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Wong DFK, Cheung YCH, Oades LG, Ye SS, Ng YNP. Strength-based cognitive-behavioural therapy and peer-to-peer support in the recovery process for people with schizophrenia: A randomised control trial. Int J Soc Psychiatry 2024; 70:364-377. [PMID: 38032017 DOI: 10.1177/00207640231212096] [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] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND AIMS Dysfunctional cognition and negative symptoms in schizophrenia are associated with persistently low social functioning and quality of life (QoL). Recovery interventions report only a modest effect in improving social functioning and QoL. This study examined the therapeutic effects and pathways of interventions using strength-based cognitive-behavioural therapy (SBCBT) and peer-to-peer support (PSP) approaches. METHODS A randomised control trial compared SBCBT, PSP and TAU (treatment-as-usual) by recruiting 127 individuals with schizophrenia spectrum disorders and low social functioning. RESULTS The three-group comparison found SBCBT produced improved social functioning and social support at post-intervention and 6-month follow-up while PSP reported improved social QoL and defeatist beliefs, but none remained at 6-month follow-up. Unsurprising, no improvement was found in any areas for TAU, both at post-test and 6-month follow-up. Regarding mechanisms of change, improvements in hope and personal recovery consistently and significantly accounted for improvements in social functioning and many aspects of QoL of participants, thus indicating the important contribution of hope and personal recovery in strength-based interventions for people with schizophrenia. CONCLUSION This rigorously designed study provides the first few solid empirical evidence on the effectiveness of SBCBT and PSP in recovery from schizophrenia and provides initial evidence of the linkage between dysfunctional cognition, hope and recovery in schizophrenia.
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Affiliation(s)
- Daniel Fu Keung Wong
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Yves Cho Ho Cheung
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Lindsay G Oades
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, Victoria, Australia
| | - Shengquan Sam Ye
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Yat-Nam Petrus Ng
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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Lofthouse MK, Waite P, Černis E. Developing an understanding of the relationship between anxiety and dissociation in adolescence. Psychiatry Res 2023; 324:115219. [PMID: 37119790 DOI: 10.1016/j.psychres.2023.115219] [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: 06/14/2022] [Revised: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
Anxiety is a common problem in adolescence which is hypothesised to be associated with dissociation, a range of distressing symptoms linked to reduced psychosocial functioning. Yet, to date, research into the mechanisms of dissociation in adolescents has been limited. The present study investigated the link between trait anxiety and dissociative experiences (depersonalisation and 'felt sense of anomaly') using an online survey. Cognitive appraisals of dissociation, perseverative thinking, and body vigilance were assessed as potential mediating factors of this relationship. 1211 adolescents aged 13-18 years were recruited via social media advertisements and local schools. Linear regression showed a moderate positive relationship between trait anxiety and both dissociation constructs. Hierarchical regression indicated that cognitive appraisals of dissociation and perseverative thinking mediated the relationship between trait anxiety and both dissociation constructs, but trait anxiety was a significant predictor for felt sense of anomaly but not depersonalisation after including the mediators. The final models accounted for 58.7% of variance in depersonalisation and 68.4% of variance in felt sense of anomaly. These results support the hypothesis that dissociation is associated with anxiety in adolescence. They also demonstrate that cognitive-behavioural conceptualisations may be valid for understanding dissociation in adolescence.
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Affiliation(s)
- Miss Katie Lofthouse
- University of Oxford, Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University of East Anglia, Norwich Medical School, Chancellors Drive, Norwich NR4 7TJ, United Kingdom
| | - Polly Waite
- University of Oxford, Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Emma Černis
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Oxford OX3 7JX, United Kingdom; University of Birmingham School of Psychology, Edgbaston, Birmingham B15 2TT, United Kingdom
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Casella CB, Zuccolo PF, Sugaya L, de Souza AS, Otoch L, Alarcão F, Gurgel W, Fatori D, Polanczyk GV. Brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression during the COVID-19 pandemic: a randomised controlled trial protocol. Trials 2022; 23:899. [PMID: 36273162 DOI: 10.1186/s13063-022-06836-2] [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: 08/13/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had major impacts in many different spheres, including mental health. Children and adolescents are especially vulnerable because their central nervous system is still in development and they have fewer coping resources than do adults. Increases in the prevalence of depressive and anxiety symptomatology have been reported worldwide. However, access to mental health care is limited, especially for the paediatric population and in low- and middle-income countries. Therefore, we developed a brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression. The aim of this proposed study is to test the efficacy of the intervention. METHODS We will conduct a two-arm, parallel randomised controlled trial involving children and adolescents (8-11 and 12-17 years of age, respectively) with symptoms of anxiety, depression or both, according to the 25-item Revised Child Anxiety and Depression Scale (t-score > 70). A total of 280 participants will be randomised to the intervention group or the active control group, in a 1:1 ratio. Those in the intervention group will receive five weekly sessions of cognitive-behavioural therapy via teleconference. The sessions will focus on stress responses, family communication, diaphragmatic breathing, emotions, anger management, behavioural activation and cognitive restructuring. Participants in both groups will have access to 15 videos covering the same topics. Participant-guardian pairs will be expected to attend the sessions (intervention group), watch the videos (control group) or both (intervention group only). A blinded assessor will collect data on symptoms of anxiety, depression and irritability, at baseline, at the end of the intervention and 30 days thereafter. Adolescents with access to a smartphone will also be invited to participate in an ecological momentary assessment of emotional problems in the week before and the week after the intervention, as well as in passive data collection from existing smartphone sensors throughout the study. DISCUSSION Internet-delivered interventions play a major role in increasing access to mental health care. A brief, manualised, internet-delivered intervention might help children and adolescents with anxiety or depressive symptomatology, even outside the context of the COVID-19 pandemic. TRIAL REGISTRATION ClinicalTrials.gov NCT05139433. Registered prospectively in November 2021. Minor amendments made in July 2022.
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Affiliation(s)
- Caio Borba Casella
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Pedro Fonseca Zuccolo
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luisa Sugaya
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Aline Santana de Souza
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luara Otoch
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Fernanda Alarcão
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wagner Gurgel
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Daniel Fatori
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Guilherme V Polanczyk
- Department and Institute of Psychiatry, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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O'Brien A, Anderson R, Mazzucchelli T, Egan SJ. A protocol for unguided internet self-help cognitive behaviour therapy for perfectionism in adolescents at-risk of eating disorders. Internet Interv 2022; 29:100565. [PMID: 36034181 PMCID: PMC9399281 DOI: 10.1016/j.invent.2022.100565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
UNLABELLED Perfectionism has a strong association with eating disorders, anxiety and depression. Unguided internet cognitive behaviour therapy for perfectionism has demonstrated efficacy in female adolescents without elevated eating disorder symptoms. No research to date has examined unguided internet cognitive behaviour therapy for perfectionism for adolescents with elevated eating disorder symptoms as an indicated prevention for eating disorders and co-occurring symptoms of anxiety and depression. The protocol outlines the plan for a randomised controlled trial of a co-designed, unguided internet cognitive behaviour therapy for perfectionism with female adolescents with elevated symptoms of eating disorders. The intervention will be a 4-week programme compared to a waitlist control. Outcomes on eating disorder symptoms, anxiety and depression will be measured pre and post intervention and follow-up. TRIAL REGISTRATION This trial was registered on 23 September 2020 with the Australian New Zealand Clinical Trials Registry (ACTRN12620000951954P).
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Affiliation(s)
- Amy O'Brien
- Discipline of Psychology, School of Population Health, Curtin University, GPO Box U1987, Perth 6845, Australia
| | - Rebecca Anderson
- Discipline of Psychology, School of Population Health, Curtin University, GPO Box U1987, Perth 6845, Australia,enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Trevor Mazzucchelli
- Discipline of Psychology, School of Population Health, Curtin University, GPO Box U1987, Perth 6845, Australia,enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sarah J. Egan
- Discipline of Psychology, School of Population Health, Curtin University, GPO Box U1987, Perth 6845, Australia,enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia,Corresponding author at: enAble Institute and School of Population Health, Curtin University, Australia.
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Melesse TG, Chau JPC, Nan MA. Effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer: A systematic review and meta-analysis. J Psychosom Res 2022; 157:110805. [PMID: 35378435 DOI: 10.1016/j.jpsychores.2022.110805] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/17/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This systematic review aimed to summarise the effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer without limitations on publication date. METHODS Thirteen English and seven Chinese electronic databases were searched from April to June 2021. Randomised control trials, quasi-experimental studies, pre-test post-test studies with a control group, factorial or cross-over designs that included children ≤18 years old and during various stages of the cancer trajectory, who have received cognitive-behavioural therapy, and reported (anxiety, depression, stress, quality of life, self-efficacy, fatigue, pain, behavioural distress, anger, and/or academic performance) were included. RESULTS Eight studies with quality of evidence ranging from low to high risk of bias were included. The results show cognitive-behavioural therapy has favourable effects on anxiety, depression, pain and behavioural distress. The meta-analysis also show that it reduces anxiety (SMD = -0.89, 95% CI (-1.45, -0.32), p < 0.002), depression (SMD = -0.90, 95% CI (-1.40, -0.39), p < 0.0005), and pain (SMD = -0.56, 95% CI (-1.04, -0.08), p < 0.002). It also has a favourable effect on stress, anger and self-efficacy, though the results are drawn from a single study. CONCLUSION Cognitive-behavioural therapy has the potential to reduce anxiety, depression and pain for children with cancer. It also shows promise in reducing behavioural distress. Although effects on stress, anger, and self-efficacy have been found to be significant, there have been limited studies on these aspects of functioning and more research is needed. The findings are drawn from heterogeneous participants and interventions, thus emphasising the need to conduct well-designed intervention studies, including cancer survivors.
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Affiliation(s)
- Tenaw Gualu Melesse
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Paediatric and Child Health Nursing, College of Health Sciences, Debre Markos University, Ethiopia.
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - M A Nan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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Schäfer AGM. [Innovative interventions in pain physiotherapy : Advancing care for people with chronic pain]. Schmerz 2022; 36:248-255. [PMID: 35301593 DOI: 10.1007/s00482-022-00631-3] [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: 09/14/2021] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic pain, with a prevalence of at least 17%, is a costly health problem associated with a high burden of disease. Musculoskeletal chronic pain is particulary common, which in many cases is treated with physiotherapy. AIM The aim of this paper is to provide an overview of innovative, promising physiotherapy interventions in pain management, to present their effectiveness and to discuss their implementation in healthcare. METHODS A narrative review was conducted. The Cochrane, Medline (via PubMed) and PEDro databases were searched using the search terms chronic pain, physiotherapy, prevention, pain education, behavioural intervention, eHealth, and systematic review as well as chronic pain, guideline and relevant synonyms. RESULTS One guideline review, two guidelines and ten systematic reviews were included. Chronic pain prevention, digital health apps, lifestyle interventions and behavioural approaches were identified as promising and effective interventions for people with chronic pain, showing the potential to meaningfully complement pain physiotherapy and improve quality of care. CONCLUSIONS Despite the predominantly positive results from systematic reviews, implementation in everyday care is difficult due to conditions of care and the contemporary education system for physiotherapists in Germany. Health services research can play an important role in accelerating the transfer of innovations into practice.
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Affiliation(s)
- Axel Georg Meender Schäfer
- Fakultät Soziale Arbeit und Gesundheit, Hochschule für angewandte Wissenschaft und Kunst, Goschentor 1, 31134, Hildesheim, Deutschland.
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Teismann T, Gysin-Maillart A. [Psychotherapy after a suicide attempt-current evidence and evaluation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021. [PMID: 34878566 DOI: 10.1007/s00103-021-03466-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
Suizidversuche gelten als einer der wichtigsten Risikofaktoren für Suizide. Vor diesem Hintergrund wurden in den letzten Jahren diverse Psychotherapieangebote für Personen nach einem Suizidversuch entwickelt und untersucht. Im Rahmen dieses Artikels wird der aktuelle Stand der Effektivitätsforschung zusammengefasst, es werden Beispiele für erfolgreiche suizidfokussierte Psychotherapieprogramme gegeben und der gegenwärtige Forschungs- und Wissensstand wird kritisch reflektiert. Die Ergebnisse von 2 aktuellen Cochrane-Reviews zur Psychotherapie nach selbstverletzendem Verhalten im Kindes‑, Jugend- und Erwachsenenalter sowie Befunde aus 14 weiteren Metaanalysen zur psychologischen Suizidprävention, die in den vergangenen 5 Jahren publiziert wurden, werden überblicksartig dargestellt. Die kognitive Verhaltenstherapie (KVT) und die dialektisch-behaviorale Therapie (DBT) haben sich als effektiv erwiesen. Insgesamt sind die gemittelten Effektstärken jedoch von geringer Größe und diverse methodische Probleme verunmöglichen weitreichende Schlussfolgerungen. Grundsätzlich kommt der suizidspezifischen Psychotherapie in der individuumszentrierten Suizidprävention besondere Bedeutung zu; die empirische Fundierung und Dissemination entsprechender Programme sind jedoch noch unzureichend.
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Fares-Otero NE, Trautmann S, Pfaltz MC, Rodriguez-Jimenez R. Letter to the Editor: Targeting adverse stress-related consequences of the COVID-19 crisis in individuals with psychotic disorders and childhood maltreatment. J Psychiatr Res 2021; 138:453-455. [PMID: 33964683 PMCID: PMC9750188 DOI: 10.1016/j.jpsychires.2021.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Natalia E. Fares-Otero
- Corresponding author. Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Avda. de Córdoba s/n, 28041, Madrid, Spain
| | | | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Faculty of Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Faculty of Medicine, Complutense University of Madrid (UCM), Madrid, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
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Lawton K, Spencer A. A Full Systematic Review on the Effects of Cognitive Behavioural Therapy for Mental Health Symptoms in Child Refugees. J Immigr Minor Health 2021; 23:624-639. [PMID: 33590440 PMCID: PMC8068688 DOI: 10.1007/s10903-021-01151-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
Global conflict in 2019 created record numbers of displaced children. These children have experienced multiple traumas and subsequently suffer high levels of mental health symptoms. Cognitive-behavioural therapy (CBT) is commonly used for post-traumatic stress disorder (PTSD), depression and anxiety, however the current evidence-base of CBT in child refugees is sparse, with mixed results. This study aimed to assess the effects of CBT on symptoms of PTSD, depression and anxiety in child refugees/AS. Ethics were reviewed and granted by the University of Manchester ethics committee. Medline, Embase, Cochrane, PsycINFO and CINAHL were systematically searched. Studies were included if CBT was delivered to refugee/AS children with pre and post-intervention measures of symptoms. Sixteen studies fulfilled criteria. In all studies, mental health symptom scores post-intervention had reduced, suggesting an improvement in mental health following CBT. This reduction was statistically significant in twelve studies (p < 0.001-0.5), clinically significant in eight studies and maintained at follow-up periods. No adverse effects of CBT were identified. This is the first systematic review to focus solely on CBT in child refugee populations, with unanimously positive results. Its use is cautiously recommended, however the need for more methodologically rigorous studies in this population is highlighted.
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Affiliation(s)
- Katie Lawton
- St Helens and Knowsley Teaching Hospitals NHS Trust, 474, Kings Road, Stretford, Manchester, M32 8QW, UK.
| | - Angela Spencer
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Panagiotopoulos NAI, Istikoglou CI, Liappas I, Kentroti D, Andreou E, Rizavas I, Vlissides D. [Cognitive - behavioral psychotherapy of patients with tinnitus]. Psychiatriki 2021; 33:124-138. [PMID: 34052789 DOI: 10.22365/jpsych.2021.017] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In this work 112 studies were reviewed and 21 of them were considered as more reliable and more credible. It is well known that Cognitive-Behavioural Therapy (CBT) is the most valid approach regarding its effectiveness. There are many variations of CBT used in patients with tinnitus, but the most effective appears to be the Cognitive-Behavioural Acceptance and Commitment Therapy. Also, treatment-variations consist in the use of hearing aids, and psycho-education. The Acceptance and Commitment Therapy is a third-generation psychological intervention invented by Steven Hayes in 1986. This therapy also applies to the treatment of many psychological problems, such as depression, anxiety, psychoses and substance use problems, and chronic diseases. The purpose of this therapy is not to reduce symptoms, but to improve health and behaviour changes in order for the patient to accept the inevitable pain involved in his/her condition. There are other forms of therapy that come from the broader spectrum of CBT, such as book-therapy (self-help method), rehabilitation treatment of tinnitus, and the Axiological Model based solely on cognitive psychotherapy inspired by the CBT founder, Aaron Beck. Because the latter treatment is at its first steps, there is no literature yet, and it must be considered as an experimental model. It is also well known that intervention with CBT could significantly reduce the anxiety and stress caused by tinnitus. The CBT technique incorporates many elements used to treat tinnitus, such as self-assessment, applied relaxation, cognitive restructuring, behavioral activation, and positive mental imagery. Finally, it becomes apparent that the tinnitus problem, which is serious for these patients, is increasingly affecting the psychiatric and psychotherapeutic communities.
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Affiliation(s)
| | - Christos I Istikoglou
- Psychiatric Department, "Konstantopouleio" General Hospital of Nea Ionia, Athens, Greece
| | - Ioannis Liappas
- First Department of Psychiatry, University of Athens, Eginition Hospital, Greece
| | - Dimitra Kentroti
- Psychiatric Department, "Konstantopouleio" General Hospital of Nea Ionia, Athens, Greece
| | - Elisavet Andreou
- Psychiatric Department, "Konstantopouleio" General Hospital of Nea Ionia, Athens, Greece
| | | | - Demetrios Vlissides
- Forrest House Psychiatric Unit, Royal Oldham Hospital, Pennine Care Trust, Oldham, UK
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Lopez-Gonzalez H, Griffiths MD, Estévez A. Why Some Sports Bettors Think Gambling Addiction Prevented Them from Becoming Winners? A Qualitative Approach to Understanding the Role of Knowledge in Sports Betting Products. J Gambl Stud 2020; 36:903-920. [PMID: 32253656 DOI: 10.1007/s10899-020-09944-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/28/2022]
Abstract
Sports betting products rely upon a balance between their knowledge and chance based structural characteristics. The emphasis by bookmakers on mastering the knowledge-based elements to become winners poses significant challenges for those seeking help for gambling disorder. Bettors find difficulties in integrating their preconceptions about the role of knowledge and skills in winning, into the new cognitive restructuring fostered by cognitive-behavioural therapy. Using a grounded theory approach, this study collected data from 43 Spanish sports bettors undergoing treatment for gambling disorder. The results suggest sports bettors neutralize some gambling-related cognitive distortions during CBT but retain others. Sports bettors try to eliminate them but encounter external validation to retain them, as well as internal incongruences to integrate them into a coherent understanding of how gambling works. The results are discussed with the aim of providing practical guidance as to how skill versus chance related persistent cognitions can be addressed in CBT.
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Affiliation(s)
- Hibai Lopez-Gonzalez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Feixa Llarga s/n, Hospitalet del Llobregat, 08907, Barcelona, Spain.
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Ana Estévez
- Psychology Department, University of Deusto, Bilbao, Spain
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Waters AM, Candy SG, Zimmer-Gembeck MJ, Groth TA, Craske MG, Bradley BP, Mogg K. A School-Based Comparison of Positive Search Training to Enhance Adaptive Attention Regulation with a Cognitive-Behavioural Intervention for Reducing Anxiety Symptoms in Children. J Abnorm Child Psychol 2019; 47:1821-40. [PMID: 31073880 DOI: 10.1007/s10802-019-00551-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Many children experience anxiety but have limited access to empirically-supported interventions. School-based interventions using brief, computer-assisted training provide a viable way of reaching children. Recent evidence suggests that computer-delivered 'positive search training' (PST) reduces anxiety in children. This multi-informant, randomised controlled trial compared classroom-based, computer-delivered PST (N = 116) to a classroom-based, therapist-delivered cognitive-behavioural intervention (CBI) (N = 127) and a curriculum-as-usual control condition (CAU) (N = 60) in 7-11 year old children. Primary outcomes were child and parent report of child anxiety symptoms. Secondary outcomes were child and parent report of child depressive symptoms and child attention biases. Outcomes were assessed before and after the interventions, and six- and 12-months post-intervention. Teacher report of children's social-emotional functioning was assessed at pre- and post-intervention. As expected, compared to CAU, children receiving PST and the CBI reported greater anxiety reductions by post-intervention and six-month follow-up but, unexpectedly, not at 12-month follow-up. Partially consistent with hypotheses, compared to CAU, parents reported greater anxiety reductions in children receiving PST, but not the CBI, at 12-month follow-up. Contrary to expectation, there was a pre- to post-intervention increase in threat attention bias in PST compared to the other conditions, with no significant differences at follow-up. In support of hypotheses, teachers reported higher post-intervention social-emotional functioning in Year 5 students receiving the CBI but, unexpectedly, lower post-intervention functioning in students receiving PST. There were no effects on depressive symptoms. Further research is needed on strategies to maintain long-term benefits and determine preventative versus early intervention effects.
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Jones EJ, Howell JA, Tonta KE, Egan SJ, Hasking PA, Boyes ME, McEvoy PM, Mazzucchelli TG. Guided Internet-delivered cognitive behaviour therapy for perfectionism in a non-clinical sample of adolescents: A study protocol for a randomised controlled trial. Internet Interv 2020; 21:100342. [PMID: 32868991 PMCID: PMC7449979 DOI: 10.1016/j.invent.2020.100342] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Perfectionism is elevated across a range of psychopathologies and has been shown to impede treatment outcomes. There is also evidence suggesting elevated perfectionism may contribute to the onset and maintenance of non-suicidal self-injury. There is a growing body of evidence suggesting that Internet-delivered cognitive-behavioural therapy for perfectionism reduces perfectionism and symptoms of psychological disorders and that reductions are maintained at 3-month and 6-month follow-up. There may also be reductions in non-suicidal self-injury, although no study has investigated this potential benefit. Given that associations between perfectionism and psychopathology are observed across both adults and adolescents, the need for the development of interventions targeting adolescents is essential for early intervention and prevention. METHODS The present study will employ a randomised controlled trial to examine the efficacy of 8-week guided Internet-delivered cognitive-behavioural therapy for perfectionism in adolescents compared to a waitlist control group. The primary outcome is perfectionism, and secondary outcomes include symptoms of psychological disorders, well-being, and non-suicidal self-injury. Outcomes will be assessed at pre-intervention, post-intervention, 1-month follow-up, 3-month follow-up, and 6-month follow-up. A minimum of 240 participants will be recruited online through social media, Australian universities, and schools across Australia. Generalised linear mixed models will be used to test for changes in outcomes between the intervention group and the waitlist control. DISCUSSION The outcomes of this trial will contribute to the literature on perfectionism and psychopathology in adolescents, as well as the efficacy of guided Internet-delivered interventions for adolescents. TRIAL REGISTRATION The trial was registered on the 20th of June 2019 at the Australia New Zealand Clinical Trials Registry (ACTRN12619000881134). TRIAL STATUS This is protocol version 1.0. Participant recruitment began on 31 July 2019 and is still actively running with an anticipated completion date in the fourth quarter of 2020.
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Affiliation(s)
- Emily J. Jones
- School of Psychology, Curtin University, Western Australia,Corresponding author at: School of Psychology, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Joel A. Howell
- School of Psychology, Curtin University, Western Australia
| | - Kate E. Tonta
- School of Psychology, Curtin University, Western Australia
| | - Sarah J. Egan
- School of Psychology, Curtin University, Western Australia
| | | | - Mark E. Boyes
- School of Psychology, Curtin University, Western Australia
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14
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Coates JM, Gullo MJ, Feeney GFX, McD Young R, Dingle GA, Clark PJ, Connor JP. Craving mediates the effect of impulsivity on lapse-risk during alcohol use disorder treatment. Addict Behav 2020; 105:106286. [PMID: 32007828 DOI: 10.1016/j.addbeh.2019.106286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/07/2019] [Accepted: 12/30/2019] [Indexed: 01/11/2023]
Abstract
Rash impulsiveness, the propensity for approach behaviour despite potential negative consequences, is associated with stronger alcohol craving in patients with Alcohol Use Disorder (AUD). This relationship is poorly understood and implications for treatment response are unexamined. This study explored the relationship between rash impulsiveness, craving, and treatment response among 304 outpatients enrolled in a 12-week abstinence-based Cognitive-Behavioural Therapy (CBT) program for AUD. Assessments were completed pre-and-post treatment, with craving and alcohol consumption monitored at each treatment session. Higher rash impulsiveness predicted more frequent craving over treatment (b = 0.95, 95% CI = 0.40, 1.50). Higher craving was associated with greater lapse-risk (b = 0.04, 95% CI = 0.03, 0.05), with the association between craving and lapse-risk increasing as treatment progressed (b = 0.01, 95% CI = 0.01, 0.02). Craving positively mediated the relationship between rash impulsiveness and lapse-risk (µ = 0.38, 95% CI = 0.10, 0.70). Contrary to hypotheses, the risk of lapse in response to craving was not moderated by rash-impulsiveness. These results suggest that AUD patients with a predisposition for rash impulsiveness are more vulnerable to alcohol craving, and subsequently, poorer treatment outcomes.
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15
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Goldsmith K, Hudson JL, Chalder T, Dennison L, Moss-Morris R. How and for whom does supportive adjustment to multiple sclerosis cognitive-behavioural therapy work? A mediated moderation analysis. Behav Res Ther 2020; 128:103594. [PMID: 32272288 DOI: 10.1016/j.brat.2020.103594] [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: 10/25/2019] [Revised: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
The supportive adjustment for multiple sclerosis (saMS) randomised controlled trial showed cognitive behavioural therapy (CBT) reduced distress at 12-months compared to supportive listening (SL). Larger changes in distress and functional impairment following CBT occurred in participants with clinical distress at baseline. This secondary analysis investigates whether CBT treatment effects occur through pre-defined CBT mechanisms of change in the total cohort and clinically distressed subgroup. 94 participants were randomised to saMS CBT or SL. Primary outcomes were distress and functional impairment (12 months). Mediators included cognitive-behavioural variables at post-treatment (15 weeks). Structural equation mediation and mediated-moderation models adjusting for baseline confounders assessed mediation overall and by distress level. Significant mediation was found but only for those with clinical distress at baseline. Illness acceptance (-0.20, 95% confidence interval -0.01 to -0.46) and reduced embarrassment avoidance behaviours (-0.22, -0.02 to -0.58) mediated CBT's effect on distress. Changes in beliefs about processing emotions (-0.19, -0.001 to -0.46) mediated CBT's effect on functional impairment. saMS CBT had effects on distress and functional impairment via some of the hypothesised mechanisms drawn from a theoretical model of adjustment for MS but only among participants with clinical distress at baseline. Increasing acceptance and emotional expression and decreasing embarrassment avoidance improves MS adjustment.
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Affiliation(s)
- Kimberley Goldsmith
- King's College London, Department of Biostatistics & Informatics, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Trudie Chalder
- King's College London, Psychological Medicine Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Laura Dennison
- Department of Psychology, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Rona Moss-Morris
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
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16
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Dalle Grave R, Sartirana M, Calugi S. Personalized cognitive-behavioural therapy for obesity (CBT-OB): theory, strategies and procedures. Biopsychosoc Med 2020; 14:5. [PMID: 32175002 PMCID: PMC7063798 DOI: 10.1186/s13030-020-00177-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 11/29/2022] Open
Abstract
Personalized cognitive-behavioural therapy for obesity (CBT-OB) is a new treatment that combines the traditional procedures of standard behavioural therapy for obesity (i.e., self-monitoring, goal setting, stimulus control, contingency management, behavioural substitution, skills for increasing social support, problem solving and relapse prevention) with a battery of specific cognitive strategies and procedures. These enable the treatment to be individualized, and to help patients to address the cognitive processes that previous research has found to be associated with treatment discontinuation, the amount of weight lost and long-term weight-loss maintenance. The treatment programme can be delivered at three levels of care, outpatient, day hospital and residential, and includes six modules, which are introduced according to the individual patient’s needs as part of a flexible, personalized approach. The primary goals of CBT-OB are to help patients to (i) achieve, accept and maintain healthy weight loss; (ii) adopt a lifestyle conducive to weight control; and (iii) develop a stable “weight-control mindset”. A randomized controlled trial has found that 88 patients suffering from morbid obesity treated with CBT-OB followed a period of residential treatment achieved a mean weight loss of 15% after 12 months, with no tendency to regain weight between 6 and 12 months. The treatment efficacy is also supported by data from a study assessing the effects of group CBT-OB delivered in a real-world clinical setting. In that study, 77 patients with morbid obesity who completed the treatment achieved 9.9% weight loss after 18 months. These promising results, if confirmed by future clinical studies, suggest that CBT-OB has the potential to be more effective than traditional weight-loss lifestyle-modification programmes.
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Affiliation(s)
- Riccardo Dalle Grave
- 1Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89 37016 Garda (VR), Verona, Italy
| | | | - Simona Calugi
- 1Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89 37016 Garda (VR), Verona, Italy
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17
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Hvenegaard M, Moeller SB, Poulsen S, Gondan M, Grafton B, Austin SF, Kistrup M, Rosenberg NGK, Howard H, Watkins ER. Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial. Psychol Med 2020; 50:11-19. [PMID: 30630555 DOI: 10.1017/s0033291718003835] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression. METHODS A total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224). RESULTS RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03-0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered. CONCLUSIONS This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.
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Affiliation(s)
- Morten Hvenegaard
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Stine B Moeller
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Gondan
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ben Grafton
- Cognition and Emotion Lab, School of Psychology, University of Western Australia, Crawley, Australia
| | - Stephen F Austin
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Morten Kistrup
- Psychiatric Outpatient Service, Mental Health Centre North Zealand, Hillerød, Denmark
| | - Nicole G K Rosenberg
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen, Denmark
| | - Henriette Howard
- Mental Health Centre for Child and Adolescent Psychiatry, Glostrup, Denmark
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
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18
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Mas RR, López-Jiménez T, Pujol-Ribera E, Martín MIFS, Moix-Queraltó J, Montiel-Morillo E, Rodríguez-Blanco T, Casajuana-Closas M, González-Moneo MJ, Juárez EN, Juárez MN, Roura-Olivan M, Martin-Peñacoba R, Pie-Oncins M, Balagué-Corbella M, Muñoz MÁ, Violan C, Berenguera A. Effectiveness of a multidisciplinary BIOPSYCHOSOCIAL intervention for non-specific SUBACUTE low back pain in a working population: a cluster randomized clinical trial. BMC Health Serv Res 2019; 19:962. [PMID: 31831074 PMCID: PMC6909445 DOI: 10.1186/s12913-019-4810-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 12/04/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a multifactorial condition with individual and societal impact that affects populations globally. Current guidelines for the treatment of LBP recommend pharmacological and non-pharmacological strategies. The aim of this study was to compare usual clinical practice with the effectiveness of a biopsychosocial multidisciplinary intervention in reducing disability, severity of pain and improving quality of life in a working population of patients with subacute (2-12 weeks), non-specific LBP. METHODS Longitudinal cluster randomized clinical trial conducted in 39 Primary Health Care Centres (PHCC) of Barcelona, with patients aged 18-65 years (n = 501; control group = 239; 26 PHCC, intervention group = 262; 13 PHCC). The control group received usual clinical care. The intervention group received usual clinical care plus a biopsychosocial multidisciplinary intervention, which consisted of physiotherapy, cognitive-behavioural therapy and medication. The main outcomes were changes in the Roland Morris Disability Questionnaire (RMDQ), and the minimal clinically important differences. Secondary outcomes were changes in the McGill Pain (MGPQ) and Quality of Life (SF-12) questionnaires. Assessment was conducted at baseline, 3 and 12 months. Analysis was by intention-to-treat and analyst-blinded. Multiple imputations were used. RESULTS Of the 501 enrolled patients, 421 (84%) provided data at 3 months, and 387 (77.2%) at 12 months. Mean age was 46.8 years (SD: 11.5) and 64.7% were women. In the adjusted analysis of the RMDQ outcome, only the intervention group showed significant changes at 3 months (- 1.33 points, p = 0.005) and at 12 months (- 1.11 points, p = 0.027), but minimal clinically important difference were detected in both groups. In the adjusted analysis of the RMDQ outcome, the intervention group improvement more than the control group at 3 months (- 1.33 points, p = 0.005) and at 12 months (- 1.11 points, p = 0.027). The intervention group presented a significant difference. Both groups presented a minimal clinically important difference, but more difference in the intervention group. The intervention group presented significant differences in the MGPQ scales of current pain intensity and VAS scores at 3 months. No statistically significant differences were found in the physical and mental domains of the SF-12. CONCLUSIONS A multidisciplinary biopsychosocial intervention in a working population with non-specific subacute LBP has a small positive impact on disability, and on the level of pain, mainly at short-term, but no difference on quality of life. TRIAL REGISTRATION ISRCTN21392091 (17 oct 2018) (Prospectively registred).
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Affiliation(s)
- Romina Raczy Mas
- Gerència Territorial de Barcelona, Catalan Institute of Health, c/ Sardenya, 375, Entl, 08025 Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- Department of Paediatrics, Gynaecology and Obstetrics and Preventive Medicine, Universitat Autònoma de Barcelona Faculty of Medicine-Bellaterra, 08193 (Cerdanyola del Vallès), Spain
| | - Tomàs López-Jiménez
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- Department of Paediatrics, Gynaecology and Obstetrics and Preventive Medicine, Universitat Autònoma de Barcelona Faculty of Medicine-Bellaterra, 08193 (Cerdanyola del Vallès), Spain
| | | | - Jenny Moix-Queraltó
- Department of Basic, Evolutionary and Educational Psychology, Universitat Autònoma de Barcelona Faculty of Psychology, Building B. Campus de la UAB, Bellaterra, 08193 Barcelona, Spain
| | | | - Teresa Rodríguez-Blanco
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - Marc Casajuana-Closas
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- Department of Paediatrics, Gynaecology and Obstetrics and Preventive Medicine, Universitat Autònoma de Barcelona Faculty of Medicine-Bellaterra, 08193 (Cerdanyola del Vallès), Spain
| | | | - Ester Núñez Juárez
- SAP Support to Diagnosis and Treatment, Gerència Territorial de Barcelona, Catalan Institute of Health, 08001 Barcelona, Spain
| | - Montse Núñez Juárez
- Unit of Functional Rehabilitation, Department of Rheumatology, Hospital Clínic Universitari, 08036 Barcelona, Spain
| | | | | | - Magda Pie-Oncins
- Primary Care Centre Sant Martí, SAP Litoral, 08020 Barcelona, Spain
| | - Montse Balagué-Corbella
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - Miguel-Ángel Muñoz
- Gerència Territorial de Barcelona, Catalan Institute of Health, c/ Sardenya, 375, Entl, 08025 Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- Department of Paediatrics, Gynaecology and Obstetrics and Preventive Medicine, Universitat Autònoma de Barcelona Faculty of Medicine-Bellaterra, 08193 (Cerdanyola del Vallès), Spain
| | - Concepción Violan
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - Anna Berenguera
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
- Department of Paediatrics, Gynaecology and Obstetrics and Preventive Medicine, Universitat Autònoma de Barcelona Faculty of Medicine-Bellaterra, 08193 (Cerdanyola del Vallès), Spain
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López-López JA, Davies SR, Caldwell DM, Churchill R, Peters TJ, Tallon D, Dawson S, Wu Q, Li J, Taylor A, Lewis G, Kessler DS, Wiles N, Welton NJ. The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis. Psychol Med 2019; 49:1937-1947. [PMID: 31179960 PMCID: PMC6712954 DOI: 10.1017/s003329171900120x] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 07/11/2018] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 11/05/2022]
Abstract
Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of -1.11 (95% credible interval -1.62 to -0.60) for face-to-face CBT, -1.06 (-2.05 to -0.08) for hybrid CBT, and -0.59 (-1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
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Affiliation(s)
- José A. López-López
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Basic Psychology & Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Sarah R. Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah M. Caldwell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Tim J. Peters
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah Tallon
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Qi Wu
- Faculty of Health Sciences, University of York, York, UK
| | - Jinshuo Li
- Faculty of Health Sciences, University of York, York, UK
| | - Abigail Taylor
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - David S. Kessler
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J. Welton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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20
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Weise C, Kaiser G, Janda C, Kues JN, Andersson G, Strahler J, Kleinstäuber M. Internet-Based Cognitive-Behavioural Intervention for Women with Premenstrual Dysphoric Disorder: A Randomized Controlled Trial. Psychother Psychosom 2019; 88:16-29. [PMID: 30783069 DOI: 10.1159/000496237] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Given the high prevalence of clinically relevant premenstrual symptoms and the associated impairment, there is a need for effective treatments. Initial evidence suggests cognitive-behavioural therapy (CBT) as an effective treatment for premenstrual dysphoric disorder (PMDD). The aim of the current randomized clinical trial was to evaluate an Internet-based CBT (iCBT) to reduce the burden of PMDD. METHODS In all, 174 women with PMDD were recruited via newspaper articles, flyers, and social media. They were randomized to a treatment group (TG; n = 86) or waitlist control group (CG; n = 88). Women of the TG received an 8-week therapist-guided iCBT. Data were assessed before and after treatment/waiting, and 6 months after intervention with prospective symptom diaries and questionnaires in the premenstrual phase. Treatment effects and moderators were analysed using hierarchical linear modelling. RESULTS Significant time × group interaction effects on functional impairment and psychological impairment, impact on everyday life, symptom intensity, and symptom disability in favour of the TG indicated the efficacy of the treatment. Follow-up assessments demonstrated treatment effects to be stable until 6 months after treatment. Additionally, significant interactions with moderator variables were found. In the TG, higher levels of active coping and lower levels of support-seeking coping were associated with stronger improvement in interference in everyday life and symptom intensity. In addition, lower levels of perceived stress were associated with stronger improvement in functional impairment. CONCLUSION The iCBT was highly effective in reducing the burden of PMDD. It appears to be particularly important to address coping styles and stress management in the treatment.
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Affiliation(s)
- Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany,
| | - Gudrun Kaiser
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Carolyn Janda
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Johanna N Kues
- Department for Anaesthesiology and Intensive Care, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jana Strahler
- Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany
| | - Maria Kleinstäuber
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany.,Department of Psychological Medicine, Dunedin Medical School, University of Otago, Dunedin, New Zealand
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21
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Pellizzer ML, Waller G, Wade TD. Predictors of outcome in cognitive behavioural therapy for eating disorders: An exploratory study. Behav Res Ther 2019; 116:61-68. [PMID: 30798180 DOI: 10.1016/j.brat.2019.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/01/2018] [Revised: 01/25/2019] [Accepted: 02/06/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Early decrease in symptoms is a consistent predictor of good treatment outcome across all eating disorders. The current study explored the predictive value of novel early change variables in a transdiagnostic, non-underweight sample receiving 10-session cognitive behavioural therapy. METHOD Participants who reported bingeing and/or purging in the week preceding baseline assessment (N = 62) were included in analyses. Early change variables were calculated for novel (body image flexibility, body image avoidance, body checking, and fear of compassion) and established predictors (behavioural symptoms and therapeutic alliance). Outcomes were global eating disorder psychopathology and clinical impairment at posttreatment and three-month follow-up. Intent-to-treat analyses were conducted using linear regression, adjusting for baseline values of the relevant outcome and early change in behavioural symptoms. RESULTS Early improvement in body image flexibility was the most consistent predictor of good outcome. Early change in body image avoidance and the fear of expressing and receiving compassion to/from others were significant predictors in some analyses. DISCUSSION Novel early change variables were significant predictors of eating disorder outcomes in this exploratory study. Model testing is required to understand the exact mechanisms by which these variables impact on outcomes, and whether there is potential benefit of modifying existing protocols. ANZCTR TRIAL NUMBER ACTRN12615001098527.
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Affiliation(s)
- Mia L Pellizzer
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia.
| | - Glenn Waller
- Department of Psychology, University of Sheffield, United Kingdom
| | - Tracey D Wade
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
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Gerlicher AMV, Tüscher O, Kalisch R. L-DOPA improves extinction memory retrieval after successful fear extinction. Psychopharmacology (Berl) 2019; 236:3401-3412. [PMID: 31243481 PMCID: PMC6892771 DOI: 10.1007/s00213-019-05301-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE A promising strategy to prevent a return of fear after exposure-based therapy in anxiety disorders is to pharmacologically enhance the extinction memory consolidation presumed to occur after exposure. Accumulating evidence suggests that the effect of a number of pharmacological consolidation enhancers depends on a successful fear reduction during exposure. Here, we employed the dopamine precursor L-DOPA to clarify whether its documented potential to enhance extinction memory consolidation is dependent on successful fear extinction. METHODS In two double-blind, randomized and placebo-controlled experiments (experiment 1: N = 79, experiment 2: N = 32) comprising fear conditioning (day 1), extinction followed by administration of 150 mg L-DOPA or placebo (day 2) and a memory test (day 3) in healthy male adults, conditioned responses were assessed as differential skin conductance responses. We tested whether the effect of L-DOPA on conditioned responses at test depended on conditioned responses at the end of extinction in an experiment with a short (10 trials, experiment 1) and long (25 trials, experiment 2) extinction session. RESULTS In both experiments, the effect of L-DOPA was dependent on conditioned responses at the end of extinction. That is, post-extinction L-DOPA compared to placebo administration reduced conditioned responses at test only in participants showing a complete reduction of conditioned fear at the end of extinction. CONCLUSION The results support the potential use of L-DOPA as a pharmacological adjunct to exposure treatment, but point towards a common boundary condition for pharmacological consolidation enhancers: a successful reduction of fear in the exposure session.
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Affiliation(s)
- A. M. V. Gerlicher
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany ,Deutsches Resilienz Zentrum (DRZ), Johannes Gutenberg University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,Present Address: Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WS Amsterdam, The Netherlands
| | - O. Tüscher
- Deutsches Resilienz Zentrum (DRZ), Johannes Gutenberg University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - R. Kalisch
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131 Mainz, Germany ,Deutsches Resilienz Zentrum (DRZ), Johannes Gutenberg University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
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Hartmann JA, McGorry PD, Schmidt SJ, Amminger GP, Yuen HP, Markulev C, Berger GE, Chen EYH, de Haan L, Hickie IB, Lavoie S, McHugh MJ, Mossaheb N, Nieman DH, Nordentoft M, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma SK, Yung AR, Nelson B. Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis. Psychother Psychosom 2018; 86:292-299. [PMID: 28903120 DOI: 10.1159/000477551] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. METHODS A sample of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. RESULTS In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. CONCLUSIONS Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.
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Affiliation(s)
- Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
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Abstract
There is a paucity of research in the UK which examines problem gambling and that which does exist is mainly quantitative, focuses on male samples and fails to look at treatment seeking populations or obstacles preventing problem gamblers from seeking treatment. This paper presents findings from part of a larger qualitative study that explored the experience of treatment for female problem gamblers. Data were collected using semi-structured interviews with eight women who had received individual cognitive-behavioural therapy in the National Health Service for their gambling problem. An interpretative phenomenological analysis approach was applied in the research process, identifying three main themes, of which the subtheme 'Barriers to Treatment' is examined here. Internal and external barriers to treatment organically emerged in all female participants' accounts and appear to have an impact on service utilisation. Input directly from gamblers can be combined with findings from other studies to devise better ways of reaching female problem gamblers. A better understanding of barriers to treatment can also provide valuable direction for future research and suggest applications in clinical service provision and treatment planning.
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Affiliation(s)
- Anna Kaufman
- Department of Psychology, City University London, Northampton Square, London, EC1V 0HB, UK.
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Werner-Seidler A, Johnston L, Christensen H. Digitally-delivered cognitive-behavioural therapy for youth insomnia: A systematic review. Internet Interv 2018; 11:71-78. [PMID: 30135762 PMCID: PMC6084877 DOI: 10.1016/j.invent.2018.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022] Open
Abstract
Sleep disturbance is common among young people, with consequences for academic, emotional and behavioural development. Cognitive-behavioural therapy for insomnia (CBT-I) is efficacious, yet it is costly and not available to many who need it. Digitally-delivered CBT-I (eCBT-I) has the potential to overcome these barriers. The purpose of this systematic review was to identify studies which report on the efficacy or effectiveness of eCBT-I for young people with sleep disturbance. Electronic databases were systematically searched and three studies met inclusion criteria. Two studies used the same online intervention for adolescents with insomnia symptoms, while the other was conducted in a college sample of individuals who opted into a stress-management study. Results showed that eCBT-I improved sleep efficiency, sleep quality, sleep-onset latency and total sleep time with effect sizes ranging from 0.17-1.30 (Cohen's d). This suggests that eCBT-I is a promising intervention for young people, but more studies are needed to verify the conditions under which it is most effective.
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Key Words
- Adolescence
- BDI-II, Beck Depression Inventory-II
- CBT-I, Cognitive-behavioural therapy for insomnia
- Cognitive-behavioural therapy
- Insomnia
- PSQI, Pittsburgh Sleep Quality Index
- SE, sleep efficiency
- SOL, sleep onset latency
- SQ, sleep quality
- STAI-S, State-Trait Anxiety Inventory State Version
- Sleep disturbance
- TIB, time in bed
- TST, total sleep time
- WASO, wake after sleep onset
- eCBT-I, digitally-delivered CBT-I
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Alammehrjerdi Z, Ezard N, Dolan K. Methamphetamine dependence in methadone treatment services in Iran: the first literature review of a new health concern. Asian J Psychiatr 2018; 31:49-55. [PMID: 29414387 DOI: 10.1016/j.ajp.2018.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/12/2017] [Revised: 12/12/2017] [Accepted: 01/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Methamphetamine dependence is a serious health problem among Iranian methadone patients. AIM The current study is the first research that reviewed the prevalence of methamphetamine dependence and the associated harms among Iranian methadone patients. The other aims were to review the history of receiving methamphetamine treatment among methadone patients and the evaluated psychosocial treatments for methamphetamine dependence and/or associated harms. METHODS Searching included both peer-reviewed literature and grey literature in English and Persian. Reference lists of the relevant papers and reports were searched manually for more information. The time period between 1 January 2005 and 28 October 2017 was set for searching. FINDINGS Available evidence indicated that methamphetamine dependence increased from 3.9% among the two genders in 2007 to 60.3% among men in 2014 and 89.5% among women in 2015-2016. The prevalence of methamphetamine dependence was higher among female methadone patients than their male counterparts. Methamphetamine dependence was associated with multiple health problems in the social and health contexts of the two genders especially women. However, receiving methamphetamine treatment was negligible. The review indicated that cognitive-behavioural therapy improved psychological well-being. The Matrix Model led to abstinence from methamphetamine and improved psychological well-being. Motivational interviewing increased attendance in treatment. Family therapy improved the quality of life and social support. However, more similar studies were needed. CONCLUSION Despite a serious increase in methamphetamine dependence, there were a few evaluated psychosocial treatments. There is an immediate need to evaluate efficacious psychosocial treatments especially for women. Methamphetamine treatment should be provided in methadone treatment services.
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Affiliation(s)
- Zahra Alammehrjerdi
- Program of International Research and Training, National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Ismail A, Moore C, Alshishani N, Yaseen K, Alshehri MA. Cognitive behavioural therapy and pain coping skills training for osteoarthritis knee pain management: a systematic review. J Phys Ther Sci 2017; 29:2228-2235. [PMID: 29643612 PMCID: PMC5890238 DOI: 10.1589/jpts.29.2228] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 08/19/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022] Open
Abstract
[Purpose] To investigate the effectiveness of cognitive-behavioural therapy (CBT) and
pain coping skills training (PCST) on pain level in adults with osteoarthritis of the knee
(KOA) in comparison with usual care. [Subjects and Methods] Five databases were
systematically searched for relevant randomised controlled trials (RCTs) according to the
selected eligibility criteria (inception to June 7, 2016). PEDro scale was used to assess
the validity of included studies. [Results] Four studies met the inclusion criteria and
all studies had high methodological quality. The total number of participants was 665
across the four included studies. All participants had been diagnosed with KOA (clinical
and radiographic evaluation). The majority of the population were female (71.13%). The
interventions utilised were: CBT, CBT for insomnia (CBT-I), PCST, and PCST combined with
behavioral weight management (BWM) in one study and with exercise in another study. The
outcome measure for pain in KOA was the WOMAC scale. Overall, three studies have reported
clinical improvement in KOA pain perception after 12-month follow-up time point.
[Conclusion] This review has recognised the need for future studies that have rigorous
methodological quality, and investigate the effect of mutual CBT and PCST protocols on KOA
pain and pain-related functional and psychological abilities.
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Affiliation(s)
- Ayah Ismail
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Catherine Moore
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Natasha Alshishani
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Khalid Yaseen
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
| | - Mansour Abdullah Alshehri
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdul Aziz University: Jeddah, Saudi Arabia
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Mikocka-Walus A, Bampton P, Hetzel D, Hughes P, Esterman A, Andrews JM. Cognitive-Behavioural Therapy for Inflammatory Bowel Disease: 24-Month Data from a Randomised Controlled Trial. Int J Behav Med. 2017;24:127-135. [PMID: 27432441 PMCID: PMC5288424 DOI: 10.1007/s12529-016-9580-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease (IBD). In the few small studies, cognitive-behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety or depression. However, there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT. METHODS The present two-arm pragmatic randomised controlled trial aimed to establish the impact of CBT on disease course after 24 months of observation. The study compared standard care plus CBT (+CBT) with standard care alone (SC). CBT was delivered over 10 weeks, face-to-face (F2F) or online (cCBT). The data were analysed using linear mixed-effects models. RESULTS CBT did not significantly influence disease activity as measured by disease activity indices at 24 months (Crohn's Disease Activity Index (CDAI), p = 0.92; Simple Clinical Colitis Activity Index (SCCAI), p = 0.88) or blood parameters (C-reactive protein (CRP), p < 0.62; haemoglobin (Hb), p = 0.77; platelet, p = 0.64; white cell count (WCC), p = 0.59) nor did CBT significantly affect mental health, coping or quality of life (all p > 0.05). CONCLUSIONS Therefore, we conclude that CBT does not influence the course of IBD over 24 months. Given the high rate of attrition, particularly in the CBT group, future trials should consider a personalised approach to psychotherapy, perhaps combining online and one-to-one therapist time.
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Elison S, Jones A, Ward J, Davies G, Dugdale S. Examining effectiveness of tailorable computer-assisted therapy programmes for substance misuse: Programme usage and clinical outcomes data from Breaking Free Online. Addict Behav 2017. [PMID: 28645092 DOI: 10.1016/j.addbeh.2017.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
RATIONALE When evaluating complex, tailorable digital behavioural interventions, additional approaches may be required alongside established methodologies such as randomised controlled trials (RCTs). Research evaluating a computer-assisted therapy (CAT) programme for substance misuse, Breaking Free Online (BFO), is informed by Medical Research Council (MRC) guidance recommending examination of 'mechanisms of action' of individual intervention strategies, which is relevant when evaluating digital interventions with content that may evolve over time. AIMS To report findings from examination of mechanisms of action of tailoring advice within the BFO programme and outcomes from specific intervention strategies. METHODOLOGY Analysis of covariance and linear regressions were used to assess intervention completion data, and psychometric and clinical outcomes, for 2311 service users accessing drug and alcohol treatment services across the UK. RESULTS Tailoring advice provided to users appeared to prompt them to prioritise completion of intervention strategies associated with their areas of highest biopsychosocial impairment. Completion of specific intervention strategies within BFO were associated with specific clinical outcomes, with a dose response also being found. Mechanisms of action analyses revealed the primacy of cognitions, with cognitive restructuring strategies being associated with improvements in mental health, severity of substance dependence, quality of life and global biopsychosocial functioning. CONCLUSIONS The MRC framework provides an evolved research paradigm within the field of digital behavioural change. By assessing baseline profiles of need, BFO can target the most appropriate clinical content for individual users. Mechanisms of action research can be used to inform modifications to BFO to continually update clinical content and the technology platform.
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Deppermann S, Vennewald N, Diemer J, Sickinger S, Haeussinger FB, Dresler T, Notzon S, Laeger I, Arolt V, Ehlis AC, Fallgatter AJ, Zwanzger P. Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy. Neuroimage Clin 2017; 16:668-677. [PMID: 29085773 PMCID: PMC5650598 DOI: 10.1016/j.nicl.2017.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/01/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND A relevant proportion of patients with panic disorder (PD) does not improve even though they receive state of the art treatment for anxiety disorders such as cognitive-behavioural therapy (CBT). At the same time, it is known, that from a neurobiological point of view, PD patients are often characterised by prefrontal hypoactivation. Intermittent Theta Burst Stimulation (iTBS) is a non-invasive type of neurostimulation which can modulate cortical activity and thus has the potential to normalise prefrontal hypoactivity found in PD. We therefore aimed at investigating the effects of iTBS as an innovative add-on to CBT in the treatment for PD. METHODS In this double-blind, bicentric study, 44 PD patients, randomised to sham or verum stimulation, received 15 sessions of iTBS over the left prefrontal cortex (PFC) in addition to 9 weeks of group CBT. Cortical activity during a cognitive as well as an emotional (Emotional Stroop) paradigm was assessed both at baseline and post-iTBS treatment using functional near-infrared spectroscopy (fNIRS) and compared to healthy controls. RESULTS In this manuscript we only report the results of the emotional paradigm; for the results of the cognitive paradigm please refer to Deppermann et al. (2014). During the Emotional Stroop test, PD patients showed significantly reduced activation to panic-related compared to neutral stimuli for the left PFC at baseline. Bilateral prefrontal activation for panic-related stimuli significantly increased after verum iTBS only. Clinical ratings significantly improved during CBT and remained stable at follow-up. However, no clinical differences between the verum- and sham-stimulated group were identified, except for a more stable reduction of agoraphobic avoidance during follow-up in the verum iTBS group. LIMITATIONS Limitations include insufficient blinding, the missing control for possible state-dependent iTBS effects, and the timing of iTBS application during CBT. CONCLUSION Prefrontal hypoactivity in PD patients was normalised by add-on iTBS. Clinical improvement of anxiety symptoms was not affected by iTBS.
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Key Words
- ANOVA, analysis of variance
- CAQ, Cardiac Anxiety Questionnaire
- CBSI, correlation-based signal improvement
- CBT, cognitive-behavioural therapy
- Cognitive-behavioural therapy
- ER, error rate
- Emotion regulation
- Functional near-infrared spectroscopy
- HAM-A, Hamilton Anxiety Rating Scale
- HHb, deoxyhemoglobin
- Intermittent Theta Burst Stimulation
- LOCF, last observation carried forward
- O2Hb, oxyhemoglobin
- PAS, Panic and Agoraphobia Scale
- PD, panic disorder
- PFC, prefrontal cortex
- Panic disorder
- RM-ANOVA, repeated-measures analysis of variance
- ROI, region of interest
- RT, reaction time
- fNIRS, functional near-infrared spectroscopy
- iTBS, intermittent Theta Burst Stimulation
- rTMS, repetitive Transcranial Magnetic Stimulation
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Affiliation(s)
- Saskia Deppermann
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Nadja Vennewald
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Julia Diemer
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
- kbo-Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany
| | - Stephanie Sickinger
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Florian B. Haeussinger
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
- Graduate School LEAD, Europastr. 6, University of Tuebingen, 72072 Tuebingen, Germany
| | - Swantje Notzon
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Inga Laeger
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Volker Arolt
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
- Graduate School LEAD, Europastr. 6, University of Tuebingen, 72072 Tuebingen, Germany
- Cluster of Excellence CIN, Otfried-Mueller-Str. 25, University of Tuebingen, 72076 Tuebingen, Germany
| | - Peter Zwanzger
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
- kbo-Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany
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Cao J, Liu Q, Li Y, Yang J, Gu R, Liang J, Qi Y, Wu H, Liu X. Cognitive behavioural therapy attenuates the enhanced early facial stimuli processing in social anxiety disorders: an ERP investigation. Behav Brain Funct 2017; 13:12. [PMID: 28754179 PMCID: PMC5534051 DOI: 10.1186/s12993-017-0130-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 04/13/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies of patients with social anxiety have demonstrated abnormal early processing of facial stimuli in social contexts. In other words, patients with social anxiety disorder (SAD) tend to exhibit enhanced early facial processing when compared to healthy controls. Few studies have examined the temporal electrophysiological event-related potential (ERP)-indexed profiles when an individual with SAD compares faces to objects in SAD. Systematic comparisons of ERPs to facial/object stimuli before and after therapy are also lacking. We used a passive visual detection paradigm with upright and inverted faces/objects, which are known to elicit early P1 and N170 components, to study abnormal early face processing and subsequent improvements in this measure in patients with SAD. Methods Seventeen patients with SAD and 17 matched control participants performed a passive visual detection paradigm task while undergoing EEG. The healthy controls were compared to patients with SAD pre-therapy to test the hypothesis that patients with SAD have early hypervigilance to facial cues. We compared patients with SAD before and after therapy to test the hypothesis that the early hypervigilance to facial cues in patients with SAD can be alleviated. Results Compared to healthy control (HC) participants, patients with SAD had more robust P1–N170 slope but no amplitude effects in response to both upright and inverted faces and objects. Interestingly, we found that patients with SAD had reduced P1 responses to all objects and faces after therapy, but had selectively reduced N170 responses to faces, and especially inverted faces. Interestingly, the slope from P1 to N170 in patients with SAD was flatter post-therapy than pre-therapy. Furthermore, the amplitude of N170 evoked by the facial stimuli was correlated with scores on the interaction anxiousness scale (IAS) after therapy. Conclusions Our results did not provide electrophysiological support for the early hypervigilance hypothesis in SAD to faces, but confirm that cognitive-behavioural therapy can reduce the early visual processing of faces. These findings have potentially important therapeutic implications in the assessment and treatment of social anxiety. Trial registration HEBDQ2014021
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Affiliation(s)
- Jianqin Cao
- Department of Nursing, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Quanying Liu
- Laboratory of Movement Control and Neuroplasticity, KU Leuven, 3001, Louvain, Belgium.,Neural Control of Movement Laboratory, ETH Zurich, 8057, Zurich, Switzerland
| | - Yang Li
- Department of Nursing, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Jun Yang
- Department of Nursing, Harbin Medical University, Daqing, Heilongjiang Province, China
| | - Ruolei Gu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Jin Liang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Yanyan Qi
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Haiyan Wu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China.
| | - Xun Liu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100101, China
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Schröder A, Ørnbøl E, Jensen JS, Sharpe M, Fink P. Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual care for functional somatic syndromes. J Psychosom Res 2017; 94:73-81. [PMID: 28183406 DOI: 10.1016/j.jpsychores.2017.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 06/23/2016] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Patients with functional somatic syndromes (FSS) such as fibromyalgia and chronic fatigue syndrome have a poor outcome and can incur high healthcare and societal costs. We aimed to compare the medium-term (16months) cost-effectiveness and the long-term (40months) economic outcomes of a bespoke cognitive-behavioural group treatment (STreSS) with that of enhanced usual care (EUC). METHODS We obtained complete data on healthcare and indirect costs (i.e. labour marked-related and health-related benefits) from public registries for 120 participants from a randomised controlled trial. Costs were calculated as per capita public expenses in 2010 €. QALYs gained were estimated from the SF-6D. We conducted a medium-term cost-effectiveness analysis and a long-term cost-minimization analysis from both a healthcare (i.e. direct cost) and a societal (i.e. total cost) perspective. RESULTS In the medium term, the probability that STreSS was cost-effective at thresholds of 25,000 to 35,000 € per QALY was 93-95% from a healthcare perspective, but only 50-55% from a societal perspective. In the long term, however, STreSS was associated with increasing savings in indirect costs, mainly due to a greater number of patients self-supporting. When combined with stable long-term reductions in healthcare expenditures, there were total cost savings of 7184 € (95% CI 2271 to 12,096, p=0.004) during the third year after treatment. CONCLUSION STreSS treatment costs an average of 1545 €. This cost was more than offset by subsequent savings in direct and indirect costs. Implementation could both improve patient outcomes and reduce costs.
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Affiliation(s)
- Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens S Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sharpe
- Psychological Medicine Research, Department of Psychiatry, University of Oxford, UK
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Lavell CH, Farrell LJ, Waters AM, Cadman J. Predictors of treatment response to group cognitive behavioural therapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2016; 245:186-93. [PMID: 27544784 DOI: 10.1016/j.psychres.2016.08.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 07/11/2016] [Accepted: 08/08/2016] [Indexed: 11/22/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating mental health disorder, occurring in 1-2% of children and adolescents. Current evidence-based treatments produce promising rates of remission; however, many children and youth do not fully remit from symptoms. The current study explored predictors of treatment response to a group cognitive-behavioural treatment program for pediatric OCD (N=43). Higher levels of child depression and parental rejection at baseline were found to be associated with higher OCD symptoms at post-treatment. Family accommodation was found to be associated with OCD symptom severity at 12-months follow-up. Further, children who were classified as treatment responders at 12-months follow-up had fewer depressive symptoms at baseline than non-responders at 12-months. Results indicate that child depression and adverse family factors may contribute to poorer treatment response for children and youth with OCD. This finding suggests current treatments should be refined for these young people in order to better suit their individual needs.
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Ngai FW, Wong PWC, Chung KF, Leung KY. The effect of telephone-based cognitive-behavioural therapy on parenting stress: A randomised controlled trial. J Psychosom Res 2016; 86:34-8. [PMID: 27302544 DOI: 10.1016/j.jpsychores.2016.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 01/25/2016] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
UNLABELLED Objective Stress related to parenting has detrimental effects on the well-being of children, parents and the family system as a whole. There are limited studies about the efficacy of cognitive-behavioural therapy delivered by telephone in reducing parenting stress. The present study investigates the effect of telephone-based cognitive-behavioural therapy on parenting stress at six weeks and six months postpartum. METHODS This is a multi-site randomised controlled trial. A total of 397 Chinese mothers at risk of postnatal depression were randomly assigned to receive either telephone-based cognitive-behavioural therapy or routine postpartum care. Parental stress was assessed by the Parenting Stress Index Short Form at six weeks and six months postpartum. RESULTS The findings revealed that mothers who had received telephone-based cognitive-behavioural therapy showed significantly lower levels of parenting stress than women only receiving routine postpartum care at six weeks (mean difference=9.42, 95% confidence interval 5.85-12.99, p<0.001, Cohen's d=0.52) and six months postpartum (mean difference=3.58, 95% confidence interval 0.07-7.09, p=0.046, Cohen's d=0.20). CONCLUSION Telephone-based cognitive-behavioural therapy is a promising treatment modality for supporting parenting and reducing stress during the transition period. Integration of telephone-based cognitive-behavioural therapy into routine postpartum care might facilitate positive adaptation in particular for mothers at risk of postnatal depression.
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Affiliation(s)
- Fei Wan Ngai
- The Hong Kong Polytechnic University, Hong Kong.
| | - Paul Wai-Ching Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Ka Fai Chung
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hospital Authority, Hong Kong
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McIntosh VVW, Jordan J, Carter JD, Frampton CMA, McKenzie JM, Latner JD, Joyce PR. Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy. Psychiatry Res 2016; 240:412-420. [PMID: 27149410 DOI: 10.1016/j.psychres.2016.04.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 11/30/2015] [Revised: 02/05/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
Cognitive-behavioural therapy (CBT) is the recommended treatment for binge eating, yet many individuals do not recover, and innovative new treatments have been called for. The current study compares traditional CBT with two augmented versions of CBT; schema therapy, which focuses on early life experiences as pivotal in the history of the eating disorder; and appetite-focused CBT, which emphasises the role of recognising and responding to appetite in binge eating. 112 women with transdiagnostic DSM-IV binge eating were randomized to the three therapies. Therapy consisted of weekly sessions for six months, followed by monthly sessions for six months. Primary outcome was the frequency of binge eating. Secondary and tertiary outcomes were other behavioural and psychological aspects of the eating disorder, and other areas of functioning. No differences among the three therapy groups were found on primary or other outcomes. Across groups, large effect sizes were found for improvement in binge eating, other eating disorder symptoms and overall functioning. Schema therapy and appetite-focused CBT are likely to be suitable alternative treatments to traditional CBT for binge eating.
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Affiliation(s)
- Virginia V W McIntosh
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand.
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | - Janice M McKenzie
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Janet D Latner
- Psychology Department, University of Hawaii at Manoa, Hawaii, USA
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Selinheimo S, Vuokko A, Sainio M, Karvala K, Suojalehto H, Järnefelt H, Paunio T. Comparing cognitive-behavioural psychotherapy and psychoeducation for non-specific symptoms associated with indoor air: a randomised control trial protocol. BMJ Open 2016; 6:e011003. [PMID: 27266771 PMCID: PMC4908864 DOI: 10.1136/bmjopen-2015-011003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Indoor air-related conditions share similarities with other conditions that are characterised by medically unexplained symptoms (MUS)-a combination of non-specific symptoms that cannot be fully explained by structural bodily pathology. In cases of indoor air-related conditions, these symptoms are not fully explained by either medical conditions or the immunological-toxicological effects of environmental factors. The condition may be disabling, including a non-adaptive health behaviour. In this multifaceted phenomenon, psychosocial factors influence the experienced symptoms. Currently, there is no evidence of clinical management of symptoms, which are associated with the indoor environment and cannot be resolved by removing the triggering environmental factors. The aim of this study is to compare the effect of treatment-as-usual (TAU) and two psychosocial interventions on the quality of life, and the work ability of employees with non-specific indoor air-related symptomatology. METHODS AND ANALYSES The aim of this ongoing randomised controlled trial is to recruit 60 participants, in collaboration with 5 occupational health service units. The main inclusion criterion is the presence of indoor air-related recurrent symptoms in ≥2 organ systems, which have no pathophysiological explanation. After baseline clinical investigations, participants are randomised into interventions, which all include TAU: cognitive-behavioural psychotherapy, psychoeducation and TAU (control condition). Health-related quality of life, measured using the 15D-scale, is the primary outcome. Secondary outcomes include somatic and psychiatric symptoms, occupational factors, and related underlying mechanisms (ie, cognitive functioning). Questionnaires are completed at baseline, at 3, 6 and 12-month follow-ups. Data collection will continue until 2017. The study will provide new information on the individual factors related to indoor air-associated symptoms, and on ways in which to support work ability. ETHICS AND DISSEMINATION The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa, Finland, has granted approval for the study. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02069002; Pre-results.
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Affiliation(s)
| | - Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Markku Sainio
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tiina Paunio
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
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Rolving N, Nielsen CV, Christensen FB, Holm R, Bünger CE, Oestergaard LG. Preoperative cognitive-behavioural intervention improves in-hospital mobilisation and analgesic use for lumbar spinal fusion patients. BMC Musculoskelet Disord 2016; 17:217. [PMID: 27206497 PMCID: PMC4875713 DOI: 10.1186/s12891-016-1078-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catastrophic thinking and fear-avoidance belief are negatively influencing severe acute pain following surgery causing delayed ambulation and discharge. We aimed to examine if a preoperative intervention of cognitive-behavioural therapy (CBT) could influence the early postsurgical outcome following lumbar spinal fusion surgery (LSF). METHODS Ninety patients undergoing LSF due to degenerative spinal disorders were randomly allocated to either the CBT group or the control group. Both groups received surgery and postoperative rehabilitation. In addition, the CBT group received a preoperative intervention focussed on pain coping using a CBT approach. Primary outcome was back pain during the first week (0-10 scale). Secondary outcomes were mobility, analgesic consumption, and length of hospitalisation. Data were retrieved using self-report questionnaires, assessments made by physical therapists and from medical records. RESULTS No difference between the groups' self-reported back pain (p = 0.76) was detected. Independent mobility was reached by a significantly larger number of patients in the CBT group than the control group during the first three postoperative days. Analgesic consumption tended to be lower in the CBT group, whereas length of hospitalisation was unaffected by the CBT intervention. CONCLUSION Participation in a preoperative CBT intervention appeared to facilitate mobility in the acute postoperative phase, despite equally high levels of self-reported acute postsurgical pain in the two groups, and a slightly lower intake of rescue analgesics in the CBT group. This may reflect an overall improved ability to cope with pain following participation in the preoperative CBT intervention. TRIAL REGISTRATION The study was approved by the Danish Protection Agency (2011-41-5899) and the Ethics Committee of the Central Denmark Region (M-20110047). The trial was registered in Current Controlled Trials ( ISRCTN42281022 ).
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Affiliation(s)
- Nanna Rolving
- Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1-3, 8600, Silkeborg, Denmark. .,Regional Hospital Silkeborg, Silkeborg, Denmark.
| | - Claus Vinther Nielsen
- Department of Social Medicine and Rehabilitation, School of Public Health, Aarhus University, Aarhus, Denmark.,Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark
| | | | - Randi Holm
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Cody Eric Bünger
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1-3, 8600, Silkeborg, Denmark.,Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C. Clinical management of perinatal anxiety disorders: A systematic review. J Affect Disord 2016; 190:543-550. [PMID: 26571104 DOI: 10.1016/j.jad.2015.11.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 07/07/2015] [Revised: 10/16/2015] [Accepted: 11/01/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4-39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited. METHODS A systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS 18 articles met inclusion criteria. Selected studies supported the use of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD), panic disorder (PD) and specific phobia both in pregnancy and postpartum. Selective serotonin reuptake inhibitors (SSRIs) led to significant OCD and PD improvement both in pregnancy and postpartum with no side effects for the babies. In the largest clinical sample to date, 65% of postpartum patients who entered the open-label trial of fluvoxamine (up to 300mg/day) experienced a 30% or greater decrease in the total score of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). During pregnancy, SSRIs and tricyclic antidepressants (TCAs) led to remission of panic symptoms and healthy outcomes for the babies. LIMITATIONS Study design, mostly case reports, and enrolment of subjects mainly from outpatient specialty units might have limited community-wide generalisability. CONCLUSIONS Keeping in mind the scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that CBT should be the first treatment offered to pregnant and breastfeeding women with AnxD. However SSRIs can represent a first line treatment strategy, and not exclusively in cases where AnxD is refractory to CBT.
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Affiliation(s)
- C Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Treatment of Affective Disorders in Perinatal Period Unit, University Hospital of Parma, Parma, Italy; Department of Mental Health, Local Healthy Service of Parma, Parma, Italy.
| | - P Ossola
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy.
| | - A Amerio
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - B D Daniel
- Treatment of Affective Disorders in Perinatal Period Unit, University Hospital of Parma, Parma, Italy; Department of Mental Health, Local Healthy Service of Parma, Parma, Italy.
| | - M Tonna
- Department of Mental Health, Local Healthy Service of Parma, Parma, Italy.
| | - C De Panfilis
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Treatment of Affective Disorders in Perinatal Period Unit, University Hospital of Parma, Parma, Italy; Department of Mental Health, Local Healthy Service of Parma, Parma, Italy.
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Bayliss P, Holttum S. Experiences of antidepressant medication and cognitive-behavioural therapy for depression: a grounded theory study. Psychol Psychother 2015; 88:317-34. [PMID: 25164390 DOI: 10.1111/papt.12040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/01/2013] [Revised: 07/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To develop a preliminary model of the experiences of people undergoing combined treatment with antidepressant medication and cognitive-behavioural therapy (CBT) for depression. DESIGN The study used a qualitative methodology informed by grounded theory. METHODS Participants were 12 adults who had received treatment with antidepressant medication and CBT for depression. Participants engaged in a semistructured interview about their experiences. Interviews were transcribed and analysed using components of grounded theory methodology. RESULTS Medication was often seen as an initial aid to surviving a crisis. Staying on medication longer term resulted in some participants feeling caught in a 'drug loop'. Feeling that medication was unhelpful or actively harmful could contribute to participants seeking CBT. Medics also offered information on CBT and acted as gatekeepers, meaning that negotiation was sometimes necessary. CBT was described as a process of being guided towards skilled self-management. Occasionally, participants felt that medication had facilitated CBT at one or more stages. Conversely, developing skilled self-management through CBT could reduce feelings of dependency on medication and affect several of the other elements maintaining the 'drug loop'. CONCLUSIONS Antidepressant medication and CBT are perceived and experienced differently, with CBT often being seen as an alternative to medication, or even as a means to discontinue medication. Service users' experiences and beliefs about medication may thus affect their engagement and goals in CBT, and it may be important for therapists to consider this. PRACTITIONER POINTS Practitioners who prescribe medication should ensure that they also provide information on the availability and appropriateness of CBT, and engage in an open dialogue about treatment options. CBT practitioners should explore aspects of clients' experiences and beliefs about medication. This would particularly include clients' experiences of the effects of medication, their beliefs about dependency on medication, their relationships with prescribers, and their future wishes. Practitioners should consider advocating for clients or supporting them to behave more assertively with prescribers. All practitioners should ensure they have up-to-date knowledge of antidepressant medication.
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Affiliation(s)
- Paul Bayliss
- Sussex Partnership NHS Foundation Trust, East Sussex, UK
| | - Sue Holttum
- Salomons Centre for Applied Psychology, Canterbury Christchurch University, Kent, UK
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40
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Pugh M. A narrative review of schemas and schema therapy outcomes in the eating disorders. Clin Psychol Rev 2015; 39:30-41. [PMID: 25932958 DOI: 10.1016/j.cpr.2015.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 10/27/2014] [Revised: 03/02/2015] [Accepted: 04/15/2015] [Indexed: 12/25/2022]
Abstract
Whilst cognitive-behavioural therapy has demonstrated efficacy in the treatment of eating disorders, therapy outcomes and current conceptualizations still remain inadequate. In light of these shortcomings there has been growing interest in the utility of schema therapy applied to eating pathology. The present article first provides a narrative review of empirical literature exploring schemas and schema processes in eating disorders. Secondly, it critically evaluates outcome studies assessing schema therapy applied to eating disorders. Current evidence lends support to schema-focused conceptualizations of eating pathology and confirms that eating disorders are characterised by pronounced maladaptive schemas. Treatment outcomes also indicate that schema therapy, the schema-mode approach, and associated techniques are promising interventions for complex eating disorders. Implications for clinical practice and future directions for research are discussed.
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Affiliation(s)
- Matthew Pugh
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, Royal Holloway, University of London, London, England, United Kingdom.
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Abstract
UNLABELLED Background. Some individuals with visible differences have been found to experience psychosocial adjustment problems that can lead to social anxiety and isolation. Various models of psychosocial intervention have been used to reduce social anxiety and appearance related distress in this population. The objective of this review was to update a previous systematic review assessing the efficacy of psychosocial intervention programs for adults with visible differences. The original review (Bessell & Moss, 2007) identified 12 papers for inclusion. Methods. A search protocol identified studies from 13 electronic journal databases. METHODS Studies were selected in accordance with pre-set inclusion criteria and relevant data were extracted. Results. This update identified an additional four papers that met the inclusion criteria. Two papers provided very limited evidence for the efficacy of a combined cognitive-behavioural and social skills training approach. None of the papers provided sufficient evidence for the optimal duration, intensity or setting of psychosocial interventions for this population. Discussion. The review concluded that a greater number of Randomised Controlled Trials and experimental studies were required to increase the methodological validity of intervention studies.
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Affiliation(s)
- Alyson Norman
- School of Psychology, Plymouth University , Portland Square, Drake Circus, Plymouth , UK
| | - Timothy P Moss
- Centre for Appearance Research, University of the West of England, Frenchay Campus , Bristol , UK
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Christensen SS, Frostholm L, Ørnbøl E, Schröder A. Changes in illness perceptions mediated the effect of cognitive behavioural therapy in severe functional somatic syndromes. J Psychosom Res 2015; 78:363-70. [PMID: 25541119 DOI: 10.1016/j.jpsychores.2014.12.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [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: 07/11/2014] [Revised: 11/18/2014] [Accepted: 12/07/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although there is substantial evidence that cognitive behavioural therapy alleviates symptoms in functional somatic syndromes, the mechanisms of change are less investigated. This study examined whether changes in illness perceptions mediated the effect of cognitive behavioural therapy. METHODS We analysed additional data from a randomised controlled trial comparing completers of cognitive behavioural group therapy (46 patients) to an enhanced usual care group (66 patients). Proposed mediators (illness perceptions) and primary (physical health) and secondary (somatic symptoms and illness worry) outcomes were assessed by means of questionnaires at referral, baseline, end of treatment, and 10 and 16 months after randomisation. Multiple mediation analysis determined whether (1) changes in specific illness perceptions during treatment mediated the effect of cognitive behavioural therapy (primary analysis), and (2) whether changes in illness perceptions during the whole trial period were associated with improved outcome (secondary analysis). RESULTS Improvements in illness perceptions during treatment partially mediated the effect of cognitive behavioural therapy on physical health one year after treatment (sum of indirect effects 1.556, BCa 95% CI (0.006; 3.620)). Improving perceived control was particularly important. Changes in illness perceptions from baseline to 16 months after randomisation were associated with clinically meaningful improvements in physical health, somatic symptoms and illness worry during the same period. CONCLUSION Our results suggest that changing patients' illness perceptions is an important process in cognitive behavioural therapy for functional somatic syndromes. Challenging patients' own understanding of their illness may hence be a key element of successful treatment.
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Affiliation(s)
- Sara Sletten Christensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark.
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Turner H, Marshall E, Stopa L, Waller G. Cognitive-behavioural therapy for outpatients with eating disorders: effectiveness for a transdiagnostic group in a routine clinical setting. Behav Res Ther 2015; 68:70-5. [PMID: 25816766 DOI: 10.1016/j.brat.2015.03.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 11/17/2014] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 11/18/2022]
Abstract
Whilst there is a growing evidence to support the impact of cognitive-behavioural therapy (CBT) in the treatment of adults with eating disorders, much of this evidence comes from tightly controlled efficacy trials. This study aimed to add to the evidence regarding the effectiveness of CBT when delivered in a routine clinical setting. The participants were 203 adults presenting with a range of eating disorder diagnoses, who were offered CBT in an out-patient community eating disorders service in the UK. Patients completed measures of eating disorder pathology at the start of treatment, following the sixth session, and at the end of treatment. Symptoms of anxiety, depression, and psychosocial functioning were measured pre- and post-treatment. Approximately 55% of patients completed treatment, and there were no factors that predicted attrition. There were significant improvements in eating disorder psychopathology, anxiety, depression and general functioning, with particular changes in eating attitudes in the early part of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. These findings confirm that evidence-based forms of CBT can be delivered with strong outcomes in routine clinical settings. Clinicians should be encouraged to deliver evidence-based treatments when working in these settings.
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Affiliation(s)
- Hannah Turner
- Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton SO19 5ES, UK; Clinical Psychology Programme, Psychology Academic Unit, University of Southampton, Shackleton Building (44a), Highfield Campus, Southampton, Hampshire SO17 1BJ, UK.
| | - Emily Marshall
- Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton SO19 5ES, UK
| | - Lusia Stopa
- Clinical Psychology Programme, Psychology Academic Unit, University of Southampton, Shackleton Building (44a), Highfield Campus, Southampton, Hampshire SO17 1BJ, UK
| | - Glenn Waller
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK
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Tsaousides T, D'Antonio E, Varbanova V, Spielman L. Delivering group treatment via videoconference to individuals with traumatic brain injury: a feasibility study. Neuropsychol Rehabil 2014; 24:784-803. [PMID: 24810148 DOI: 10.1080/09602011.2014.907186] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 10/25/2022]
Abstract
The objective was to assess the feasibility of delivering a group treatment to improve emotional regulation via videoconferencing to individuals with traumatic brain injury (TBI). A pre-post feasibility study was undertaken. Seven individuals with TBI were recruited at a brain injury research centre in an urban medical centre. The main measures were therapist assessment of session-by-session progress and feasibility, Difficulties in Emotion Regulation Scale (DERS), Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire (BREQ), Satisfaction with Therapy and Therapist Scale (STTS), and exit interview. Attendance across sessions and participants was over 90%. Adequate skill acquisition and ease of use of the technology were demonstrated. Self-reported satisfaction with treatment was high. Participants noted several benefits in terms of the treatment delivery modality. There was no change is self-reported emotional dysregulation. This is the first study to report the use of videoconferencing for the delivery of group treatment to individuals with TBI. The exceptional compliance and self-reported satisfaction suggest that this treatment delivery option could be a viable alternative for increasing access to healthcare in this population. The findings of the study supported the development of a large clinical trial to assess treatment effectiveness.
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Affiliation(s)
- Theodore Tsaousides
- a Department of Rehabilitation Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Turner H, Tatham M, Lant M, Mountford VA, Waller G. Clinicians' concerns about delivering cognitive-behavioural therapy for eating disorders. Behav Res Ther 2014; 57:38-42. [PMID: 24793719 DOI: 10.1016/j.brat.2014.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 01/27/2014] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 12/29/2022]
Abstract
Despite research supporting the effectiveness of evidence-based interventions in the treatment of eating disorders, those interventions are under-utilised in routine clinical practice, possibly due to clinicians' concerns about delivering the relevant techniques. This study examined what elements of therapy clinicians worry about when delivering cognitive-behavioural therapy (CBT) for the eating disorders, and what clinician variables are associated with such concerns. The participants were 113 clinicians who used individual CBT with eating disorder patients. They completed a novel measure of concerns about delivering elements of CBT, as well as demographic characteristics and a standardised measure of intolerance of uncertainty. Clinicians worried most about body image work and ending treatment, but least about delivering psychoeducation. Their concerns fell into four distinct factors. Older, more experienced clinicians worried less about delivering the CBT techniques, but those with greater levels of prospective and inhibitory anxiety worried more about specific factors in the CBT techniques. Clinicians' capacity to tolerate uncertainty might impair their delivery of evidence-based CBT, and merits consideration as a target in training and supervision of CBT clinicians.
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Affiliation(s)
- Hannah Turner
- Southern Health Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Marie Lant
- Barnsley Specialist Adult Learning Disability Health Service, South West Yorkshire Partnership NHS Foundation Trust, UK
| | - Victoria A Mountford
- South London and Maudsley Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, King's College London, London, UK
| | - Glenn Waller
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2NT, UK.
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Jahoda A, Willner P, Rose J, Kroese BS, Lammie C, Shead J, Woodgate C, Gillespie D, Townson J, Felce D, Stimpson A, Rose N, MacMahon P, Nuttall J, Hood K. Development of a scale to measure fidelity to manualized group-based cognitive behavioural interventions for people with intellectual disabilities. Res Dev Disabil 2013; 34:4210-4221. [PMID: 24077070 DOI: 10.1016/j.ridd.2013.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Received: 06/10/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 06/02/2023]
Abstract
The context for the present study was a cluster-randomized controlled trial of a group-based anger-management intervention, delivered by day-service staff. We aimed to develop a scale to measure the fidelity of manualized cognitive-behavioural therapy (CBT) delivered to adults with intellectual disabilities in group-based settings. A 30-item monitoring instrument (the MAnualized Group Intervention Check: MAGIC) was adapted from an existing fidelity-monitor instrument for individual CBT. Two sessions for 27 groups were observed by pairs of monitors who had no other contact with the intervention. 16 observers participated, in 15 unique pairings. Observers recorded high levels of inter-rater reliability and the scale had good internal consistency. Fidelity ratings predicted two key outcomes of the intervention, and were themselves predicted by the therapists' clinical supervisors.
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Affiliation(s)
- Andrew Jahoda
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
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