Cognitive behavioural therapy

Psychological therapies for the management of chronic pain (excluding headache) in adults.: Background: Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012. Objectives: To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) com

Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women.: Objectives: This randomized controlled study compared acceptance and commitment therapy (ACT), cognitive-behavioral therapy (CBT), and a control group. Method: The participants were 50 incarcerated women diagnosed with current substance use disorder. Two psychologists carried out pre- and posttreatment assessment and a 6-month follow-up assessment using the following instruments: Anxiety Sensitivity Index, Addiction Severity Index-6, Mini International Neuropsychiatric Interview, and Acceptance

Cognitive mediators of treatment for social anxiety disorder: comparing acceptance and commitment therapy and cognitive-behavioral therapy.: Objective: To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder. Method: Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n=25) or ACT (n=25) for DSM-IV social anxiety disorder. Results: Multilevel m

Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review.: Background: Emotional disorders, such as anxiety and depression, are one of the main causes of disability worldwide. Recent reviews suggest that Acceptance and Commitment Therapy is effective in treating emotional disorders. However, they appraise mainly individual approaches. This review aimed to analyze published studies regarding the usefulness of Acceptance and Commitment Therapy, applied on a group basis, in the treatment of anxiety and depression. Methods: A systematic review of the litera

Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review.: Background: Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill train

Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes.: Internet-based acceptance and commitment therapy (iACT) primarily targets the process of psychological flexibility. Its accessibility and low-intensity delivery are applicable across different treatment and prevention scenarios. This transdiagnostic meta-analysis reviews the effectiveness of iACT on anxiety, depression, quality of life, and psychological flexibility across individuals with different psychological and somatic conditions/complaints, or undiagnosed complaints. Seven databases were

Mindfulness groups for distressing voices and paranoia: a replication and randomized feasibility trial.

Background: The clinical literature cautions against use of meditation by people with psychosis. There is, however, evidence for acceptance-based therapy reducing relapse, and some evidence for clinical benefits of mindfulness groups for people with distressing psychosis, though no data on whether participants became more mindful. Aims: To assess feasibility of randomized evaluation of group mindfulness therapy for psychosis, to replicate clinical gains observed in one small uncontrolled study, and to assess for changes in mindfulness. Method: Twenty-two participants with current distressing psychotic experiences were allocated at random between group-based mindfulness training and a waiting list for this therapy. Mindfulness training comprised twice-weekly sessions for 5 weeks, plus home practice (meditation CDs were supplied), followed by 5 weeks of home practice. Results: There were n…

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Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia.

Study objectives: Despite effective cognitive behavioral treatments for chronic insomnia, such treatments are underutilized. This study evaluated the impact of a 5-week, online treatment for insomnia. Design: This was a randomized controlled trial with online treatment and waiting list control conditions. Participants: Participants were 118 adults with chronic insomnia. Setting: Participants received online treatment from their homes. Intervention: Online treatment consisted of psychoeducation, sleep hygiene, and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, and help with medication tapering. Measurement and results: From pre- to post-treatment, there was a 33% attrition rate, and attrition was related to referral status (i.e., dropouts were more likely to have been referred for treatment rather than recruited from the community). Usin…

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A pilot randomised controlled trial comparing a health-related lifestyle self-management intervention with standard cardiac rehabilitation following an acute cardiac event: Implications for a larger clinical trial.

Purpose: This pilot study was to assess the feasibility of the health-related lifestyle self-management (HeLM) intervention as a strategy to decrease cardiovascular risk following acute coronary syndrome. Methods: Participants in this randomised controlled trial were recruited from a tertiary teaching hospital in metropolitan Sydney Australia. The multifaceted HeLM intervention, using the principles of the transtheoretical model, involved the use of bibliotherapy, a structured evidence-based approach to cardiovascular risk reduction, a communication strategy with general practitioners, three supportive telephone calls to participants and provision of behavioural prompts and a health record diary. Differences in behavioural and clinical outcomes between the HeLM intervention group (n=29) and the standard cardiac rehabilitation group (n=22) were assessed. Results: A total of 125 participan…

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Modular psychotherapy for anxiety in older primary care patients.

Objective: To develop and test a modular psychotherapy protocol in older primary care patients with anxiety disorders. Design: Randomized, controlled pilot study. Setting: University-based geriatric medicine clinics. Participants: Thirty-one elderly primary care patients with generalized anxiety disorder or anxiety disorder not otherwise specified. Intervention: Modular form of psychotherapy compared with enhanced community treatment. Measurements: Self-reported, interviewer-rated, and qualitative assessments of anxiety, worry, depression, and mental health-related quality of life. Results: Both groups showed substantial improvements in anxiety symptoms, worry, depressive symptoms, and mental health-related quality of life. Most individuals in the enhanced community treatment condition reported receiving medications or some other form of professional treatment for anxiety. Across both co…

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How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal.

It has been suggested that reappraisal strategies are more effective than suppression strategies for regulating emotions. Recently, proponents of the acceptance-based behavior therapy movement have further emphasized the importance of acceptance-based emotion regulation techniques. In order to directly compare these different emotion regulation strategies, 202 volunteers were asked to give an impromptu speech in front of a video camera. Participants were randomly assigned to one of three groups. The Reappraisal group was instructed to regulate their anxious arousal by reappraising the situation; the Suppression group was asked to suppress their anxious behaviors; and the Acceptance group was instructed to accept their anxiety. As expected, the Suppression group showed a greater increase in heart rate from baseline than the Reappraisal and Acceptance groups. Moreover, the Suppression grou…

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Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder.

Objective: This randomized controlled trial tested the effectiveness of an 18-month mentalization-based treatment (MBT) approach in an outpatient context against a structured clinical management (SCM) outpatient approach for treatment of borderline personality disorder. Method: Patients (N=134) consecutively referred to a specialist personality disorder treatment center and meeting selection criteria were randomly allocated to MBT or SCM. Eleven mental health professionals equal in years of experience and training served as therapists. Independent evaluators blind to treatment allocation conducted assessments every 6 months. The primary outcome was the occurrence of crisis events, a composite of suicidal and severe self-injurious behaviors and hospitalization. Secondary outcomes included social and interpersonal functioning and self-reported symptoms. Outcome measures, assessed at 6-mont…

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Guided and unguided self-help for social anxiety disorder: randomised controlled trial.

Background: Internet-delivered self-help programmes with added therapist guidance have shown efficacy in social anxiety disorder, but unguided self-help has been insufficiently studied. Aims: To evaluate the efficacy of guided and unguided self-help for social anxiety disorder. Method: Participants followed a cognitive-behavioural self-help programme in the form of either pure bibliotherapy or an internet-based treatment with therapist guidance and online group discussions. A subsequent trial was conducted to evaluate treatment specificity. Participants (n = 235) were randomised to one of three conditions in the first trial, or one of four conditions in the second. Results: Pure bibliotherapy and the internet-based treatment were better than waiting list on measures of social anxiety, general anxiety, depression and quality of life. The internet-based therapy had the highest effect sizes…

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Evaluation of an intervention program for anxious adolescent boys who are bullied at school.

Purpose: This study tested the efficacy of an intervention for anxious adolescent boys experiencing bullying at school. The cognitive-behavioral intervention focused on targeting individual factors that appear to increase an adolescent's vulnerability to bullying experiences such as anxiety, low self-esteem, and use of maladaptive coping strategies. Methods: Adolescent boys reporting anxiety symptoms and the recent experience of being bullied at school (grades 7-10) were randomly assigned by group to intervention (n = 22) or wait-list (n = 24) conditions. Depressive and anxiety symptoms and bullying experiences were measured before and after the intervention, and at a 3-month follow-up for the intervention condition. Results: The intervention was effective in significantly reducing adolescent's bullying experiences as well as their anxiety, depression, and the degree of distress associat…

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Improving the mental health, healthy lifestyle choices, and physical health of Hispanic adolescents: a randomized controlled pilot study.

Background: Obesity and mental health disorders are 2 major public health problems in American adolescents, with prevalence even higher in Hispanic teens. Despite the rapidly increasing incidence and adverse health outcomes associated with overweight and mental health problems, very few intervention studies have been conducted with adolescents to improve both their healthy lifestyles and mental health outcomes. Even fewer studies have been conducted with Hispanic youth. The purpose of this study was to evaluate the preliminary efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, and Nutrition) program, a manualized educational and cognitive behavioral skills-building program, on Hispanic adolescents' healthy lifestyle choices as well as mental and physical health outcomes. Methods: A cluster randomized controlled pi…

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Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: a randomized efficacy trial.

In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls …

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Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial.

Background: The treatment of perinatal depression is a public-health priority because of its high prevalence and association with disability and poor infant development. We integrated a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan and assessed the effect of this intervention on maternal depression and infant outcomes. Methods: We randomly assigned 40 Union Council clusters in rural Rawalpindi, Pakistan, in equal numbers to intervention or control. Married women (aged 16-45 years) in their third trimester of pregnancy with perinatal depression were eligible to participate. In the intervention group, primary health workers were trained to deliver the psychological intervention, whereas in the control group untrained health workers made an equal number of visits to the depressed mothers. The primary outcomes…

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Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial.

Background: No accepted intervention exists for borderline personality disorder presenting in adolescence. Aims: To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care. Method: In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15-18 years who fulfilled two to nine of the DSM-IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months. Results: Eighty-six patients were randomised and 78 (CAT n=41; GCC n=37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures bu…

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Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial.

Psychological treatments for chronic pain, particularly those based upon cognitive behavioural principles, have generally been shown to be efficacious. Recently, a treatment has been developed based upon the fear-avoidance model of chronic musculoskeletal pain, which suggests chronic pain can be relieved by exposing the individual to movements and tasks that have been avoided due to fear of (re)injury. This graded in vivo exposure treatment has been found to be beneficial in case studies. The present investigation utilized a randomized controlled trial method to assess the effectiveness of graded in vivo exposure relative to other conditions. Forty-four chronic low back pain patients were randomly assigned to graded in vivo exposure, graded activity, or a wait-list condition. While only trend differences were observed for pain-related disability, patients in the graded in vivo exposure c…

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Neurocognitive enhancement therapy with vocational services: work outcomes at two-year follow-up.

Unlabelled: Neurocognitive enhancement therapy (NET) is a remediation program for the persistent and function-limiting cognitive impairments of schizophrenia. In a previous study in veterans, NET improved work therapy outcomes as well as executive function and working memory. The present study aimed to determine whether NET could enhance functional outcomes among schizophrenia and schizoaffective patients in a community mental health center receiving community-based vocational services. Method: Patients (N=72) participated in a hybrid transitional and supported employment program (VOC) and were randomized to either NET+VOC or VOC only. NET+VOC included computer-based cognitive training, work feedback and a social information information-processing group. VOC only also included two weekly support groups. Active intervention was 12 months with 12 month follow-up. Follow-up rate was 100%. R…

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A randomized group intervention trial to enhance mood and self-efficacy in people with multiple sclerosis.

Objectives: To document mood, self-efficacy, and resiliency in people with multiple sclerosis (MS) following a brief group psychological intervention, and to examine whether benefits were greater than those derived from provision of education or group social interaction. Design: A randomized controlled intervention trial assessing outcomes at five time points over a 1-year follow-up. Methods: Participants with MS were assigned to one of three groups: one receiving brief group psychological intervention (PG) comprising three 90 minute cognitive behavioural sessions supported by an Information Booklet dealing with mental and emotional issues relating to MS; a group provided only with educational material - the information booklet group (IBG); and a group who not only received the booklet but also participated in non-structured social discussion (SDG) sessions similar in length and number t…

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Web-based self-help for problem drinkers: a pragmatic randomized trial.

Aims: Self-help interventions for adult problem drinkers in the general population have proved effective. The question is whether this also holds for self-help interventions delivered over the internet. Design: We conducted a pragmatic randomized trial with two parallel groups, using block randomization stratified for gender and with follow-up at 6 months. Setting: The intervention and trial were conducted online in the Netherlands in 2003-2004. Participants: We selected 261 adult problem drinkers from the general population with a weekly alcohol consumption above 210 g of ethanol for men or 140 g for women, or consuming at least 60 g (men) or 40 g (women) at least 1 day a week over the past 3 months. Participants were randomized to either the experimental drinking less (DL) condition or to the control condition (PBA). Intervention: DL is a web-based, multi-component, interactive self-he…

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Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up.

Objective: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week manual-based group treatment program for outpatients with borderline personality disorder that combines cognitive behavioral elements and skills training with a systems component. The authors compared STEPPS plus treatment as usual with treatment as usual alone in a randomized controlled trial. Method: Subjects with borderline personality disorder were randomly assigned to STEPPS plus treatment as usual or treatment as usual alone. Total score on the Zanarini Rating Scale for Borderline Personality Disorder was the primary outcome measure. Secondary outcomes included measures of global functioning, depression, impulsivity, and social functioning; suicide attempts and self-harm acts; and crisis utilization. Subjects were followed 1 year posttreatment. A linear mixed-effects model was used in…

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Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?

This study compared Panic Online (PO), an internet-based CBT intervention, to best-practice face-to-face CBT for people with panic disorder with or without agoraphobia. Eighty-six people with a primary diagnosis of panic disorder were recruited from Victoria, Australia. Participants were randomly assigned to either PO (n=46) or best practice face-to-face CBT (n=40). Effects of the internet-based CBT program were found to be comparable to those of face-to-face CBT. Both interventions produced significant reductions in panic disorder and agoraphobia clinician severity ratings, self reported panic disorder severity and panic attack frequency, measures of depression, anxiety, stress and panic related cognitions, and displayed improvements in quality of life. Participants rated both treatment conditions as equally credible and satisfying. Participants in the face-to-face CBT treatment group c…

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Attention bias toward threat in pediatric anxiety disorders.

Objective: To examine attention bias toward threat faces in a large sample of anxiety-disordered youths using a well-established visual probe task. Method: Study participants included 101 children and adolescents (ages 7-18 years) with generalized anxiety disorder, social phobia, and/or separation anxiety disorder enrolled in a multisite anxiety treatment study. Nonanxious youths (n = 51; ages 9-18 years) were recruited separately. Participants were administered a computerized visual probe task that presents pairs of faces portraying threat (angry), positive (happy), and neutral expressions. They pressed a response key to indicate the spatial location of a probe that replaced one of the faces on each trial. Attention bias scores were calculated from response times to probes for each emotional face type. Results: Compared to healthy youths, anxious participants demonstrated a greater atte…

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A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence.

The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components--cognitive therapy only (CPT-C) and written accounts (WA)--for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. The intent-to-treat (ITT) sample included 150 adult women with PTSD who were randomized into 1 of the 3 conditions. Each condition consisted of 2 hr of therapy per week for 6 weeks; blind assessments were conducted before treatment, 2 weeks following the last session, and 6 months following treatment. Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment. Secondary measures assessed anxiety, anger, shame, guilt, and dysfunctional cognitions. Independent ratings of adherence and competence were al…

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Emotion-regulation skills as a treatment target in psychotherapy.

Background: Deficits in emotion-regulation skills have been shown to be integral to the development and maintenance of a wide range of mental disorders. Aim: To evaluate the importance of these skills as a treatment target in psychotherapeutic interventions. Method: Nine specific emotion-regulation skills were assessed in a sample of 289 inpatients before and after cognitive-behavioural treatment. Self-reports of success in pretreatment skills application were first compared to those of 246 non-clinical controls. Pretreatment skills application and change in skills application during therapy were then related to a variety of outcome measures. Finally, the effects of integrating a brief training of general emotion-regulation skills into the CBT-based treatment were evaluated in a controlled trial. Results: Uni- and multivariate analyses identified the skills of acceptance, tolerance, and …

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Changing network support for drinking: initial findings from the network support project.

The aim of this study was to determine whether a socially focused treatment can effect change in the patient's social network from one that reinforces drinking to one that reinforces sobriety. Alcohol dependent men and women (N = 210) recruited from the community were randomly assigned to 1 of 3 outpatient treatment conditions: network support (NS), network support + contingency management (NS + CM), or case management (CaseM; a control condition). Analysis of drinking rates for 186 participants at 15 months indicated a significant interaction effect of Treatment x Time, with both NS conditions yielding better outcomes than the CaseM condition. Analyses of social network variables at posttreatment indicated that the NS conditions did not reduce social support for drinking relative to the CaseM condition but did increase behavioral and attitudinal support for abstinence as well as Alcohol…

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Modelling treatment-effect heterogeneity in randomized controlled trials of complex interventions (psychological treatments).

We describe instrumental variable (IV) methods for the estimation of the 'dose'-response effects of psychological interventions in randomized controlled trials in which there is variability in the patients' adherence to the allocated therapy (that is, variability in the actual number of sessions of therapy attended) and also variability in the strength of the therapeutic alliance between patients and their therapists. The effect of the therapy on outcome is assumed to be a function of both the number of sessions attended and the strength of the therapeutic alliance, with no intervention effects in the absence of any sessions attended (an exclusion restriction) and the effect of the strength of the alliance being represented by a multiplicative term (interaction) in the treatment-effect model. The IV methods that are described allow for: (a) hidden confounding between sessions, alliance a…

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Hypnotic taper with or without self-help treatment of insomnia: a randomized clinical trial.

This study aimed to assess the efficacy of a minimal intervention focusing on hypnotic discontinuation and cognitive-behavioral treatment (CBT) for insomnia. Fifty-three adult chronic users of hypnotics were randomly assigned to an 8-week hypnotic taper program, used alone or combined with a self-help CBT. Weekly hypnotic use decreased in both conditions, from a nearly nightly use at baseline to less than once a week at posttreatment. Nightly dosage (in lorazepam equivalent) decreased from 1.67 mg to 0.12 mg. Participants who received CBT improved their sleep efficiency by 8%, whereas those who did not remained stable. Total wake time decreased by 52 min among CBT participants and increased by 13 min among those receiving the taper schedule alone. Total sleep time remained stable throughout withdrawal in both CBT and taper conditions. The present findings suggest that a systematic withdr…

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Naltrexone and cognitive behavioral coping skills therapy for the treatment of alcohol drinking and eating disorder features in alcohol-dependent women: a randomized controlled trial.

Background: Despite important gender differences in drinking patterns, physiological effects of alcohol, and co-occurring psychiatric conditions, relatively little is known about the efficacy of naltrexone for the treatment of alcohol dependence in women. This study investigated the safety and efficacy of naltrexone in combination with Cognitive Behavioral Coping Skills Therapy (CBCST) in a sample of alcohol-dependent women, some with comorbid eating pathology. Methods: One hundred three women meeting DSM-IV criteria for alcohol dependence (29 with comorbid eating disturbances) were randomized to receive either naltrexone 50 mg or placebo for 12 weeks in addition to weekly group CBCST. Subjects were enrolled between October 1995 and December 2000 at an outpatient research clinic. Results: No significant differences were observed on the primary outcomes of time to first drinking day, time…

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