CBT and its family of structured treatments.
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151 to 175 of 2,546A proof-of-concept pilot randomized comparative trial of brief Internet-based compassionate mind training and cognitive-behavioral therapy for perinatal and intending to become pregnant women.
Objective: Depression is a prevalent and costly mental health problem that affects women as well as their larger communities, with substantial impacts on mother and infant during childbearing years. Face-to-face care has not adequately addressed this global concern due to difficulties in scaling these resources. Internet interventions, which can provide psychological tools to those lacking adequate access, show promise in filling this void.
Method: We conducted a 2-condition proof-of-concept pilot randomized trial comparing brief Internet-based cognitive behavioural therapy (CBT) and brief Internet-based compassionate mind training (CMT) for women who are currently pregnant, became pregnant within the last year, and intend to become pregnant in the future.
Results: We found that, although CMT and CBT demonstrated near equivalence in improving affect, self-reassurance, self-criticism, and…
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Feature-level analysis of a novel smartphone application for smoking cessation.
Background: Currently, there are over 400 smoking cessation smartphone apps available, downloaded an estimated 780,000 times per month. No prior studies have examined how individuals engage with specific features of cessation apps and whether use of these features is associated with quitting.
Objectives: Using data from a pilot trial of a novel smoking cessation app, we examined: (i) the 10 most-used app features, and (ii) prospective associations between feature usage and quitting.
Methods: Participants (n = 76) were from the experimental arm of a randomized, controlled pilot trial of an app for smoking cessation called "SmartQuit," which includes elements of both Acceptance and Commitment Therapy (ACT) and traditional cognitive behavioral therapy (CBT). Utilization data were automatically tracked during the 8-week treatment phase. Thirty-day point prevalence smoking abstinence was asse…
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Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial.
Background: Internet-based cognitive behavior therapy for depression has been tested in several trials but there are no internet studies on behavioral activation (BA), and no studies on BA over the internet including components of acceptance and commitment therapy (ACT). The aim of this study was to develop and test the effects of internet-delivered BA combined with ACT against a waiting list control condition as a first test of the effects of treatment.
Methods: Selection took place with a computerized screening interview and a subsequent semi-structured telephone interview. A total of 80 individuals from the general public were randomized to one of two conditions. The treatment lasted for 8 weeks after which both groups were assessed. We also included a 3 month follow-up. The treatment included interactive elements online and a CD-ROM for mindfulness and acceptance exercises. In additi…
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An evaluation of the effects of diagnostic composition on individual treatment outcome within transdiagnostic cognitive-behavioral group therapy for anxiety.
Recently, studies have supported the efficacy of treating anxiety disorders utilizing a transdiagnostic, or non-diagnosis-specific, framework (Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179-186; Garcia, M. S. (2004). Effectiveness of cognitive-behavioural group therapy in patients with anxiety disorders. Psychology in Spain, 8, 89-97; Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79-97). Transdiagnostic group treatment packages focus on the common aspects inherent across the anxiety disorders such as behavioral and cognitive avoidance, and faulty cognitive appraisals of threat potential or meaning (Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a un…
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Shawyer F, Farhall J, Mackinnon A, Trauer T, Sims E, Ratcliff K, Larner C, Thomas N, Castle D, Mullen P, Copolov D (2012)randomised controlled trialMEDLINE-indexed journal, not yet read by usBehaviour research and therapy71 citations A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders.
Command hallucinations represent a special problem for the clinical management of psychosis. While compliance with both non-harmful and harmful commands can be problematic, sometimes in the extreme, active efforts to resist commands may also contribute to their malignancy. Previous research suggests Cognitive Behaviour Therapy (CBT) to be a useful treatment for reducing compliance with harmful command hallucinations. The purpose of this trial was to evaluate whether CBT augmented with acceptance-based strategies from Acceptance and Commitment Therapy could more broadly reduce the negative impact of command hallucinations. Forty-three participants with problematic command hallucinations were randomized to receive 15 sessions of the intervention "TORCH" (Treatment of Resistant Command Hallucinations) or the control, Befriending, then followed up for 6 months. A sub-sample of 17 participant…
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Nordin L, Rorsman Ia (2012)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of rehabilitation medicine48 citations Cognitive behavioural therapy in multiple sclerosis: a randomized controlled pilot study of acceptance and commitment therapy.
Objective: The aim of this study was to design a trial that could evaluate the effect of acceptance and commitment therapy as a group-intervention for multiple sclerosis patients with psychological distress.
Design: Randomized controlled trial with assessment at pretreatment, end of treatment, and at 3-month follow-up.
Subjects: Multiple sclerosis outpatients with elevated symptoms of anxiety and/or depression (n = 21).
Methods: Patients were randomly assigned to acceptance and commitment therapy or relaxation training. Both treatments consisted of 5 sessions over 15 weeks containing didactic sessions, group discussions, and exercises. Outcome was assessed by self-rated symptoms of anxiety, depression, and a measure of acceptance.
Results: At 3-month follow-up, the relaxation training group had a significant decline in anxiety symptoms whereas the acceptance and commitment therapy group …
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Hesser H, Gustafsson T, Lundén C, Henrikson O, Fattahi K, Johnsson E, Zetterqvist Westin V, Carlbring P, Mäki-Torkko E, Kaldo V, Andersson G (2012)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of consulting and clinical psychology152 citations A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus.
Objective: Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format.
Method: Ninety-nine participants (mean age = 48.5 years; 43% female) who were significantly distressed by tinnitus were recruited from the community. Participants were randomly assigned to CBT (n = 32), ACT (n = 35), or a control condition (monitored Internet discussion forum; n = 32), and they were assessed with standardized self-report measures (Tinnitus Handicap Inventory; Hospital Anxiety and Depression Scale; Quality of Life Inventory; Perceived Stress Scale; Tinnitus Acceptance Questionnaire) at pre-, posttreatment (8 weeks), and 1-year follow-up.
Results: Mixed-effects linear regression analysis of all randomized pa…
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Moderators and non-specific predictors of treatment outcome for anxiety disorders: a comparison of cognitive behavioral therapy to acceptance and commitment therapy.
Objective: Understanding for whom, and under what conditions, treatments exert their greatest effects is essential for developing personalized medicine. Research investigating moderators of outcome among evidence-based treatments for anxiety disorders is lacking. The current study examined several theory-driven and atheoretical putative moderators of outcome in cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).
Method: Eighty-seven patients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) anxiety disorder completed 12 sessions of ACT or CBT and were assessed with a self-report measure of anxiety at baseline, post-treatment, and 6- and 12-month follow-up assessments.
Results: CBT outperformed ACT among those at moderate levels of baseline anxiety sensitivity, and among those wi…
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Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia.
Interventions based on Cognitive Behavioral Therapy (CBT) are widely used to treat chronic pain, but the brain mechanisms responsible for these treatment effects are poorly understood. The aim of this study was to validate the relevance of the cortical control theory in response to an exposure-based form of CBT, Acceptance and Commitment Therapy, in patients with chronic pain. Forty-three female patients diagnosed with fibromyalgia syndrome were enrolled in a randomized, 12-week, waiting-list controlled clinical trial (CBT n=25; controls n=18). CBT was administered in groups of six patients during 12 weekly sessions. Functional magnetic resonance imaging (fMRI) during pressure-evoked pain was assessed before and after treatment or the 12-week period. Self-report questionnaires of depression and anxiety were administered pre- and posttreatment as well as 3 months following end of treatmen…
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Wetherell JL, Afari N, Rutledge T, Sorrell JT, Stoddard JA, Petkus AJ, Solomon BC, Lehman DH, Liu L, Lang AJ, Atkinson HJ (2011)randomised controlled trialMEDLINE-indexed journal, not yet read by usPain280 citations A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain.
Individuals reporting chronic, nonmalignant pain for at least 6 months (N=114) were randomly assigned to 8 weekly group sessions of acceptance and commitment therapy (ACT) or cognitive-behavioral therapy (CBT) after a 4-6 week pretreatment period and were assessed after treatment and at 6-month follow-up. The protocols were designed for use in a primary care rather than specialty pain clinic setting. All participants remained stable on other pain and mood treatments over the course of the intervention. ACT participants improved on pain interference, depression, and pain-related anxiety; there were no significant differences in improvement between the treatment conditions on any outcome variables. Although there were no differences in attrition between the groups, ACT participants who completed treatment reported significantly higher levels of satisfaction than did CBT participants. These…
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Effectiveness and cost offset analysis of group CBT for hypochondriasis delivered in a psychiatric setting: an open trial.
Hypochondriasis is highly prevalent in medical settings, has detrimental effects for affected individuals, and is associated with high societal costs. Although cognitive behavior therapy (CBT) has been shown to be effective in the treatment of hypochondriasis, it is not widely available because of a lack of properly trained therapists. Therefore, it is essential to evaluate therapy forms that require less therapist time. The authors investigated the effect and economic impact of group CBT delivered in a psychiatric setting among 24 people with hypochondriasis. A within-group design with prolonged baseline was used, and all participants received 10 weeks of group-based treatment. The primary outcome measures were the Health Anxiety Inventory and the Illness Attitude Scales. Results indicate significant improvement on both measures at posttreatment and 6-month follow-up (Cohen's d = 1.03-1…
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Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash.
Cognitive behavior therapy (CBT) has made important contributions to chronic pain management, but the process by which it is effective is not clear. Recently, strong arguments have been raised concerning the need for theory driven research to e.g. identify mechanisms of change in CBT and enhance the effectiveness of this type of treatment. However, the number of studies addressing these issues is still relatively scarce. Furthermore, the arrival of varieties of CBT with seemingly different process targets increases the need for such information. The present study explored the processes of change in a previously reported successful randomized controlled trial evaluating the effectiveness of an exposure-based form of behavioral and cognitive therapy, Acceptance and Commitment Therapy (ACT), on improvement in pain-related disability and life satisfaction for patients suffering from whiplash…
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Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain--a randomized controlled trial.
Although several studies have illustrated the effectiveness of cognitive behavior therapy (CBT) on adult pain patients, there are few randomized controlled trials on children and adolescents. There is particularly a need for studies on pediatric patients who are severely disabled by longstanding pain syndromes. Acceptance and Commitment Therapy, as an extension of traditional CBT, focuses on improving functioning and quality of life by increasing the patient's ability to act effectively in concordance with personal values also in the presence of pain and distress. Following a pilot study, we sought to evaluate the effectiveness of an ACT-oriented intervention based on exposure and acceptance strategies and to compare this with a multidisciplinary treatment approach including amitriptyline (n=32). The ACT condition underwent a relatively brief treatment protocol of approximately 10 weekly…
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Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial.
Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. An approach that promotes acceptance of, or willingness to experience, pain and other associated negative private events (e.g. fear, anxiety, and fatigue) instead of reducing or controlling symptoms has received increasing attention. Although the empirical support for treatments emphasizing exposure and acceptance (such as acceptance and commitment therapy) is growing, there is clearly a need for more outcome studies, especially randomized controlled trials. In this study, parti…
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The impact of CBT and ACT models using psychology trainee therapists: a preliminary controlled effectiveness trial.
The present study compares the impact of individualized treatment provided by trainee therapists based on a traditional cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT) model. Fourteen therapists were given initial training in CBT and ACT. Outpatients (N = 28) were randomized to either approach, with each therapist treating one client within each model, linked to a functional analysis. Clients treated within an ACT model showed better symptom improvement than the CBT clients, despite the fact that students felt initially less knowledgeable about ACT and were more fearful throughout when it was used. CBT improved client self-confidence more rapidly than ACT, and ACT improved acceptance more than CBT. Both processes predicted better outcomes; acceptance remained predictive when controlling for self-confidence but not vice versa. Overall, therapists with limited …
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Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results.
Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affectiv…
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A brief cognitive-behavioral approach to reducing anxiety sensitivity decreases pain-related anxiety.
Anxiety sensitivity (AS; fear of anxiety-related sensations) is a known risk factor for anxiety disorders and recently has been linked to pain disorders. The present study was guided by the hypothesis that a program designed to reduce AS levels might also result in a decrease in anxiety related to pain sensations. Female undergraduates, selected as either high or low in AS according to screening scores on the Anxiety Sensitivity Index (ASI), were randomly assigned to participate in 3 1-hour, small group sessions of either cognitive behavioral therapy (CBT; psycho-education, cognitive restructuring, and interoceptive exposure) or a non-specific treatment (NST). Immediately prior to and following the intervention, participants completed the 20-item Pain Anxiety Symptoms Scale (PASS-20). Consistent with hypothesis, results revealed a 3-way interaction between AS group, intervention conditio…
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The effect of non-pharmacological sleep interventions on glycaemic measures in adults with sleep disturbances and behaviours: A systematic review and meta-analysis.
Background: Sleep insufficiency is known to negatively impact on glucose metabolism. Consequently, there is interest in determining the impact of improving sleep on glucose metabolism. We conducted a meta-analysis of studies that aimed at improving sleep using cognitive behavioural therapy for insomnia (CBT-I) and/or sleep hygiene or sleep extension on glucose metabolism.
Methods: Searches were performed on MEDLINE, EMBASE, CINAHL and Cochrane. We included studies featuring adults≥18years, a sleep intervention and glycaemic measurements. The pooled mean differences were calculated by the inverse variance method.
Results: 24 studies (15 CBT-I and/or sleep hygiene; 9 sleep extension) were included. Meta-analysis of 12 studies (n = 2,044) of CBT-I and/or sleep hygiene demonstrated a significant reduction in HbA1c of 0.27% (95% CI 0.07, 0.47, I2 74%, p = 0.008) compared to control. In T2DM (…
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Telehealth versus face-to-face delivery of cognitive behavioural therapy for insomnia: A systematic review and meta-analysis of randomised controlled trials.
ObjectiveThis systematic review and meta-analysis compared the effectiveness of the delivery of care to patients with insomnia via telehealth to its delivery face-to-face. MethodsWe searched Medline, Embase, and Cochrane CENTRAL from inception to 11 January 2023, and conducted a citation analysis on 13 June 2023. No language restrictions were imposed. We included randomised controlled trials. Where feasible, mean differences were calculated; we used a random effects model. ResultsFour trials (239 patients) were included. There were no significant differences between telehealth and face-to-face for insomnia severity scores shortly post-intervention (MD 1.13, 95% CI -0.29-2.55) or at 3 months (mean difference (MD) 1.79, 95% CI -0.01-3.59). There were no differences in Short Form-36 physical and mental scores, Work and Social Adjustment scores, and sleep quality components. Depression score…
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Effectiveness of current digital cognitive behavioural therapy for insomnia interventions for adolescents with insomnia symptoms: A systematic review and meta-analysis.
Sleep problems occur in up to 20%-45% of adolescents. This systematic review and meta-analysis examined the effectiveness of digital sleep interventions, based on cognitive behavioural therapy for insomnia, for adolescents with insomnia symptoms. The objective was to synthesise and quantify, through meta-analyses, changes in sleep following completion of a digital sleep-based intervention. MEDLINE, PubMed, PsycINFO, Scopus, EMBASE, CENTRAL, and Web of Science databases were searched from January 2012 to March 2024. Within-subject studies or randomized-controlled trials reporting the effects of digital cognitive behavioural therapy for insomnia were included. Risk of bias was assessed using the integrated quality criteria for the review of multiple study designs. Random-effects meta-analyses estimated pooled standardised within-subject mean differences to assess effectiveness. Nine studie…
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Pharmacological and Non-Pharmacological Interventions to Improve Sleep in People with Cognitive Impairment: A Systematic Review and Meta-Analysis.
Sleep disturbance is common among people with cognitive impairment and, when present, is an important target for intervention because it potentially leads to negative outcomes and cognitive decline. Given this association, sleep represents a potential public health target, although evidence for efficacy is lacking. For this study, a systematic review and meta-analysis was undertaken of controlled clinical trials of pharmacological and non-pharmacological interventions to improve sleep in mild cognitive impairment and dementia. A total of 144 trials involving 13,471 participants (median 50 per trial) were included. To measure sleep, 68 trials used subjective measures exclusively, and 41 used only objective measures, while 35 used a combination. In all, 287 discrete sleep outcome measures were reported. Bright light therapy was the most frequently examined non-pharmacological intervention,…
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Grief-focused cognitive behavioral therapies for prolonged grief symptoms: A systematic review and meta-analysis.
Background: Studies suggest that cognitive behavioral therapies (CBTs) may be efficacious in reducing symptoms of prolonged grief disorder (PGD), but no comprehensive overview and pooled estimate of CBTs' effect on PGD in adulthood exist. We conducted a systematic review and meta-analysis of randomized controlled trials.
Method: Studies were selected independently by two researchers based on a systematic literature search in Pubmed, APA PsycInfo, Web of Science, and Embase. Meta-analyses provided pooled effect sizes for the effects of CBTs on PGD symptoms and secondary outcomes. We explored potential moderators of effect, risk of bias of included studies, and evaluated the quality of the meta-analytical evidence through the Grading of Recommendations, Assessment, Development, and Evaluation system.
Results: The meta-analysis included 22 studies of 2,602 bereaved adults (averaged study Ma…
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The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis.
Background: Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to evaluate the effectiveness of psychosocial interventions on non-physiological symptoms of menopause (depression, anxiety, cognition, and quality of life) through systematic review and meta-analysis.
Methods: Five databases were searched from inception to August 2023 for randomized controlled trials. Pre- and post-test means and standard deviations for groups were extracted and used to calculate effect sizes. The effectiveness of Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Interventions (MBI) on depression and anxiety were examined by subgroup analysis.
Results: Thirty studies comprising 3501 women were included. From meta-analysis, mood symptoms significantly benefited from CBT (anxiety: d = -0.22, 95 % CI = -0.35, -0.10; depression: d = -0.33, 95 % CI = -…
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The effect of single-component sleep restriction therapy on depressive symptoms: A systematic review and meta-analysis.
Sleep restriction therapy is a behavioural component within cognitive behavioural therapy for insomnia and is an effective standalone treatment for insomnia, but its effect on depressive symptoms remains unclear. This review aimed to synthesise and evaluate the impact of single-component sleep restriction therapy on depressive symptoms relative to a control intervention. We searched electronic databases and sleep-related journals for randomised controlled trials and uncontrolled clinical trials, published from 1 January 1986 until 19 August 2023, that delivered sleep restriction therapy to adults with insomnia. Random-effects meta-analysis of standardised mean differences and Cochrane risk of bias assessment were performed on randomised controlled trials, while uncontrolled clinical trials were discussed narratively. The meta-analysis was pre-registered on PROSPERO (ID: CRD42020191803). …
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Digital cognitive behavioural therapy for patients with insomnia and depression: A systematic review and meta-analysis.
What is known on the subject: Sleep problems are common among those with depression, and there is increasing evidence that sleep problems should be addressed during treatment simultaneously rather than treating depression alone. The first-line treatment for insomnia is cognitive behavioural therapy for insomnia (CBT-I), due to a lack of well-trained therapists and patient time constraints (travelling, work), CBT-I has not been popularized. The development of digital cognitive behavioural therapy for insomnia (dCBT-I) is making the treatment more accessible.
What this paper adds to existing knowledge: Interventions for dCBT-I were significantly better than other control conditions in both reducing insomnia and improving depression in patients with depression and insomnia comorbidities. The effect was found to be related to the duration of the intervention and the severity of insomnia befo…
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