID: 37832277 DOI: 10.1016/j.jpsychores.2023.111516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Cognitive behavioural therapy (CBT) is increasingly used to manage Disorders of Gut-Brain Interaction (DGBIs). This systematic review aimed to review the evidence for the effectiveness of CBT-based interventions for patients with gastroduodenal DGBIs. METHODS Medline, Embase, PubMed, Cochrane Central, and Scopus were searched in July 2022. Studies were included if they investigated the effects of a CBT-based intervention on gastrointestinal symptoms and/or psychological outcomes pre- and post-intervention in patients with gastroduodenal DGBIs. Case studies, studies not in English, and studies with patients under 18 years were excluded. Results were synthesised narratively, and standardised effect sizes were calculated where possible. RESULTS Nine studies (seven RCTs and two pre/post studies) were identified, with data reported in 10 articles (total N = 602). The studies investigated patients with functional dyspepsia (n = 7), rumination syndrome (n = 1), and supragastric belching (n = 1). The studies had heterogeneous interventions, methodologies, and outcomes, precluding meta-analysis, as well as a moderate-high risk of bias and high drop-outs rates. Findings demonstrated decreased gastrointestinal symptoms and improved anxiety, depression, and quality of life, from pre- to post-intervention, with medium to large effect sizes for symptoms and small to large effect sizes for psychological outcomes. Efficacy was maintained at follow-up, up to one year later. CONCLUSIONS This review suggests promising evidence that CBT effectively improves gastrointestinal symptoms and psychological outcomes in patients with gastroduodenal DGBIs. However, heterogeneity, risk of bias, and lack of statistical reporting were noted, indicating the need for more robust research and standardisation.
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Affiliation(s)
- Mikaela Law
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Isabella Pickering
- Alimetry Ltd., Auckland, New Zealand; The Department of Psychological Medicine, The University of Auckland, New Zealand
| | | | | | - Chris Varghese
- The Department of Surgery, The University of Auckland, New Zealand
| | - Armen Gharibans
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Greg O'Grady
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Christopher N Andrews
- Alimetry Ltd., Auckland, New Zealand; The Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Canada
| | - Stefan Calder
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand.
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Karlsson-Good M, Kaldo V, Lundberg L, Kraepelien M, Anthony SA, Holländare F. Increasing the accessibility to internet-based cognitive behavioural therapy for depression: A single-blind randomized controlled trial of condensed versus full-text versions. Internet Interv 2023; 34:100678. [PMID: 37840646 PMCID: PMC10570001 DOI: 10.1016/j.invent.2023.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
Background Research shows that internet-based cognitive behavioural therapy (iCBT) is an effective treatment for depression. However, little is known about how the length of the text material in iCBT affects outcomes. Objective The aim of this study was to test whether a condensed iCBT version for depression would be non-inferior to the existing full-text version in reducing depressive symptoms at post-treatment. We also wanted to test non-inferiority for secondary outcomes and explore reading speed and ADHD symptoms as potential moderators. Method A single-blind randomized controlled trial was conducted (N = 267) comparing two versions of guided iCBT for depression; full-text (around 60,000 words) and condensed (around 30,000 words, with the option to listen to the text). Estimated between-group effect sizes and their confidence intervals for depression, anxiety and quality of life, were compared to a pre-determined non-inferiority margin (ES = 0.4). Moderation analyses of reading speed and ADHD symptoms were conducted. Results The condensed version of iCBT was non-inferior to the full-text version on post-treatment measures for depressive symptoms (95 % CI = -0.42-0.24), anxiety symptoms (95 % CI = -0.24-0.32), and quality of life (95 % CI = -0.09-0.49). Non-inferiority was inconclusive for depressive symptoms at the one-year follow-up (95 % CI = -0.60-0.47). There was no significant moderation effects of reading speed (p = 0.06) or ADHD symptoms (p = 0.11) on depressive symptoms. Conclusion These results indicate that a condensed version of iCBT for depression is as effective at treating depression as the full-text version. By shortening texts, iCBT may be made available to more people. Due to unequal dropout rates between the groups, these results are preliminary and need to be replicated.
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Affiliation(s)
- Magnus Karlsson-Good
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Susanne A. Anthony
- Department of Pediatrics, Skåne University Hospital, Region Skåne, Malmö, Sweden
| | - Fredrik Holländare
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Richardson M, Cathro M, Kleinstäuber M. Nocebo Hypothesis Cognitive Behavioural Therapy (NH-CBT) for non-epileptic seizures: a consecutive case series. Behav Cogn Psychother 2023:1-20. [PMID: 38018147 DOI: 10.1017/s1352465823000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Research has demonstrated that implementation of Nocebo Hypothesis Cognitive Behavioural Therapy (NH-CBT) achieved full symptom remission in 93% of people with Functional Neurological Symptoms Disorder (FNSD), most of them exhibiting motor symptoms. The basis for NH-CBT is consistent with a predictive coding aetiological model of FNSD. This idea is transparently shared with people with FNSD in the form of telling them that their symptoms are caused by a nocebo effect, usually followed by some physical activity that aims to change the person's belief about their body. AIMS To demonstrate that a version of NH-CBT can also be effective in eliminating or reducing non-epileptic seizures (assumed to be a sub-type of FNSD). METHOD A consecutive case series design was employed. Participants were treated with NH-CBT over a 12-week period. The primary outcome measure was seizure frequency. Numerous secondary measures were employed, as well as a brief qualitative interview to explore participants' subjective experience of treatment. RESULTS Seven out of the 10 participants became seizure free at least 2 weeks before their post-treatment assessment, and all stayed seizure-free for at least 5 months. Six of those seven remained seizure free at 6-month follow-up. There were large positive effect sizes for the majority of secondary measures assessed. CONCLUSIONS This case series provides evidence of feasibility and likely utility of NH-CBT in reducing the frequency of non-epileptic seizures.
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Affiliation(s)
- Matt Richardson
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael Cathro
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Psychology, Utah State University, Logan, Utah, USA
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Wei Y, Zhang R, Wang Y, Womer FY, Dong S, Zheng J, Zhang X, Wang F. Towards a neuroimaging biomarker for predicting cognitive behavioural therapy outcomes in treatment-naive depression: Preliminary findings. Psychiatry Res 2023; 329:115542. [PMID: 37890407 DOI: 10.1016/j.psychres.2023.115542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Clear prognostic indicators of cognitive behavioural therapy (CBT) are lacking for depression. This study aims to identify a biomarker that predicts CBT outcomes in depression. We developed a machine learning algorithm to predict post-CBT Hamilton Depression Rating Scale (HAMD) using pre-CBT regional homogeneity (ReHo). We examined transcriptomic signatures of regions with CBT-related ReHo changes. Twenty-five patients completed CBT and had increased ReHo in the dorsolateral prefrontal cortex (DLPFC) following CBT. Pre-CBT ReHo in left DLPFC was shown to be a predictor of post-HAMD scores. We identified left DLPFC ReHo as a neuroimaging biomarker for therapeutic effects of CBT in depression.
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Affiliation(s)
- Yange Wei
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China; Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ran Zhang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yang Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fay Y Womer
- Department of Psychiatry and Behavioural Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shuai Dong
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Junjie Zheng
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.
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Barakat S, Burton AL, Cunich M, Hay P, Hazelton JL, Kim M, Lymer S, Madden S, Maloney D, Miskovic-Wheatley J, Rogers D, Russell J, Sidari M, Touyz S, Maguire S. A randomised controlled trial of clinician supported vs self-help delivery of online cognitive behaviour therapy for Bulimia Nervosa. Psychiatry Res 2023; 329:115534. [PMID: 37844353 DOI: 10.1016/j.psychres.2023.115534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
High dropout rates and poor adherence associated with digital interventions have prompted research into modifications of these treatments to improve engagement and completion rates. This trial aimed to investigate the added benefit of clinician support when paired alongside a ten-session, online cognitive behaviour therapy (CBT) self-help intervention for bulimia nervosa (BN). As part of a three-arm, phase II randomised controlled trial, 114 participants (16 years or over) with full or subthreshold BN were randomly assigned to complete the intervention in a self-help mode (with administrative researcher contact; n = 38), with adjunct clinician support (weekly 30-minute videoconferencing sessions; n = 37), or a no-treatment waitlist control (WLC; n = 39). Baseline to post-treatment (12-weeks) decreases in objective binge episode frequency were significantly greater for clinician-supported participants as compared to WLC, but not for self-help when compared to WLC. However, due to continued improvements for self-help across follow-up (24-weeks), both arms outperformed WLC when analysed as an overall rate of change across three timepoints. Clinician-supported participants outperformed self-help in regards to laxative use and dietary restraint. Our results demonstrate that good clinical outcomes can be achieved with a relatively brief online CBT-based program even in the absence of structured clinical support, indicating a possible overreliance upon clinician support as a primary adherence-facilitating mechanism.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Amy L Burton
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia
| | - Michelle Cunich
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia; Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia; Co-Lead, Implementation and Policy, Cardiovascular Initiative, University of Sydney, Camperdown, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia; Mental Health Services South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Jessica L Hazelton
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Marcellinus Kim
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sharyn Lymer
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Sloane Madden
- Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Daniel Rogers
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Janice Russell
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Morgan Sidari
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; Queensland Eating Disorder Service, Metro North Hospital and Health, Brisbane, QLD, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
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Warbrick LA, Dunn BD, Moran PA, Campbell J, Kessler D, Marchant K, Farr M, Ryan M, Parkin M, Sharpe R, Turner K, Sylianou M, Sumner G, Wood E. Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol. Pilot Feasibility Stud 2023; 9:170. [PMID: 37798752 PMCID: PMC10552316 DOI: 10.1186/s40814-023-01394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The NHS Talking Therapies for Anxiety and Depression programme ('TTad'; formerly Improving Access to Psychological Therapies 'IAPT') delivers high-intensity cognitive behavioural therapy (CBT) to over 200,000 individuals each year for common mental health problems like depression and anxiety. More than half of these individuals experience comorbid personality difficulties, who show poorer treatment outcomes. TTad therapists report feeling unskilled to work with clients with personality difficulties, and enhancing the training of TTad therapists may lead to improved treatment outcomes for individuals presenting with secondary personality difficulties alongside depression and anxiety. METHODS This is a pre-post non-randomised mixed-method feasibility study, exploring the feasibility and acceptability of a 1-day training workshop for high-intensity (HI) CBT therapists. The workshop is focused on understanding and assessing personality difficulties and adapting HICBT treatments for anxiety and depression to accommodate client needs. The feasibility and acceptability of the workshop and the evaluation procedures will be investigated. It will be examined to what extent the workshop provision leads to improvements in therapist skills and confidence and explored to what extent the training has the potential to enhance clinical outcomes for this client group. DISCUSSION This feasibility study will provide data on the acceptability and feasibility of delivering brief therapist training to adapt usual HICBT to optimise care for individuals with secondary personality difficulties seeking treatment in TTad services for a primary problem of depression and/or anxiety. The study will also evaluate proof of concept that such an approach has the potential to improve clinical outcomes for those with secondary personality difficulties and report any possible harms identified. The study will inform the design of a future randomised controlled trial designed to test the effectiveness and cost-effectiveness of the training. TRIAL REGISTRATION ISRCTN81104604 . Submitted on 6th June 2022. Registration date: 3rd January 2023.
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Affiliation(s)
- Laura A Warbrick
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK.
- College of Medicine and Health, University of Exeter, Exeter, UK.
| | - Barnaby D Dunn
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Paul A Moran
- Bristol Medical School, University of Bristol, Bristol, UK
| | - John Campbell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David Kessler
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Marchant
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Michelle Farr
- Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Mary Ryan
- Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK
| | - Megan Parkin
- Royal Devon University Healthcare NHS Foundation Trust, Tiverton, UK
| | | | - Katrina Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Gemma Sumner
- Everyturn Mental Health, Newcastle Upon Tyne, UK
| | - Emma Wood
- Everyturn Mental Health, Newcastle Upon Tyne, UK
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Ma M, Yang M, Li Y, Hou L, Li M, Wang X, Li Z, Guo K, Liu X, Cheng Y, Niu J, Yang K. Cognitive behavioural therapy for functional abdominal pain disorders in children and adolescents: A systematic review of randomized controlled trials. Behav Res Ther 2023; 169:104397. [PMID: 37696176 DOI: 10.1016/j.brat.2023.104397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
AIM Although Cognitive behavioural therapy (CBT) potentially holds efficacy in addressing functional abdominal pain disorders (FAPDs) amongst children and adolescents, the persistent efficacy is uncertain. METHODS We searched three databases to identify related randomized controlled trials (RCTs). Meta-analysis was performed using RevMan and Stata. Subgroup analyses were mainly conducted based on follow-up time. The GRADE approach was used to evaluate the certainty of the evidence. RESULTS A total of 14 RCTs evaluating 858 patients were included. All RCTs were rated as having a high risk of bias. Compared with control groups, CBT was associated with improvement of general functional impairment (standardized mean difference (SMD) = -0.77, 95% CI [-1.12, -0.42], p < 0.05), higher treatment success (relative risk (RR) = 2.35, 95% CI [1.50, 3.69], p < 0.05), improvement of abdominal pain symptoms (SMD = -0.48, 95% CI [-0.73, -0.23], p < 0.05), QoL (SMD = 0.42, 95% CI [0.20, 0.64], p < 0.05), and psychological states (SMD = -0.95, 95% CI [-1.62, -0.27], p < 0.05). CONCLUSION This meta-analysis provides low to moderate quality evidence that CBT could significantly improve clinical outcomes and QoL for children and adolescents with FAPDs with improvement persisting until short-term follow-up. However, there were discrepancies regarding CBT's effects at mid- and long-term follow-up across different outcomes. More high-quality and longer-duration studies are thus warranted to explore the effectiveness of CBT in the future. SYSTEMATIC REVIEW REGISTRATION ON PROSPERO CRD42022369353.
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Affiliation(s)
- Mina Ma
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, PR China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China
| | - Minyan Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, PR China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China
| | - Yanfei Li
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, PR China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China
| | - Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, PR China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China
| | - Meixuan Li
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, PR China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China
| | - Xinyi Wang
- School of the Second Clinical Medicine, Lanzhou University, Lanzhou, Gansu, PR China
| | - Zijun Li
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, PR China
| | - Ke Guo
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, PR China
| | - Xian Liu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, PR China
| | - Yuanyuan Cheng
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, PR China
| | - Junqiang Niu
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, PR China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China; Department of Traditional Chinese Medicine, School of the First Clinical Medicine, Lanzhou University, Lanzhou, Gansu, PR China.
| | - Kehu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, PR China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, PR China; Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, PR China.
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Jones MD, Casson SM, Barry BK, Li SH, Valenzuela T, Cassar J, Lamanna C, Lloyd AR, Sandler CX. eLearning improves allied health professionals' knowledge and confidence to manage medically unexplained chronic fatigue states: A randomized controlled trial. J Psychosom Res 2023; 173:111462. [PMID: 37619433 DOI: 10.1016/j.jpsychores.2023.111462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES To evaluate the impact of eLearning by allied health professionals on improving the knowledge and confidence to manage people with medically unexplained chronic fatigue states (FS). METHODS Using a parallel randomized controlled trial design, participants were randomized 1:1 to a 4-week eLearning or wait-list control group. Knowledge and self-reported confidence in clinical skills to implement a therapeutic intervention for patients with FS were assessed at baseline, post-intervention and follow-up. Secondary outcomes (adherence and satisfaction with online education, knowledge retention) were also assessed. Data was analyzed using intention-to-treat. RESULTS There were 239 participants were randomized (eLearning n = 119, control n = 120), of whom 101 (85%) eLearning and 107 (89%) control participants completed baseline assessments and were included in the analysis. Knowledge (out of 100) improved significantly more in the eLearning group compared to the control group [mean difference (95% CI) 8.6 (5.9 to 11.4), p < 0.001]. Knowledge was reduced in the eLearning group at follow-up but was still significantly higher than baseline [6.0 (3.7 to 8.3), p < 0.001]. Median change (out of 5) in confidence in clinical skills to implement the FS intervention was also significantly greater in the eLearning group compared to the control group [knowledge: eLearning (1.2), control (0); clinical skills: eLearning (1), control (0.1); both p < 0.001)]. Average time spent on the eLearning program was 8.8 h. Most participants (80%) rated the lesson difficulty as at the "right level", and 91% would recommend it to others. CONCLUSIONS eLearning increased knowledge and confidence to manage FS amongst allied health professionals and was well-accepted. REGISTRATION ACTRN12616000296437 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370222&isReview=true.
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Affiliation(s)
- Matthew D Jones
- The Kirby Institute, The University of New South Wales, Sydney, Australia; School of Health Sciences, The University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Sally M Casson
- The Kirby Institute, The University of New South Wales, Sydney, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Benjamin K Barry
- School of Health Sciences, The University of New South Wales, Sydney, Australia; Medical School, The University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Sophie H Li
- Black Dog Institute and School of Psychology, The University of New South Wales Australia, Sydney, Australia
| | - Trinidad Valenzuela
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Joanne Cassar
- The Kirby Institute, The University of New South Wales, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Camillo Lamanna
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Carolina X Sandler
- The Kirby Institute, The University of New South Wales, Sydney, Australia; School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
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Li S, Yong Y, Li Y, Li J, Xie J. Cognitive-Based Interventions for Improving Psychological Health and Well-Being for Parents of Children with Developmental Disabilities: A Systematic Review and Meta-analysis. J Autism Dev Disord 2023:10.1007/s10803-023-06063-x. [PMID: 37668850 DOI: 10.1007/s10803-023-06063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/06/2023]
Abstract
This review aims to systematically summarize existing evidence to determine the effectiveness of cognitive-based interventions (CBIs) on psychological health and well-being among parents of children with developmental disabilities (DD). Six databases were searched to identify eligible randomized controlled trials (RCTs) from their inception to April 2023. The revised Cochrane Risk of Bias tool for RCTs was applied to assess the risk of bias and the certainty of evidence was evaluated using the Grading of Recommendation, Assessment, Development and Evaluation. Meta-analyses were conducted using a random-effects model. Twenty-five RCTs involving 1915 participants were identified. The results indicated that CBIs reduced parental stress levels (Hedges' g = - 0.69), depressive symptoms (g = - 0.95), anxiety levels (g = - 0.78), and parental distress (g = - 0.29), and improved parental well-being (g = 0.62) and parent‒child relationships (g = 0.43) postintervention compared with the active/inactive control groups. Subgroup analysis of the effectiveness of interventions using mindfulness-based interventions and cognitive behavioural therapy showed positive effects. The favourable intervention duration and participant targets were also identified in this review. Furthermore, the effects of CBIs were impacted by the different types of DD among the children. This review highlighted the positive effects of CBIs on parental stress levels, depressive symptoms, anxiety levels, parental distress levels, parental well-being levels, and parent‒child relationships. Future well-designed RCTs are needed to further investigate the effects of MBIs and CBT interventions on children with DD and their parents, as well as the factors and mechanisms of action affecting the efficacy of these interventions.
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Affiliation(s)
- Sini Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China
| | - Yijing Yong
- Cognition and Human Behaviour Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China
| | - Jianhe Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China.
| | - Jiao Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China.
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, China.
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Millar JFA, Coughtrey AE, Healy A, Whittal M, Shafran R. The current status of mental contamination in obsessive compulsive disorder: A systematic review. J Behav Ther Exp Psychiatry 2023; 80:101745. [PMID: 37247969 DOI: 10.1016/j.jbtep.2022.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Over the past 25 years Mental Contamination (MC) has become recognised as a distinct construct, particularly in relation to Obsessive Compulsive Disorder (OCD). MC is defined as feelings of contamination, often located internally, that arise in the absence of contact with a contaminant, with the source proposed to be human. Despite considerable interest from researchers and clinicians, there has not been a systematic review on the relationship between MC and OCD. Therefore, a systematic review was conducted to summarise and synthesise the current status of phenomenological and experimental evidence, mechanisms, assessment, measurement, and treatment of MC in OCD (PROSPERO: CRD42021223119). METHODS All study designs were eligible provided the focus of the study was on MC and the implications of the study were linked to OCD. We searched PsychINFO, Embase, Medline, Ethos, ProQuest, conference abstracts and trial registries between 1990 and 2021. The Mixed Methods Appraisal tool was used to assess methodological quality of included studies. RESULTS We found 58 reports with a total of 67 studies that met criteria for inclusion in the review. Twenty-three of these studies used clinical samples, 28 were experimental, 12 focused on phenomenology and 8 addressed treatment. The quality of the studies was variable. LIMITATIONS Grey literature was not included, thus there may be further unpublished MC studies that have not been included in the review. CONCLUSIONS Based on the findings, mental contamination is a robust clinical construct within OCD that has important implications for understanding and treating the disorder.
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Affiliation(s)
| | | | | | - Maureen Whittal
- Vancouver CBT Centre and University of British Columbia, Canada
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Ferguson RJ, Ouimet AJ, Gardam O. Judging others makes me forget: Assessing the cognitive, behavioural, and emotional consequences of other-evaluations on self-evaluations for social anxiety. J Behav Ther Exp Psychiatry 2023; 80:101763. [PMID: 37247977 DOI: 10.1016/j.jbtep.2022.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES People with Social Anxiety Disorder (SAD) evaluate themselves negatively before, during, and after anxiety-provoking social situations, which leads to negative consequences (e.g., performance deficits, memory impairments, and post-event processing). Despite decades of research, little is known regarding whether these evaluations generalize to how they view others. Social projection theory-the belief that others are similar to oneself-might further extend the basic Cognitive Behavioural Therapy (CBT) model. Our aim was to understand whether the degree to which people negatively evaluate a visibly anxious person causes them to negatively evaluate themselves. METHODS 172 unselected participants completed several baseline questionnaires. We then randomly assigned participants to provide high-, medium-, or no-evaluation of a videotaped anxious person (i.e., other-evaluations) while we assessed their state anxiety. After, they evaluated the anxious person on multiple criteria. Participants then participated in an impromptu conversation task and subsequently evaluated their own performance. RESULTS Although our manipulation was effective, we found no emotional or behavioural differences between conditions. However, people in the high-evaluation condition recalled significantly fewer facts about their conversation partner than did people in the medium- and no-evaluation conditions. LIMITATIONS After data cleaning, the sample size was slightly smaller than planned; most analyses were nonetheless appropriately powered. Our findings may not generalize beyond unselected undergraduate students; replication in a clinical sample is warranted. CONCLUSIONS These findings highlight the cognitive consequences (i.e., memory impairments) of other-evaluations, which cognitive behavioural therapists should consider when treating individuals with SAD.
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Affiliation(s)
| | | | - Olivia Gardam
- School of Psychology, University of Ottawa, Ottawa, Canada.
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Song JZ, Luong D, Feldman ECH, Tran S, Perrier L, Eubanks K, Bayley M, Kastner M, Slepian M, Munce SEP. Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review. Orphanet J Rare Dis 2023; 18:254. [PMID: 37653505 PMCID: PMC10472575 DOI: 10.1186/s13023-023-02799-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/05/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE To identify the nature and extent of the evidence on psychological interventions among individuals with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD). MATERIALS AND METHODS Eligible studies reported on psychological interventions for individuals of all ages with EDS and/or HSD. All studies published in English were included, with no restrictions to publication year or status. MEDLINE, CINAHL, EMBASE, and PsycINFO were searched. Two reviewers independently screened studies and abstracted data. RESULTS This scoping review included 10 studies reporting on EDS, HSD, or both. Only cohort studies and case studies were identified. Four studies investigated Cognitive Behavioural Therapy (CBT), one investigated Dialectical Behavioural Therapy (DBT), two investigated psychoeducation, two investigated Intensive Interdisciplinary Pain Treatment (IIPT), and one investigated Acceptance Commitment Therapy (ACT). Interventions targeted pain management, self-destructive behaviours, and related psychological issues (e.g., depression/anxiety). Sample sizes were small (n < 50) for most studies and interventions were generally poorly described. CONCLUSIONS There is a critical need for high-quality research surrounding psychological interventions for individuals with EDS/HSD. Psychological interventions for these individuals are understudied and existing studies lack validity. Researchers should investigate psychological interventions for individuals with all types of EDS/HSD with high-quality studies to validate findings from the existing studies.
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Affiliation(s)
- Jessica Z Song
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
| | - Dorothy Luong
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Estée C H Feldman
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan Tran
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Laure Perrier
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Monika Kastner
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maxwell Slepian
- GoodHope Ehlers-Danlos Syndrome Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Milgrom J, Hirshler Y, Holt C, Skouteris H, Galbally M, East C, Glover V, Reece J, O'Donnell KJ, Walker SP, Malloy S, Gemmill AW. Early intervention to prevent adverse child emotional and behavioural development following maternal depression in pregnancy: study protocol for a randomised controlled trial. BMC Psychol 2023; 11:222. [PMID: 37542332 PMCID: PMC10401817 DOI: 10.1186/s40359-023-01244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age. METHODS Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points. DISCUSSION The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a beneficial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register: ACTRN12618001925235 Date Registered: 27 November 2018.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Yafit Hirshler
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Charlene Holt
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Megan Galbally
- Health Futures Institute, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
- Mental Health, Program Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Christine East
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Drive, Bundoora, VIC, 3086, Australia
- Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 ONN, UK
| | - John Reece
- School of Psychological Sciences, Australian College of Applied Professions, 123 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Kieran J O'Donnell
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, USA
- Department of Obstetrics Gynecology and Reproductive Sciences, 230 South Frontage Road, New Haven, CT, 06519, USA
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Susan P Walker
- Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Melbourne Medical School, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | | | - Alan W Gemmill
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia.
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Pullmer R, Potter S, Laliberte M. Enhancing eating disorder recovery: Weight control beliefs predict body dissatisfaction in group cognitive behavioural therapy for body image. Eat Behav 2023; 50:101774. [PMID: 37336160 DOI: 10.1016/j.eatbeh.2023.101774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Body dissatisfaction is one of the strongest predictors of eating disorder relapse. Yet, a dearth of research exists on factors that facilitate change in body dissatisfaction following treatment focused on symptom interruption. Recent research points to the role of weight control beliefs in predicting outcomes in patients with eating disorders. The primary objective of this research was therefore twofold: 1) To investigate the impact of group cognitive behavioural therapy (GCBT) on weight control beliefs and body dissatisfaction and 2) to examine the influence of weight control beliefs on body dissatisfaction over time. Participants were 50 adults with a recent eating disorder diagnosis who completed 10 sessions of GCBT for body image following GCBT for eating disorders. All participants completed the Eating Disorder Inventory and Weight Control Beliefs Questionnaire at baseline and post-treatment. Body dissatisfaction and weight control beliefs improved from pre- to post-treatment. Hierarchical linear regression analyses revealed that increases in lifestyle control beliefs, a subtype of weight control beliefs, predicted decreases in body dissatisfaction. Results underscore the utility of fostering healthy weight control beliefs to cultivate a positive body image in patients navigating the eating disorder recovery process.
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Affiliation(s)
- Rachelle Pullmer
- St. Joseph's Healthcare Hamilton, Eating Disorders Program, Hamilton, Ontario, Canada; St. Paul's Hospital, Eating Disorders Program, Vancouver, British Columbia, Canada.
| | - Sarah Potter
- St. Joseph's Healthcare Hamilton, Eating Disorders Program, Hamilton, Ontario, Canada
| | - Michele Laliberte
- St. Joseph's Healthcare Hamilton, Eating Disorders Program, Hamilton, Ontario, Canada
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Crabb S, Morgan A, Hunter MS, Stefanopoulou E, Griffiths G, Richardson A, Fenlon D, Fleure L, Raftery J, Boxall C, Wilding S, Nuttall J, Eminton Z, Tilt E, O'Neill A, Bacon R, Martin J. A multicentre randomised controlled trial of a guided self-help cognitive behavioural therapy to MANage the impact of hot flushes and night sweats in patients with prostate CANcer undergoing androgen deprivation therapy (MANCAN2). Trials 2023; 24:450. [PMID: 37430353 PMCID: PMC10332063 DOI: 10.1186/s13063-023-07325-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is prescribed to almost half of all men diagnosed with prostate cancer. Although ADT is effective treatment, with virtually all men with advanced disease showing initial clinical response, it is associated with troublesome side effects including hot flushes and night sweats (HFNS). HFNS can be both frequent and severe and can have a significant impact on quality of life (QoL). They can occasionally be so debilitating that patients stop ADT altogether, despite the increased risk of disease relapse or death. Previous research has found that guided self-help cognitive behavioural therapy (CBT) can be effective in reducing HFNS due to ADT when delivered by a clinical psychologist. MANCAN2 aims test whether we can train the existing NHS Prostate Cancer Nurse Specialist (CNS) team to deliver guided self-help CBT and whether it is effective in reducing the impact of HFNS in men undergoing ADT. METHODS MANCAN2 is a phase III multicentre randomised controlled trial and process evaluation. Between 144 and 196 men with prostate cancer who are currently receiving ADT and are experiencing problematic HFNS will be individually randomised in a 1:1 ratio in groups of 6-8 participants to either treatment as usual (TAU) or participation in the guided self-help CBT intervention plus TAU. A process evaluation using the normalisation process theory (NPT) framework will be conducted, to understand the CNS team's experiences of delivering the intervention and to establish the key influencers to its implementation as a routine practice service. Fidelity of implementation of the intervention will be conducted by expert assessment. The cost-effectiveness of the intervention and participant adherence to the trial intervention will also be assessed. DISCUSSION MANCAN2 will advance the program of work already conducted in development of management strategies for HFNS. This research will determine whether the severity of ADT-induced HFNS in men with prostate cancer can be reduced by a guided self-help CBT intervention, delivered by the existing NHS prostate cancer CNS team, within a multicentre study. The emphasis on this existing team, if successful, should facilitate translation through to implementation in routine practice. TRIAL REGISTRATION ISRCTN reference 58720120 . Registered 13 December 2022.
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Affiliation(s)
- Simon Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alannah Morgan
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
| | - Myra S Hunter
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | | | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
| | - Deborah Fenlon
- Swansea University, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, Wales
| | - Louisa Fleure
- Guys and St Thomas NHS Foundation Trust, St Thomas Hospital Westminster Bridge Road, London, UK
| | | | - Cherish Boxall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sam Wilding
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Jacqueline Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Emma Tilt
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Alice O'Neill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Roger Bacon
- Prostate Cancer Support Organisation (PCaSO), Emsworth, UK
| | - Jonathan Martin
- Research Department of Primary Care and Population Health, University College London, London, UK
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Phang SKA, Betzler BK, Dan YR, Bin Abd Razak HR. Current evidence does not support the routine use of cognitive behavioural therapy in total knee arthroplasty: A systematic review. J Clin Orthop Trauma 2023; 42:102204. [PMID: 37449056 PMCID: PMC10336691 DOI: 10.1016/j.jcot.2023.102204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/09/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023] Open
Abstract
Background There is a significant dissatisfaction rate in patients undergoing total knee arthroplasty (TKA), and poor mental health in patients is increasingly recognized as a major contributor to dissatisfaction. The aim was to review the effectiveness of cognitive behavioural therapy (CBT) in improving pain and functional outcomes of patients undergoing TKA and highlight important aspects that may be crucial for improvement. Methods A systematic search was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were included if they were randomized control trials that included patients undergoing unilateral or bilateral TKA, with CBT as an intervention compared against usual care, and reported outcomes in pain, knee function and any psychological outcomes as measured. Results Eight RCTs were selected which included 683 participants. The timings of CBT delivery, profiles of therapists, and outcome measures reported varied across the studies. Overall, 3 studies reported significant improvement in pain outcomes, 3 studies reported significant improvement in functional outcomes and 5 studies reported significant improvements in psychological outcomes. Conclusion Current evidence does not support the efficacy of CBT as current literature is too heterogenous. Further studies with homogenous CBT methods are required to further ascertain the true relationship between CBT and postoperative outcomes of TKA. Future studies should consider the points set out in this review, such as the importance of revisiting CBTskills, providing individualized therapy, having a supervisory team to support the fidelity of interventions, and identifying which group of patients would best benefit from CBT.
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Affiliation(s)
- Sean Kia-Ann Phang
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Brjan Kaiji Betzler
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Yuet-Ruh Dan
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
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Valdivieso-Jiménez G. Efficacy of cognitive behavioural therapy for bipolar disorder: A systematic review. Rev Colomb Psiquiatr (Engl Ed) 2023; 52:213-224. [PMID: 37867032 DOI: 10.1016/j.rcpeng.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/19/2021] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is a serious mental illness with a chronic course and significant morbidity and mortality. BD has a lifetime prevalence rate of 1%-1.5% and is characterised by recurrent episodes of mania and depression, or a mixture of both phases. Although it has harmacological and psychotherapeutic treatment, cognitive behavioural therapy (CBT) has shown beneficial effects, but there is not enough clinical information in the current literature. METHODS The main aim was to determine the efficacy of CBT alone or as an adjunct to pharmacological treatment for BD. A systematic review of 17 articles was carried out. The inclusion criteria were: quantitative or qualitative research aimed at examining the efficacy of CBT in BD patients with/without medication; publications in English language; and) being 18-65 years of age. The exclusion criteria were: review and meta-analysis articles; articles that included patients with other diagnoses in addition to BD and that did not separate the results based on such diagnoses; and studies with patients who did not meet the DSM or ICD criteria for BD. The PubMed, PsycINFO and Web of Science databases were searched up to 5 January 2020. The search strategy was: "Bipolar Disorder" AND "Cognitive Behavioral Therapy". RESULTS A total of 1531 patients both sexes were included. The weighted mean age was 40.703 years. The number of sessions ranged from 8 to 30, with a total duration of 45-120 min. All the studies show variable results in improving the level of depression and the severity of mania, improving functionality, reducing relapses and recurrences, and reducing anxiety levels and the severity of insomnia. CONCLUSIONS The use of CBT alone or adjunctive therapy in BD patients is considered to show promising results after treatment and during follow-up. Benefits include reduced levels of depression and mania, fewer relapses and recurrences, and higher levels of psychosocial functioning. More studies are needed.
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Affiliation(s)
- Glauco Valdivieso-Jiménez
- Instituto Peruano para el Estudio y Abordaje Integral de la Personalidad, Lima, Peru; Servicio de Psiquiatría, Hospital de Emergencias Villa El Salvador, Lima, Peru.
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Tallon D, Thomas L, Brabyn S, Ching BCF, Hahn JS, Jude B, X Logan M, Burrage A, Fox F, Gilbody S, Lanham P, Lewis G, Li J, MacNeill SJ, Nazareth I, Parrott S, Peters TJ, Shafran R, Turner K, Williams C, Kessler D, Wiles N. Integrated therapist and online CBT for depression in primary care (INTERACT): study protocol for a multi-centre randomised controlled trial. Trials 2023; 24:421. [PMID: 37340500 DOI: 10.1186/s13063-023-07396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is an effective treatment for depression. Self-directed online CBT interventions have made CBT more accessible at a lower cost. However, adherence is often poor and, in the absence of therapist support, effects are modest and short-term. Delivering CBT online using instant messaging is clinically and cost-effective; however, most existing platforms are limited to instant messaging sessions, without the support of between-session "homework" activities. The INTERACT intervention integrates online CBT materials and 'high-intensity' therapist-led CBT, delivered remotely in real-time. The INTERACT trial will evaluate this novel integration in terms of clinical and cost-effectiveness, and acceptability to therapists and clients. METHODS Pragmatic, two parallel-group multi-centre individually randomised controlled trial, with 434 patients recruited from primary care practices in Bristol, London and York. Participants with depression will be identified via General Practitioner record searches and direct referrals. INCLUSION CRITERIA aged ≥ 18 years; score ≥ 14 on Beck Depression Inventory (BDI-II); meeting International Classification of Diseases (ICD-10) criteria for depression. EXCLUSION CRITERIA alcohol or substance dependency in the past year; bipolar disorder; schizophrenia; psychosis; dementia; currently under psychiatric care for depression (including those referred but not yet seen); cannot complete questionnaires unaided or requires an interpreter; currently receiving CBT/other psychotherapy; received high-intensity CBT in the past four years; participating in another intervention trial; unwilling/unable to receive CBT via computer/laptop/smartphone. Eligible participants will be randomised to integrated CBT or usual care. Integrated CBT utilises the standard Beckian intervention for depression and comprises nine live therapist-led sessions, with (up to) a further three if clinically appropriate. The first session is 60-90 min via videocall, with subsequent 50-min sessions delivered online, using instant messaging. Participants allocated integrated CBT can access integrated online CBT resources (worksheets/information sheets/videos) within and between sessions. Outcome assessments at 3-, 6-, 9- and 12-month post-randomisation. The primary outcome is the Beck Depression Inventory (BDI-II) score at 6 months (as a continuous variable). A nested qualitative study and health economic evaluation will be conducted. DISCUSSION If clinically and cost-effective, this model of integrated CBT could be introduced into existing psychological services, increasing access to, and equity of, CBT provision. TRIAL REGISTRATION ISRCTN, ISRCTN13112900. Registered on 11/11/2020. Currently recruiting participants. Trial registration data are presented in Table 1.
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Affiliation(s)
- Debbie Tallon
- Bristol Medical School, Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Laura Thomas
- Bristol Medical School, Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Sally Brabyn
- ARRC 208, Department of Health Sciences, University of York, York, YO10 5DF, UK
| | - Brian Chi Fung Ching
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, WIT 7BN, UK
| | - Jane Sungmin Hahn
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, WIT 7BN, UK
| | - Berry Jude
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, WIT 7BN, UK
| | - Mekeda X Logan
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, WIT 7BN, UK
| | - Alex Burrage
- Bristol Medical School, Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Fiona Fox
- Bristol Medical School, Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Simon Gilbody
- Mental Health & Addiction Research Group, University of York & Hull York Medical School, York, UK
| | - Paul Lanham
- Public and Patient Involvement Representative, London, UK
| | - Glyn Lewis
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, WIT 7BN, UK
| | - Jinshuo Li
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Stephanie J MacNeill
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Irwin Nazareth
- Department of Primary Care & Population Health, University College London, Royal Free Site, Rowland Hill Street, London, NW3, UK
| | - Steve Parrott
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Tim J Peters
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS21 2LY, UK
| | - Roz Shafran
- Great Ormond Street Institute of Child Health London, University College London, London, WC1N 1EH, UK
| | - Katrina Turner
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Williams
- Clarice Pears Building, University of Glasgow, 90 Byres Road, Glasgow, G12 8TA, UK
- Five Areas Ltd, 1 Aurora Avenue, Clydebank, G81 1BF, UK
| | - David Kessler
- Bristol Medical School, Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Nicola Wiles
- Bristol Medical School, Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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Dissanayaka N, Brooks D, Worthy P, Mitchell L, Pachana NA, Byrne G, Keramat SA, Comans T, Bennett S, Liddle J, Chatfield MD, Broome A, Oram J, Appadurai K, Beattie E, Au T, King T, Welsh K, Pietsch A. A single-blind, parallel-group randomised trial of a Technology-assisted and remotely delivered Cognitive Behavioural Therapy intervention (Tech-CBT) versus usual care to reduce anxiety in people with mild cognitive impairment and dementia: study protocol for a randomised trial. Trials 2023; 24:420. [PMID: 37340492 DOI: 10.1186/s13063-023-07381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Anxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using cognitive behavioural therapy (CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology. METHODS A hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care. DISCUSSION This is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia. TRIAL REGISTRATION This trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 [September 2, 2022].
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Affiliation(s)
- Nadeeka Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
| | - Deborah Brooks
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Worthy
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leander Mitchell
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Gerard Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Services, Brisbane, Australia
| | - Syed Afroz Keramat
- Centre for Health services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sally Bennett
- School of Rehabilitation and Behavioural Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Jacki Liddle
- School of Rehabilitation and Behavioural Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- Metro South Hospital and Health Services, Brisbane, Australia
| | - Mark D Chatfield
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Annette Broome
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- Metro South Hospital and Health Services, Brisbane, Australia
| | - Joanne Oram
- Metro South Hospital and Health Services, Brisbane, Australia
| | | | - Elizabeth Beattie
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Tiffany Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Teagan King
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Kimberley Welsh
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ann Pietsch
- Consumer and Community Involvement Group, UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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48
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Wild J, Warnock-Parkes E, Stott R, Kwok APL, Lissillour Chan MH, Powell CLYM, Leung PWL, Clark DM, Thew GR. Video feedback to update negative self-perceptions in social anxiety disorder: A comparison of internet-delivered vs face-to-face cognitive therapy formats. J Affect Disord 2023; 331:139-144. [PMID: 36907460 PMCID: PMC10914665 DOI: 10.1016/j.jad.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Video feedback is a technique used in cognitive therapy for social anxiety disorder (CT-SAD) to update patients' negative self-perceptions of how they appear to others. Clients are supported to watch video of themselves engaging in social interactions. While typically undertaken in session with a therapist, this study aimed to investigate the effectiveness of remotely delivered video feedback embedded within an Internet-based cognitive therapy program (iCT-SAD). METHODS We examined patients' self-perceptions and social anxiety symptoms before and after video feedback in two randomised controlled trials. Study 1 compared 49 iCT-SAD participants with 47 from face-to-face CT-SAD. Study 2 was a replication using data from 38 iCT-SAD participants from Hong Kong. RESULTS In Study 1, ratings of self-perceptions and social anxiety showed significant reductions following video feedback, in both treatment formats. 92 % of participants in iCT-SAD, and 96 % in CT-SAD thought they looked less anxious compared to their predictions after viewing the videos. The change in self-perception ratings was larger in CT-SAD compared to iCT-SAD, but there was no evidence that the impact of video feedback on social anxiety symptoms around a week later differed between the two treatments. Study 2 replicated the iCT-SAD findings of Study 1. LIMITATIONS The level of therapist support in iCT-SAD videofeedback varied with clinical need and was not measured. CONCLUSIONS The findings indicate that video feedback can be delivered effectively online, and that its impact on social anxiety is not significantly different from in-person treatment delivery.
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Affiliation(s)
- Jennifer Wild
- Department of Experimental Psychology, University of Oxford, UK; Phoenix Australia, Department of Psychiatry, University of Melbourne, Australia.
| | - Emma Warnock-Parkes
- Department of Experimental Psychology, University of Oxford, UK; King's College London, London, UK
| | | | - Amy P L Kwok
- Department of Clinical Psychology, Hong Kong East Cluster, Hospital Authority, Hong Kong, China
| | - Mandy H Lissillour Chan
- Department of Clinical Psychology, Hong Kong East Cluster, Hospital Authority, Hong Kong, China
| | - Candice L Y M Powell
- New Life Psychiatric Rehabilitation Association, Hong Kong, China; Mind HK, Hong Kong, China
| | - Patrick W L Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, UK
| | - Graham R Thew
- Department of Experimental Psychology, University of Oxford, UK; Oxford University Hospitals NHS Foundation Trust, UK; Oxford Health NHS Foundation Trust, UK
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49
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Frommelt T, Bäumler L, Rohleder N, Schulte-Körne G, Platt B. Study protocol for a randomized controlled trial investigating the effect of online interpretation bias intervention on stress reactivity in the children of parents with depression: the CoCo study. BMC Psychiatry 2023; 23:378. [PMID: 37254177 DOI: 10.1186/s12888-023-04803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Current preventive interventions for the children of parents with depression demonstrate modest effects on depression incidence. This may be because existing interventions tend to comprise general psychotherapeutic tools, rather than targeting the specific mechanisms underlying familial transmission. Improved theoretical models of familial transmission could enhance the development of targeted interventions. Although existing models assume that cognitive and biological vulnerability factors influence one another, the precise mechanisms are unknown. This project is the first to experimentally test whether negative interpretation bias has an impact on cortisol response in children of parents with depression. This study protocol reports a randomised controlled trial of an interpretation bias intervention which aims to shift participants' interpretation bias in a more positive direction and thereby alter their stress response. METHODS Children aged 10-14 years who have i) one parent with a current or previous depression diagnosis, with at least one episode occurring during the child's lifetime and ii) do not have a current or previous psychiatric diagnosis themselves, will be assigned to one of two conditions: an interpretation bias intervention (n = 50) or a structurally similar placebo intervention (n = 50). The interpretation bias intervention consists of a short lab-based cognitive reappraisal of interpretations training, a four-week app-based Cognitive Bias Modification of Interpretations intervention and interpretation bias specific if-then plans. Interpretation bias will be assessed before and after the intervention using the Scrambled Sentences Task. The effect of the intervention on participants' stress response will be assessed by salivary cortisol collected at five different time points: from immediately before until 45 min after administering the Trier Social Stressor Test for Children. Stress reactivity will be measured via baseline to peak cortisol and stress recovery will be measured via the 45 min cortisol marker. We hypothesise that children who participate in the interpretation bias intervention will display a positive shift in interpretation bias and this, in turn, will alter their stress response. Children who receive the placebo intervention are expected to show a smaller positive shift in interpretation bias and stress reactivity. DISCUSSION The findings of the present study will contribute to models of familial depression transmission as well as informing preventive interventions. If training a more positive interpretation bias subsequently alters participants' stress response, then incorporating such tools may increase the efficacy of existing preventive interventions. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00028842. Registered August 19, 2022.
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Affiliation(s)
- Tonya Frommelt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany.
| | - Leonie Bäumler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Nicolas Rohleder
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstr. 49a, 91052, Erlangen, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
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50
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Redpath P, Searle A, Wall C, Venning A, Oswald T, Glover F, Herriot P. Guided Self-Help for People with Chronic Pain: Integrated Care in a Public Tertiary Pain Clinic-A Pilot Study. Pain Ther 2023; 12:449-460. [PMID: 36595182 PMCID: PMC10036713 DOI: 10.1007/s40122-022-00464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and health care utilisation. Access to timely, person-centred, cost-effective programs is unattainable for most. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Caring and supporting people with chronic pain involves a range of interventions that incorporate a multifaceted bio-psychosocial approach. Tertiary and primary chronic pain services are optimally placed to deliver integrated models of care. This pilot study explored the effectiveness of an integrated Guided Self-Help (GSH) program within a multidisciplinary tertiary pain unit in a public hospital in Australia. METHODS A service delivery evaluation was undertaken and a pilot study implemented to determine feasibility and useability of an integrated GSH program for people with chronic pain. A single-group pre-post evaluation was provided to a convenience sample of 42 people referred to the Flinders Medical Centre Pain Management Unit (FMC PMU). Delivered via telehealth or in person by postgraduate students, a manualised GSH workbook was utilised to support adherence and fidelity. Content included goal setting, pain conceptualisation, psychoeducation, activity scheduling, pacing and cognitive strategies. The purpose of the integrated GSH pilot program was to support participants in gaining increased pain literacy, knowledge of effective physical and psychological strategies and enhance self-management of their chronic pain. Levels of psychological distress (PHQ-9 and GAD-7), pain catastrophising (PCS), and pain severity/interference (BPI) were assessed at the beginning and end of support. Integrating the program within a multidisciplinary pain unit intended to facilitate and provide participants with an understanding of their pain through a psychosocial lens, build self-efficacy, and recognise the benefits of other non-medical supports to manage their chronic pain in the future. Outcome data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity - specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390). RESULTS Participants showed statistically significant improvements on the PHQ-9 [i.e., mean drop of 2.85 (t = 3.16)], GAD [mean drop of 2.52 (t = 2.71)], and PCS [mean drop of 7.77 (t = 3.47)] with small-to-moderate effect sizes. BPI scores did not change. Results were similar when stratifying analyses by those who completed 2-5 versus 6-12 sessions. CONCLUSION Integrating a GSH program for people with chronic pain into a multidisciplinary tertiary pain clinic is an efficacious and scalable way to increase access to effective strategies that can increase self-efficacy and self-management. Novel, scalable, and effective solutions are needed to improve quality of life and address disparities for people with chronic pain. The psychological shifts and benefits observed support efficacy towards self-management strategies that can increase autonomy and quality of life.
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Affiliation(s)
- Paula Redpath
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Amelia Searle
- Pain Management Unit, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Cindy Wall
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia, Darwin, Northern Territory, Australia
| | - Anthony Venning
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tassia Oswald
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Fiona Glover
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter Herriot
- Pain Management Unit, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
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