Preliminary evidence on combined cognitive behavioral therapy and motivational interviewing intervention efficacy to improve employment motivation for persons with intellectual disability

BackgroundHypertension and diabetes mellitus are independent risk factors for cardiovascular diseases. Due to the cardioprotective nature of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), they are recommended for patients with comorbid hypertension and diabetes. However, poor adherence to ACEIs/ARBs among older adults is a major public health concern. This study aimed to assess the effectiveness of a telephonic motivational interviewing (MI) intervention conducted by pharmacy students among a nonadherent older population (≥ 65 years old) with diabetes and hypertension.MethodsPatients continuously enrolled in a Medicare Advantage Plan who received an ACEI/ARB prescription between July 2017 and December 2017 were identified. Group-based trajectory modeling (GBTM) was used to identify distinct patterns of ACEI/ARB adherence during the 1-year baseline period: adherent, gaps in adherence, gradual decline, and rapid decline in adherence. Patients from the three nonadherent trajectories were randomized into MI intervention or control group. The intervention consisted of an initial call and five follow-up calls administered by MI-trained pharmacy students and tailored to the baseline ACEI/ARB adherence trajectories. The primary outcome was adherence to ACEI/ARB during the 6- and 12-month periods post-MI implementation. The secondary outcome was discontinuation, defined as no refills for ACEI/ARB during the 6- and 12-month periods post-MI implementation. Multivariable regression analyses examined the impact of MI intervention on ACEI/ARB adherence and discontinuation while adjusting for baseline covariates.ResultsA total of 240 patients in the intervention group and 480 patients as randomly selected controls were included in this study. At 6 months, patients receiving the MI intervention had significantly better adherence (β = 0.06; p = 0.03) compared with the controls. Linear and logistic regression models also showed patients in the intervention group were more likely to be adherent than controls within 12 months of intervention implementation (β = 0.06; p = 0.02 and OR: 1.46; 95% CI 1.05–2.04, respectively). MI intervention did not have any significant impact on the ACEI/ARB discontinuation.ConclusionPatients who received the MI intervention were more likely to be adherent at 6 and 12 months following the intervention initiation, despite gaps in the follow-up calls due to COVID-19. Pharmacist-led MI intervention is an effective behavioral strategy to improve medication adherence among older adults and tailoring the intervention to past adherence patterns may enhance the intervention effectiveness.This study was registered with the United States National Institutes of Health (ClinicalTrials.gov identifier NCT03985098).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40266-023-01008-6.

PROTOCOL: Cognitive‐Behavioural Therapies for Young People in Outpatient Treatment for Non‐Opioid Drug Use

Both urban and rural adults are likely to be inactive, but rural adults have less access to exercise classes or facilities to increase physical activity. To evaluate whether a telephone-only motivational interviewing (MI) intervention would increase daily physical activity of rural adults. This randomized controlled trial enrolled 86 physically inactive adults living in rural communities (mean age = 58 years, range = 30-81 years) who stated that they were ready to increase physical activity during the next 6 months. Participants were assigned randomly to MI intervention (n = 43) or control (n = 43) groups. The MI group participants received a pedometer and monthly MI telephone calls over 6 months from a counselor. Control group participants received an equal number of telephone calls without MI content. Physical activity was measured by self-report using the Community Healthy Activities Model Program For Seniors Physical Activity Questionnaire for Older Adults. Data were collected by mailed surveys and analyzed using analysis of variance. Seventy-two participants completed the study (35 in the intervention group and 37 in the control group). The telephone-only MI intervention increased self-efficacy for exercise (p = .019) but did not increase levels of physical activity (p = .572) compared with controls. The intervention increased self-efficacy for exercise but did not increase physical activity, possibly due to seasonal effects, the control condition, or the length of the MI intervention. Even so, future studies are warranted because telephone-only MI has potential as a practical, relatively inexpensive method to provide health counseling to rural adults in a broad geographic area. This study produced an effect size on physical activity that will be useful to guide future studies.

Physical activity can confer many benefits on cancer survivors, including relief of persistent symptoms related to cancer treatment. To evaluate the effect of a motivational interviewing (MI) intervention on increasing physical activity (Community Healthy Activities Model Program for Seniors questionnaire) and improving aerobic fitness (6-minute walk), health (Medical Outcomes Study Short-Form 36), and fatigue (Schwartz Cancer Fatigue Scale) in cancer survivors. A secondary purpose was to evaluate whether the effect of MI on physical activities depended on self-efficacy. Fifty-six physically inactive adult cancer survivors (mean=42 months since completion of treatment) were assigned randomly to intervention and control groups. The MI intervention consisted of one in-person counseling session followed by two MI telephone calls over 6 months. Control group participants received two telephone calls without MI content. Outcomes were measured at baseline, 3 months, and 6 months, and were analyzed using multilevel modeling. The results of the MI intervention explained significant group differences in regular physical activities (measured in caloric expenditure per week), controlling for time since completion of cancer treatment (p<.05). Aerobic fitness, physical and mental health, and fatigue were not different between groups. In the intervention group, individuals with high self-efficacy for exercise at baseline increased their physical activity more than those with low self-efficacy (p<.05). In the control group, increases in physical activity did not depend on self-efficacy. Use of MI may increase physical activity in long-term cancer survivors, especially in persons with high self-efficacy for exercise. Multilevel modeling analysis revealed individual changes that would not have been shown by analysis of group means. Future studies with larger samples or more intense MI interventions may show changes in aerobic fitness, physical and mental health, and fatigue.

Anxiety and depression are common following traumatic brain injury (TBI), often co-occurring. This study evaluated the efficacy of a 9-week cognitive behavioral therapy (CBT) program in reducing anxiety and depression and whether a three-session motivational interviewing (MI) preparatory intervention increased treatment response. A randomized parallel three-group design was employed. Following diagnosis of anxiety and/or depression using the Structured Clinical Interview for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean post-traumatic amnesia 22 days) were randomly assigned to an Adapted CBT group: (1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a (3) waitlist control (WC, n = 23) group. Groups did not differ in baseline demographics, injury severity, anxiety or depression. MI and CBT interventions were guided by manuals adapted for individuals with TBI. Three CBT booster sessions were provided at week 21 to intervention groups. Using intention-to-treat analyses, random-effects regressions controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and NDC + CBT) showed significantly greater reduction in anxiety on the Hospital Anxiety and Depression Scale [95% confidence interval (CI) -2.07 to -0.06] and depression on the Depression Anxiety and Stress Scale (95% CI -5.61 to -0.12) (primary outcomes), and greater gains in psychosocial functioning on Sydney Psychosocial Reintegration Scale (95% CI 0.04-3.69) (secondary outcome) over 30 weeks post-baseline relative to WC. The group receiving MI + CBT did not show greater gains than the group receiving NDC + CBT. Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI.

AimsPatients suffering from heart failure with preserved ejection fraction (HFpEF) report similar symptoms and reduction in quality of life to those with reduced ejection fraction but remain largely untreated. We conducted a preliminary evaluation of the acceptance, feasibility, and efficacy of a motivational interviewing (MI) intervention to support elderly patients suffering from HFpEF in maintaining or starting physical activity.Methods and resultsAt the conclusion of the exercise training in diastolic heart failure parent trial that examined the effects of supervised exercise, patients with HFpEF were offered participation in a two‐group pilot study. Based on their preference, consenting patients were assigned to either a 6 month MI intervention group (n = 19) or their physicians' usual care (n = 20). To support participants in increasing and/or maintaining their physical activity, counsellors delivered a mean of 6.5 MI sessions (face to face and via telephone) and also provided a physical activity diary as self‐management tool. At baseline and 6 months, we assessed participants' physical activity motivation (Sportbezogene Selbstkonkordanz Scale) and their physical improvements with the 6 min walk test and a cardiopulmonary exercise test. Of the entire sample (N = 39), 46% were female, their mean age was 73, 90% were in New York Heart Association Class II, and the mean ejection fraction was 61.4%. The majority of MI participants rated the intervention as acceptable, 90% perceived MI as helpful in setting specific exercise goals and overcoming barriers concerning physical activity, and 58% considered the physical activity diary as very helpful. Three‐quarters of MI participants (79%) reported an increase in their physical activity compared with the previous year. Intervention participants showed a greater increase in median peak VO2 from baseline to 6 months (baseline: 18.4 mL/kg/min; 6 months: 20.4 mL/kg/min) compared with the control group (baseline: 20.0 mL/kg/min; 6 months: 19.2 mL/kg/min; P = 0.015). There was no significant change in motivation on the Sportbezogene Selbstkonkordanz Scale for either group (MI: 1.7 vs. 3, P = 0.55; control: 4.7 vs. 4, P = 0.26) nor did patients show any significant improvements in the 6 min walk test (MI: 549 vs. 540 m, P = 0.80; control: 572 vs. 580 m, P = 0.37). Counsellors rated the implementation of the MI intervention as feasible.ConclusionsThe results from this pilot study suggest that our MI intervention was well accepted by participants and deemed feasible. It also appears to be an effective treatment to increase and maintain physical activity and exercise capacity in patients suffering from HFpEF. Our findings need to be confirmed in a randomized clinical trial with larger and unselected patient cohorts.

This chapter explores a wide range of smoking cessation strategies, emphasising the importance of both pharmacological and behavioural interventions in addressing nicotine addiction. It discusses various treatment options, including nicotine replacement therapy (NRT), electronic cigarettes (ECs), cognitive behavioural therapy (CBT), motivational interviewing (MI), and other appropriate behavioural intervention approaches. Additionally, emerging digital health solutions, such as smartphone apps, telemedicine, and text-message services, are reviewed for their potential to support smoking cessation efforts. The importance of public awareness campaigns and peer support is emphasised, as well as personalised treatment plans and the integration of multiple strategies to increase cessation success. Lastly, it stresses the need for continued research, particularly in adapting interventions to diverse populations and leveraging technology for broader reach.

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.

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.

BackgroundDelay to start antiretroviral therapy (ART) and nonadherence compromise the health and wellbeing of people living with HIV (PLWH), raise the cost of care and increase risk of transmission to sexual partners. To date, interventions to improve adherence to ART have had limited success, perhaps because they have failed to systematically elicit and address both perceptual and practical barriers to adherence. The primary aim of this study is to determine the efficacy of the Supporting UPtake and Adherence (SUPA) intervention.MethodsThis study comprises 2 phases. Phase 1 is an observational cohort study, in which PLWH who are ART naïve and recommended to take ART by their clinician complete a questionnaire assessing their beliefs about ART over 12 months. Phase 2 is a randomised controlled trial (RCT) nested within the observational cohort study to investigate the effectiveness of the SUPA intervention on adherence to ART. PLWH at risk of nonadherence (based on their beliefs about ART) will be recruited and randomised 1:1 to the intervention (SUPA intervention + usual care) and control (usual care) arms. The SUPA intervention involves 4 tailored treatment support sessions delivered by a Research Nurse utilising a collaborative Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) approach. Sessions are tailored to individual needs and preferences based on the individual patient’s perceptions and practical barriers to ART. An animation series and intervention manual have been developed to communicate a rationale for the personal necessity for ART and illustrate concerns and potential solutions. The primary outcome is adherence to ART measured using Medication Event Monitoring System (MEMS). Three hundred seventy-two patients will be sufficient to detect a 15% difference in adherence with 80% power and an alpha of 0.05. Costs will be compared between intervention and control groups. Costs will be combined with the primary outcome in cost-effectiveness analyses. Quality adjusted life-years (QALYs) will also be estimated over the follow-up period and used in the analyses.DiscussionThe findings will enable patients, healthcare providers and policy makers to make informed decisions about the value of the SUPA intervention.Trial registrationThe trial was retrospectively registered 21/02/2014, ISRCTN35514212.

The last three decades have witnessed significant advances in psychotherapy. Numerous scholarly articles and books have been devoted to pertinent topics in the field, making it difficult for the practicing clinician to keep up with this rapidly growing area. The purpose of this article is to provide some guidelines on how to evaluate the empirical literature in psychotherapy and then to explore three key areas: evidence-based psychotherapies for patients with psychiatric disorders, individual variables that predict differential outcome to treatment, and the therapeutic alliance. Finally, two case examples will be presented to illustrate how knowledge of the empirical literature can facilitate an evidence-based approach to the daily practice of psychotherapy in general psychiatry.

Background. Despite widespread health promotion campaigns, men who have sex with men (MSM) continue to be disproportionately infected with the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) in Australia. Recent increases suggest MSM are involved in sexual risk behaviour that is placing them and other men at risk of HIV/STI transmission. There is some evidence that mental health, substance use and psychological variables are related to sexual risk taking. The aim of phase one of this study was to describe the psychological well-being in MSM accessing a sexual health and infectious diseases clinic and to examine predictors of sexual risk taking behaviours. The aim of phase two was to evaluate the effectiveness of a brief Motivational Interviewing (MI) intervention in reducing unprotected anal intercourse and number of sexual partners in MSM with sexual risk behaviours. Methods. A convenience sample of 250 MSM attending for routine care (HIV positive n = 52, HIV negative n = 198) were recruited from a large metropolitan sexual health and infectious diseases (ID) clinic. Participants completed self-report questionnaires including sociodemographic questions, substance use, impulsivity, sexual sensation seeking scale and the Personality Assessment Screener (PAS). Those identified as having high sexual risk behaviours from these assessments and who agreed to participate were randomised to receive a two-session MI intervention (n = 20) or to a standard care control group (n = 21). The MI intervention incorporated a 30-45 minute face-to-face session plus 15 minute telephone booster session. The self-reported frequency of unprotected anal intercourse and number of sexual partners was determined at one and four-months follow-up. V Results. Approximately one-third (n = 83) of the total sample scored in the clinically significant range on the PAS total score. The correlation between Negative Affect/Mood (27% clinically significant) and Suicidal Thinking (29% clinically significant) domains was highest with overall Psychological Distress (r = .53, p <0.00). Multivariate analysis revealed that high sexual risk behaviour was independently positively associated with the number of sexual partners over the previous three months and sexual sensation seeking scores. A negative association was found between high sexual risk behaviour and Negative Affect (mood), Negotiation Skills and daily alcohol intake. The MI intervention group showed significant reductions in unprotected anal intercourse and number of sexual partners over the study period. The proportion of men with UAI was not significantly different between groups at one month post-test (p = .188). However, the MI intervention group reported significantly greater reductions in unprotected anal intercourse at four-months post-test (p = .041). The MI intervention group also reported significantly greater reductions in sexual partners at one- and four- months post-test relative to the control group. Conclusions. A subgroup of MSM attending primary health services display clinically significant psychological distress that warrants attention. The use of psychological screening in addition to sexual health assessment of MSM attending sexual health and ID clinics may provide valuable information for improving the well-being of these men. MI shows promise in reducing sexual risk behaviours (unprotected anal intercourse and number of partners) in MSM at high-risk of HIV/STI transmission. MI is a time-limited and brief intervention that is easily delivered in primary care settings during routine care.

BackgroundInterventions targeting multiple risk factors for cardiovascular disease (CVD), including poor diet and physical inactivity, are more effective than interventions targeting a single risk factor. A motivational interviewing (MI) intervention can provide modest dietary improvements and physical activity increases, while adding cognitive behaviour therapy (CBT) skills may enhance the effects of MI. We designed a randomised controlled trial (RCT) to examine whether specific behaviour change techniques integrating MI and CBT result in favourable changes in weight and physical activity in those at high risk of CVD. A group and individual intervention will be compared to usual care. A group intervention offers potential benefits from social support and may be more cost effective.Methods/DesignIndividuals aged between 40 and 74 years in 11 South London Clinical Commissioning Groups who are at high risk of developing CVD (≥20%) in the next 10 years will be recruited. A sample of 1,704 participants will be randomised to receive the enhanced MI intervention, delivered by trained healthy lifestyle facilitators (HLFs), in group or individual formats, in 10 sessions (plus an introductory session) over one year, or usual care. Randomisation will be conducted by King’s College London Clinical Trials Unit and researchers collecting outcome data will be blinded to treatment allocation. At 12-month and 24-month follow-up assessments, primary outcomes will be change in weight and physical activity (average steps per day). Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score. Incidence of CVD events since baseline will be recorded. A process evaluation will be conducted to evaluate factors which impact on delivery, adherence and outcome. An economic evaluation will estimate relative cost-effectiveness of each type of intervention delivery.DiscussionThis RCT assesses the effectiveness of a healthy lifestyle intervention for people at high risk of CVD. Benefits of the study include the ethnic and socioeconomic diversity of the study population and that, via social support within the group setting and long-term follow-up period, the intervention offers the potential to support maintenance of a healthy lifestyle.Trial registrationThis trial is registered with the ISRCTN registry (identifier: ISRCTN84864870, registered 15 May 2012).

Youth drug use is a severe problem worldwide. This review focuses on Cognitive-Behavioural Therapy (CBT) as a treatment for young people who misuse non-opioid drugs, such as cannabis, amphetamines, ecstasy and cocaine, which are strongly associated with a range of health and social problems. CBT is an individualized and multicomponent intervention that combines behavioural and cognitive therapy. While behavioural therapy mainly focuses on external settings and observable behaviour, cognitive therapy is concerned with internal cognitive processes. The primary focus of CBT is to reduce usersâ?T positive expectations about drug use, to enhance their self-confidence to resist drugs, and to improve their skills for problem-solving and for coping with daily life stressors. The objective of this review is to assess the effectiveness of CBT for young people (aged 13-21) in outpatient treatment for non-opioid drug use and to explore any factors that may moderate outcomes. The literature search yielded a total of 18,514 references, of which 394 were deemed potentially relevant and retrieved for eligibility determination. Of these, 360 did not fulfil the screening criteria and were excluded. Four records were unobtainable. A total of seven unique studies, reported in 17 papers, were included in the review. Meta-analysis was used to examine the effects of CBT on drug use reduction, social and family functioning, school problems, treatment retention and criminal activity compared to a group of other interventions (Adolescent Community Reinforcement Approach (ACRA), Chestnut Bloomington Outpatient (CBOP) (+Assertive Continuing Care (ACC)), Drugs Harm Psychoeducation curriculum (DHPE), Functional Family Therapy (FFT), Interactional Therapy (IT), Multidimensional Family Therapy (MDFT), and Psychoeducational Therapy (PET)). Our main objective was to evaluate the current evidence on the effect of CBT on abstinence and drug use reduction for young people in outpatient treatment for non-opioid drug use. Seven randomised trials, involving 953 participants, were included in this review. Each of the seven included studies compared CBT to another intervention. We analysed the effects in the short term (from the start of treatment to up to 6 months thereafter), medium term (from 6 months to less than 12 months after the start of treatment), and long term (12 months or more after the start of treatment). We analysed CBT that was delivered with an add-on component such as motivational interviewing (four studies) separately from CBT that was delivered without an add-on component (three studies). Based on meta-analysis of data from the four included studies analysing CBT with an add-on component, there was no evidence of a relative effect of CBT for the reduction of youth drug use frequency compared to other interventions (ACRA, CBOP (+ACC), DHPE, FFT and MDFT). The random effects standardized mean difference was -0.14 (95% CI -0.64, 0.36) for the short term based on four studies, -0.06 (95% CI -0.44, 0.32) for the medium term based on four studies and -0.15 (95% CI -0.36, 0.06) for the long term based on two studies. Based on meta-analysis of data from the four included studies analysing CBT without an add-on component, there was no evidence of a relative effect of CBT for the reduction of youth drug use frequency compared to other interventions (IT, MDFT, and PET ). The random effects standardized mean difference was -0.13 (95% CI -0.68, 0.42) for the short term based on two studies, -0.08 (95% CI -0.48, 0.31) for the medium term based on three studies and 0.02 (95% CI -0.48, 0.52) for the long term based on two studies. Thus, the available data does not support the hypothesis that there is a drug use reduction effect from using CBT with young drug users compared to other interventions (ACRA, CBOP (+ACC), DHPE, FFT, IT, MDFT, and PET ). Statistically significant heterogeneity was present in the short term. In the medium term statistically significant heterogeneity was present between studies analysing CBT with an add-on component. In the analysis of studies without an add-on component there was no statistically significant heterogeneity in the medium term. Due to the low power of detecting heterogeneity with only two studies included in the analysis, this result should be interpreted with caution. There was no heterogeneity between studies in the long term; however, with only two studies included in the analyses the power to detect heterogeneity was low. The primary outcome measured as recovery could only be analysed in the long term. The meta-analysis of CBT with an add-on component was inconclusive as the eight different comparison combinations analysed showed different results. Only one study analysing CBT without an add-on component provided data on recovery status. The reported effect was not statistically significant.

Psoriasis is a chronic, immune-mediated skin disease shown to have a multifaceted relationship with psychological factors. Because these factors have been shown to both worsen and result from psoriasis, an increasing number of studies have sought to investigate the efficacy of various psychological interventions in psoriasis management. A systematic review of PubMed® and Scopus® databases was performed for studies investigating psychological interventions in psoriasis management published from 1 January 1990 through 4 November 2018. Primary articles published in English and conveying physical treatment outcomes were included, whereas articles not describing clinical outcomes were excluded. Studies supporting intervention efficacy were graded with a level of evidence according to the Scottish Intercollegiate Guidelines Network levels of evidence. A total of 28 reports studying 27 unique sets of patients receiving psychological therapies in psoriasis management were identified, including three case reports and series and 24 clinical trials, investigating 1522 patients in total. Cognitive behavioral therapy and its variants, biofeedback, meditation and mindfulness-based therapies, hypnosis, music resonance therapy, motivational interviewing, emotional disclosure, and educational and multidisciplinary approaches have been studied in the treatment of psoriasis. Although 16 randomized controlled trials were included in this review, literature is limited by heterogeneity of methodology, analyses, and outcomes. Only 4 of 27 studies (three of which investigated cognitive behavioral therapy) were rated a level of evidence of 1+ or greater. Studies, overall, have sample sizes often < 50 patients, lack follow-up past 12months, and have attrition rates > 20%. Based on assigned levels of evidence, the most promising methods of psychological intervention in psoriasis include cognitive behavioral therapy, mindfulness-based therapies, motivational interviewing, and educational and interdisciplinary interventions. Further study is needed to determine the efficacy, practicality, and economic feasibility of these treatment options for patients with psoriasis.