Medication and cognitive-behavioral therapy treatment effects on the brain in depression

The effect of successful treatment on the emotional and physiological response to carbon dioxide inhalation in patients with panic disorder

ABSTRACT: This article is a description of the Music Therapy Assessment of Automatic Thoughts (MTAAT), a cognitive behavioral intervention designed to help couples improve communication. This method was designed to be a part of the type of communication training exercises that may take place in marriage counseling. It involves spouses taking turns improvising on percussion instruments to depict musically what they perceive as their typical pattern of communication. While one improvises, the other writes thoughts that result from what the other is musically saying. These are designed to serve as assessments of the automatic, conscious thoughts each spouse has when communicating. The results of an initial clinical application suggest that the MTAAT may successfully enable couples to communicate musically with one another and may reveal a degree of interpersonal knowledge about their relationship and the types of automatic thoughts they have while communicating verbally with one another. The authors suggest the need for research on the applicability of the MTAAT in a marriage counseling setting and other settings where therapists use cognitive behavioral music therapy interventions. The field of marriage counseling can be traced back to the early 1930's (Nichols & Schwartz, 2004). Since that time, marriage counseling has continued to grow and expand as new treatments develop. Marriage counseling is a specialized field of family therapy designed to help individuals adequately prepare for and make adjustments during marriage Qohnson, 1961). Initially, counselors utilized behavioral techniques to help couples improve communication and other types of interactions with operant conditioning (Wetchler & Piercy, 1996). For instance, some counselors used contingency contracting to enhance communication skills and other types of reciprocal behaviors (Nichols & Schwartz, 2004). With the advent of cognitive behaviorism in the 1960's, marriage counselors began to incorporate the theories of Beck (1976) and Ellis (1962) into their methods of treatment. Since that time, marriage counselors have created different cognitive behavioral approaches such as Cognitive Behavioral Couples Therapy (CBCT). CBCT developed in the late 1980's as a formal method of treatment (Epstein, Baucom, & Daiuto, 1997). In cognitive behavioral therapy, counselors help individuals gain insight and improve their ability to recognize negative automatic thoughts and change maladaptive beliefs (Abrahms, 1983; Corey, 1996; Epstein, Baucom, & Daiuto, 1997). According to McMinn (1991), automatic thoughts are spontaneous, conscious thoughts that occur in response to specific situations. Since automatic thoughts occur in response to specific situations, they are examined by the therapist because they often reflect a person's core beliefs about those situations or events (Epstein & Baucom, 2002; McMinn, 1991). The manner in which people perceive and structure their experiences determines how they feel, behave and respond (Corey, 1996; Nichols & Schwartz, 2004). Cognitive behavioral therapy maintains that people tend to incorporate faulty thinking into their lifestyle, which leads to emotional and behavioral disturbances (Corey, 1996; Luce, 2001). With the help of the counselor, clients can begin to change false beliefs about themselves and others by recognizing and challenging automatic thoughts that influence problematic behavior. Cognitive behavioral music therapy interventions typically involve the client(s) and therapist(s) making music together within the session (Standley, Johnson, Robb, Brownell, & Kim, 2004). Clients are given the opportunity to recognize cognitions while engaging in an active, music-making process. The experiential characteristics inherent in improvisational music therapy can facilitate here and now experiences that can assist couples when using cognitive behavioral interventions to improve their ability to communicate with each other. …

This article presents an integrative review of the evidence for combined motivational interviewing and cognitive behavioural interventions that promote medication adherence. We undertook this review to establish a scientific foundation for development of interventions to promote medication adherence and to guide clinical practice. The World Health Organization has designated medication adherence as a global problem. Motivational interviewing and cognitive behaviour interventions have been found to individually promote medication adherence. However, there is a gap in the literature on the effect of combined motivational interviewing and cognitive behavioural approaches to promote medication adherence. Integrative review. COCHRANE, PubMed and CINAHL were searched to access relevant studies between 2004-2014. Inclusion criteria were interventions combining motivational interviewing and cognitive behavioural therapy with medication adherence as the outcome. Articles were assessed for measures of adherence and methodological rigour. Analysis was performed using an integrative review process. Six articles met the inclusion criteria. A randomised controlled trial reported pretreatment missed doses of 5·58 and post-treatment of 0·92 and trended towards significance. Four cohort studies had effect sizes of 0·19-0·35 (p < 0·05). A case study had a pretreatment adherence rate of 25% and post-treatment 77% (p < 0·01). Although there were a limited number of studies on combined motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed. This review provides clinicians with the state of the science in relation to combined motivational interviewing and cognitive behavioural therapy interventions that promote medication adherence. A summary of intervention components and talking points are provided to aid nurses in informing decision-making and translating evidence into practice.

Recent recommendations suggest that reassuring patients with an acute bout of low back pain and encouraging a return to normal activities may be helpful in preventing the development of chronic disability. There is also a question as to whether psychologic or physical therapy interventions actually add anything to such reassurance and advice in terms of preventing chronicity. This study aimed to ascertain the preventive effects on future sick leave and health-care utilization of adding on a cognitive-behavioral group intervention or a cognitive-behavioral group intervention and preventive physical therapy (focused on activity and exercise) relative to a minimal treatment group (examination, reassurance, and activity advice). A total of 185 patients seeking care for nonspecific back or neck pain who were employed and at risk for developing long-term disability volunteered to participate in the study. Of these 185, 158 (85%) completed the pre- and 1-year follow-up assessments. Significant differences were observed on the key outcome variables of future health-care utilization and work absenteeism. For health-care utilization, the cognitive-behavioral intervention group and preventive physical therapy group had significantly fewer healthcare visits than did the Minimal Treatment Group. For work absenteeism, the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group had fewer days during the 12-month follow-up than did the Minimal Treatment Group. The risk for developing long-term sick disability leave was more than five-fold higher in the Minimal Group as compared with the other 2 groups. However, there was no difference between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group on sick leave. Taken as a whole, this study shows that adding cognitive-behavioral intervention and cognitive-behavioral intervention and preventive physical therapy can enhance the prevention of long-term disability. There was no substantial difference in the results between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group.

Health related quality of life changes in somatising patients after individual versus group cognitive behavioural therapy: A randomized clinical trial

PurposeThis study aims to evaluate and summarize the effectiveness of cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) interventions on relapse prevention and severity of symptoms among individuals with major depressive disorder (MDD). CBT is one of the most used and suggested interventions to manage MDD, whereas ICBT is a novel effective proposed approach.Design/methodology/approachThe review was conducted following the preferred reporting items for systematic review and meta-analysis protocol. A comprehensive and extensive search was performed to identify and evaluate the relevant studies about the effectiveness of CBT and ICBT on relapse prevention and severity of symptoms among patients with MDD.FindingsA total of eight research studies met the inclusion criteria and were included in this systematic review. RCT studies were conducted to assess and evaluate the effectiveness of CBT and ICBT on relapse prevention and severity of symptoms among patients with MDD. It has been found that CBT is a well-supported and evidently based effective psychotherapy for managing depressive symptoms and reducing the relapse and readmission rate among patients diagnosed with MDD. The ICBT demonstrated greater improvements in depressive symptoms during major depressive episodes among patients with MDDS. The ICBT program had good acceptability and satisfaction among participants in different countries.Research limitations/implicationsDespite the significant findings from this systematic review, certain limitations should be acknowledged. First, it is important to note that all the studies included in this review were exclusively conducted in the English language, potentially limiting the generalizability of the findings to non-English speaking populations. Second, the number of research studies incorporated in this systematic review was relatively limited, which may have resulted in a narrower scope of analysis. Finally, a few studies within the selected research had small sample sizes, which could potentially impact the precision and reliability of the overall conclusions drawn from this review. The authors recommend that nurses working in psychiatric units should use CBT interventions with patients with MDD.Practical implicationsThis paper, a review of the literature gives an overview of CBT and ICBT interventions to reduce the severity of depressive symptoms and prevent patients’ relapse and rehospitalization and shows that CBT interventions are effective on relapse prevention among patients with MDD. In addition, there is still no standardized protocol to apply the CBT intervention in the scope of reducing the severity of depressive symptoms and preventing depression relapse among patients with major depressive disorder. Further research is needed to confirm the findings of this review. Future research is also needed to find out the most effective form and contents of CBT and ICBT interventions for MDD.Social implicationsCBT is a psychological intervention that has been recommended by the literature for the treatment of major depressive disorder (MDD). It is a widely recognized and accepted approach that combines cognitive and behavioral techniques to assist individuals overcome their depressive symptoms and improve their overall mental well-being. This would speculate that effectiveness associated with several aspects and combinations of different approaches in CBT interventions and the impact of different delivery models are essential for clinical practice and appropriate selection of the interventional combinations.Originality/valueThis systematic review focuses on the various studies that explore the effectiveness of face-to-face CBT and ICBT in reducing depressive symptoms among patients with major depressive disorder. These studies were conducted in different countries such as Iran, Australia, Pennsylvania and the USA.

ObjectiveWe explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). MethodsWe undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. ResultsModerator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group.Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a “logical” treatment (MCS).Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. ConclusionPatient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.

Teachers are largely affected by OS, during their most productive years, leading to catastrophic physical, psychological, and economic burden on themselves, families and society by large. Teachers are responsible for producing the workforce of any nation, and thus have a major impact indirectly on the economy and health of a nation. There are several individual-level interventions conducted to reduce occupational stress (OS) among teachers. This study was conducted to systematically review and conduct a meta-analysis of the effectiveness of individual-level interventions to reduce occupational stress among teachers. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration ID: CRD42020149277) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Cochrane, PsycInfo, and Web of Science databases were searched using predefined search strategies covering the eligibility criteria. Studies were selected in four rounds. Risk of bias assessments were conducted with GRADE recommendations and ROBINS-I criteria for randomized and non-randomized interventions, respectively. Study selection, data extraction and bias assessments were performed independ ently by two reviewers with a third reviewer to resolve conflicts. Narrative synthesis of the findings were also performed. Clinical, methodological, and statistical heterogeneity assessments were conduct ed. Meta-analyses were performed with Review Manager 5.3 software using the "generic inverse variance method" with mean difference as the pooled estimate. Sensitivity analyses of the findings was also performed. At the initial search, 293 articles were identified and 29 subsequently selected for synthesis of findings. The findings of the meta-analysis indicated that Cognitive Behavioral Therapy (CBT) and relaxation interventions significantly reduced OS among teachers with an effect size of 6.2 (p < 0.001). Effect size was highest for combined CBT and relaxation interventions which was 6.57 (p < 0.001). Relaxation interventions only and CBT interventions only had effect sizes of 3.35 (p < 0.001) and 3.12 (p = 0.002) respectively. In sensitivity analysis, after removing low-quality studies, CBT interventions only, combined CBT and relaxation interventions and overall effect size were 6.31 (p < 0.00001), 17.36 (p < 0.00001), and 14.55 (p < 0.00001), respectively, ie, substantially greater than with low-quality studies included. Inconclusion, CBT and relaxation interventions reduce OS among teachers and it's most effective when those individual-level interventions are conducted together.

We investigated the effectiveness of online Sensate Focus exercises, delivered online as a series of 11 animation videos, in improving participants’ sexual functioning and enhancing intimacy, relationship and sexual satisfaction. We studied 35 Chinese heterosexual couples, assessed them at pretest, post-test, and a three-month follow-up. Compared to the waitlist control group, the experimental group showed improvement in orgasm in women, and this was maintained at follow-up. Also, for those with a lower function at pretest, the intervention was possibly effective in improving erectile function among men, as well as overall sexual function and pain among women. These improvements were maintained at follow-up as well. Findings from the current study suggest that online Sensate Focus intervention has potential in treating sexual dysfunction of Chinese heterosexual couples. It may also serve as the first part of a stepped care approach or be integrated with other medication or cognitive behavioral therapy treatment.

Objective: To investigate the effect of cognitive behavioral intervention on nurses with PTSD by using cognitive behavioral intervention. Methods: The subjects were selected by randomized control method, and the PTSD nurses were divided into control group (n = 30) and intervention group (n = 30). The intervention group used cognitive behavioral intervention; the control group did not use cognitive behavioral intervention. Nurses with PTSD in the two groups completed the basic situation survey, medical coping questionnaire (MCMQ) and anxiety self-rating form (SAS) psychological scale one month later. Results: There was no significant difference in MCMQ and SAS scores between the two groups before intervention (P > 0.05). After intervention, the scores of MCMQ and SAS in the intervention group were compared with the scores of MOCQ and SAS in the control group. The scores of the control group after intervention were significantly higher than those of the intervention group, with statistical significance (P 0.05). It shows that cognitive behavioral intervention therapy has the effect and value of improving the psychological status of nurses with PTSD. Conclusion: Cognitive behavioral intervention therapy combined with psychology for nurses with PTSD can effectively relieve their stress level, relieve their mood, and improve their positive coping ability and work efficiency.

Childhood social anxiety is associated with significant social and academic impairment. The purpose of this study was to compare and contrast the efficacy of two major treatments for social anxiety disorders in children: cognitive-behavioral therapy and selective serotonin reuptake inhibitor (SSRI) drug treatment. Treatment studies in the literature were evaluated using meta-analytic techniques to compare pre- and post-treatment measures of social anxiety symptoms, general anxiousness, social competency, and impairment. Results indicate that the core symptoms of social anxiety and impairment were reduced by both cognitive-behavioral treatment (ES=0.86 and 1.56) and SSRI treatment (ES=1.30 and 2.29), respectively. Similarly, peripheral symptoms of general anxiousness were reduced by both cognitive-behavioral treatment (ES=0.75) and SSRI treatment (ES=1.29). Finally, both cognitive-behavioral (ES=0.68) and SSRI treatment (ES=0.68) resulted in moderate improvements in social competence. Implications and the limitations of these meta-analytic findings are discussed with respect to the evidence-based intervention movement.

Social anxiety disorder, also known as social phobia, is highly prevalent and is associated with significant impairment. This chapter reviews theoretical models of the disorder, as well as empirically supported cognitive behavioral strategies, in an effort to inform evidence-based practice. Treatments reviewed include group and individual cognitive behavioral therapy, Internet-delivered and brief cognitive behavioral therapy, mindfulness- and acceptance-based therapies, attention bias modification programs, and combinations of cognitive behavioral therapy and medication treatments. In addition, this chapter highlights factors influencing treatment outcome. Keywords: social anxiety disorder; social phobia; treatment; psychotherapy; cognitive behavioral therapy; empirically supported treatment

Background: The world today is witnessing an upsurge of issues that are of global dimension, one of which substance abuse is one. Drug abuse which include alcohol, cannabis, cocaine, and heroine has turned many families apart and destroyed lives, corrupted the societal value and prevented many youth from fulfilling their hopes and aspirations.Therefore, the study is to examine the effectiveness of Cognitive Behavioral Therapy intervention in the management of substance abuse among selected secondary students. Methodology: The universe of study consisted of 232 subjects out of which only 129 that were selected randomly completed the programme, it consisted of 70 males and 58 females selected from secondary schools in Ejigbo Local government area through multistage sampling technique. Simple randomization was used in selecting four secondary schools and respondents were selected randomly from the registers of the school selected. The study adopted a quasi- experimental, non- equivalent control group pretest/post-test design with the Cognitive Behavioural Therapy (CBT) Intervention as the therapeutic package and an instrument tagged Cognitive Behavioural Intervention Scale (CBIS) consisting of 53 items was used. Data were analyzed using means test and analysis of covariance (ANOVA). Results: Findings revealed that cognitive behavioural therapy significantly affects substance abuse cessation among the subjects. The therapeutic intervention was of greater efficacy along the gender lines. Conclusion: It was concluded that Psychiatric Nurses should endeavor to accompany the medical regimen with cognitive behavioural therapy in the management of substance abuse to prevent relapse. It was recommended that educational authorities should employ the services of clinical psychologists.

This article explores the efficacy of sequential treatment involving medication and cognitive behavioral treatment (CBT) for insomnia. In a multiple baseline across-subjects design, 6 participants with primary chronic insomnia received 1 of the following treatment sequences: (a) concurrent combination of medication and CBT for the 10-week treatment duration (Combined); (b) medication for the first 5 weeks, with introduction of CBT at week 4 and medication withdrawal after the 5th week resulting in treatment overlap during weeks 4 and 5 (Overlapping: Medication → Combined → CBT); and (c) medication alone for the first 5 weeks followed by CBT alone for an additional 5 weeks (Medication → CBT). Each sequence led to significant sleep improvements, but these improvements occurred at different times during the intervention. Participants in the Combined and in the Overlapping sequences improved their sleep during the 1st phase of treatment, whereas those in the Medication → CBT sequence improved mostly during the 2nd phase of treatment. These preliminary results suggest that a sequential treatment is effective for chronic insomnia. In addition, the results suggest that sleep improvements are more likely to emerge when CBT is introduced, with an Overlapping sequence showing a slight advantage over the other sequences. Additional clinical trials should be conducted with larger samples to replicate these preliminary findings.

Negative schemas have been highlighted as important factors in the development and maintenance of psychosis. However, evidence for schema therapy in people with experiences of psychosis and for schema-specific interventions is lacking for these disabling core beliefs. Cognitive behavioural therapy (CBT) interventions remain a first-line recommended psychological treatment for psychosis, alongside psychotropic medication. The current review aimed for the first time to investigate if CBT interventions led to schema change in this population. A systematic search of five databases (PsycINFO, MEDLINE, Embase, CINAHL and Web of Science) identified 19 eligible studies, of which 10 were eligible for inclusion in the meta-analyses. A narrative synthesis highlighted the variety in CBT intervention length and focus. A small proportion of studies highlighted schema theory within their therapy rationale and within their subsequent CBT intervention. Meta-analytic findings demonstrated that participants receiving a CBT intervention experienced a significant reduction in their negative-self schemas at the end of therapy, compared with control participants. The findings provide evidence that CBT for psychosis can reduce negative schemas in people with psychosis. The review also offers a rationale for considering schema more explicitly within CBT for psychosis intervention studies and clinical practice.