Behavioral Group Training Research Articles

Early detection and intervention of psychosis in children and adolescents in Zurich, Switzerland: Clinical Data from 2017-2022

IntroductionThe construct of a clinical high-risk (CHR) state of psychosis has been established to describe potentially prodromal symptoms which typically appear during adolescence and young adulthood. This is a very sensitive developmental period and the clinical high risk (CHR) is associated with increased functional impairment. To address the specialities in the care for this patient population a specialized outpatient care unit for early intervention in psychosis at the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, of the University Zürich (CAPS) is established. The interdisciplinary team (psychiatrists and psychologists) supports children and adolescents with psychotic disorders or at clinical high risk for developing psychosis. The early intervention service offers specialized assessment, treatment and case management for minors with a first psychosis or CHR-state in an outpatient or inpatient setting as well as by day clinic care.ObjectivesThe evaluation main objective was to get a better understanding about this vulnerable patient group. Therefore we analysed the clinical data about CHR-state, comorbid diagnosis, treatment, medication and hospitalisation of the patients who entered the service for early intervention in psychosis.MethodsParticipants who entered the service for early intervention in psychosis were followed up in the years 2017-2021 and descriptive analysis was used to summarize the data. For the evaluation of the risk construct the participants have been classified in “no increased risk”, “CHR” or “early onset psychosis” (EOP). Additionally, ICD diagnosis, demographics and treatment (medication, psychotherapy, treatment setting) were assessed. Therapy was either psychotherapy and/or group training called DBT2P (Dialectical behavioral group training for adolescents, to prevent psychiatric disorders). Additionally, the use of a smartphone application “Robin Z”(add-on treatment tool to support the patients between the sessions) was assessed.ResultsIn the last five years we saw 300 patients (112 female, mean age 15.7) who sought the care unit for early intervention. The evaluation of the risk showed that 44 patients had no increased risk, 205 were classified with a CHR and 51 fulfilled the criteria of an early onset psychosis (18.5%). Most of the patients showed comorbid diagnosis, mainly depressive disorders (42%). The data about the treatment will be analyzed for the congress.ConclusionsDespite clinical implications, there is little data about early detection and early intervention in psychosis for children and adolescent. Therefore, the evaluation of the clinical data of the CAPS is of clinical importance and expected to add essential information in the fields of prevention and early intervention in psychosis.Disclosure of InterestNone Declared

Effect of cognitive behaviour therapy on the improvement of psychological stress.

College freshmen, as a special group who are far away from their parents and begin to study and live independently, will face psychological stress in adaption to the college life, which may affect their working and living conditions in the university and even after entering the society if not solved reasonably. Hence, it is necessary to explore how to relieve the psychological stress of freshmen. The study aimed to analyze the intervention effects of cognitive behavioral therapy on social psychological stress of freshmen under different demographic variables. 108 freshmen of Northeast Agricultural University were divided into the experimental group and control group. The correlation between psychological stress and impulse, self-esteem, and loneliness was analyzed using structural equation model and multiple regression. The experimental group received group training for one month, while the control group did not accept any intervention. The Fear of Negative Evaluation (FNE) Scale, Interaction Anxiousness Scale (IAS), and Interpersonal Efficacy Scale (IES) were used to score students before and after activities and three months after activities. The relevant information was collected for students' self-evaluation and the evaluation results from group teachers. The subjects' social psychological stress was positively correlated with loneliness and unplanned impulse, and negatively correlated with self-esteem (P < 0.001); the IAS and FNE scores of the experimental group after test were greatly lower than those of the control group, while the scores of affinity efficacy, communication efficacy, and emotional control were greatly higher than those of the control group (P < 0.05); the tracking IAS and FNE scores of the experimental group were greatly lower than those of the control group, while the scores of affinity efficacy, self-impression efficacy, communication efficacy, and emotional control were greatly higher than those of the control group (P < 0.05). All students in the experimental group were satisfied with the cognitive behavioral group training. Under the positive guidance of the team teacher, the students' psychological stress was released. The cognitive behavior group training based on impulse, self-esteem, and loneliness can effectively improve the affinity efficacy, self-impression efficacy, communication efficacy, and negative evaluation fear of freshmen, which is instrumental in easing the psychological stress of students and can maintain long-term effects.

Interventions to reduce stress, anxiety and depression symptoms in teenagers – a systematic review

Abstract Introduction Stress, anxiety and depression symptoms are frequent in teenagers. Objectives: To identify the interventions effectively able to prevent or reduce anxiety, depression and psychological stress in adolescents; to assess the effectiveness, feasibility and transferability of the interventions. Methods Comprehensive systematic review was performed. Three steps searching strategy using the databases: PsycINFO, PubMed, SCOPUS, Cochrane Library, and Google Scholar identified 679 studies and reviews. Critical appraisal was performed by 2 reviewers, data extraction performed on finally selected 59 reviews, RCT, cohort studies focused on sample size, geographical context, setting, description of intervention, measures of primary and secondary outcomes. Results The considered interventions are: Internet-based multifaceted cognitive bias modification training (CBM), Internet (iCBT) or school-based cognitive behavioral group training (CBT), Social skills training (SST), Metacognitive therapy, Psychosocial Support Intervention, organized sports participation and voluntary outdoor play, school-based resilience-focused intervention, assertiveness group training, short-term psychoanalytic psychotherapy (STPP), brief psychosocial intervention (BPI), Guided Parent-Delivered Cognitive Behaviour Therapy (GPD-CBT), Internet-based self-support method. Conclusions Interventions for promoting mental health in adolescents have to combine parenting programs with leisure activities and balanced curriculum; various approaches (physical activity, music, sports participation) should be tailored into the national, community and school contexts. Resilience factors (relationship with parents, communications with peers), development of help-seeking behaviours and available self-help programs could support early detection and assistance. Most interventions showed positive effects on short and medium term and potential transferability. Key messages Regular screening for childhood adversities and traumas and screening of symptoms as feeling sad, hopeless, worried should be performed in adolescents as they get older. Besides mental health risk factors, interventions should target developmental risk factors in transitional stages from childhood to adolescence and from adolescence to young adulthood.

Exercise Is Medicine on Campus Programs: A Descriptive Study

Exercise is Medicine® on Campus (EIM-OC) calls upon campuses to promote physical activity (PA) through education, outreach, assessment of PA levels, and referral programs. Twenty-eight EIM-OC supervisors completed a survey examining the characteristics of existing EIM-OC programs. Survey results identify participation from and collaboration among Health and Counseling Services, Campus Recreation, Wellness and Kinesiology departments. The majority of responding EIM-OC programs include special events and outreach activities. Funding and staffing for EIM-OC programs comes primarily from Kinesiology departments but often in conjunction with Campus Recreation. Referral programs are primarily targeted at students, who are referred for sedentary behavior or existing mental or physical conditions. Referral benefits include waived or reduced fees, fitness and behavioral assessments, and individualized or group training. The majority of campuses indicate that their EIM-OC program has improved relationships among involved units and provides new opportunities for students as either participants or leaders.

Combined Effects of Electroacupuncture and Behavioral Training on Learning-Memory Ability and Event-Related Potential P300 in Rats with Mid/Advanced Cerebral Infarction.

Background:The effectiveness of the combination of electroacupuncture (EA) and behavioral training (BT) for mid/advanced cerebral infarction (M/ACI) and related mechanisms remains unclear. This study aimed to investigate the combined effects on the learning-memory ability and event-related potential P300 in rats with M/ACI.Methods:Eighty rats with M/ACI were divided into Group Model (M), Group EA, Group BT, and Group EA-BT (n = 20) according to the random number with five healthy rats in Group Control (CON). On the 6th week after modeling, EA, BT, and EA-BT were given to Group EA, Group BT, and Group EA-BT, respectively, whereas Group M and Group CON were not given any intervention. Y-maze test and P300 were recorded before and after the intervention.Results:After intervention, the P300 latency was lower and the amplitude was higher in the Group EA-BT, Group EA, and Group BT than before (for latency, t = −7.638, −4.334, and −5.916; for amplitude, t = 8.125, 3.846, and 5.238; P < 0.01), with Group EA-BT superior to Group EA (for latency, t = −3.708; for amplitude, t = 3.653; P < 0.01) and Group BT (for latency, t = −2.067; for amplitude, t = 2.816; P < 0.05), with no significant difference between Group BT and EA (for latency, t = −1.439; for amplitude, t = 1.075; P > 0.05). While the performances of Y-maze tests in the Group EA-BT, Group EA, and Group BT were all better than before (t = 10.359, 4.520, and 7.791, P < 0.01), with Group EA-BT better than Group EA (t = 5.627, P < 0.01) and Group BT (t = 2.913, P < 0.01) respectively, and Group BT better than Group EA (t = 2.912, P < 0.01).Conclusion:EA or BT can affect P300 in rats with M/ACI, and the combination of these two methods can significantly improve the learning-memory ability.

Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety: Two-year follow-up of a randomized controlled trial

Background and ObjectivesThis two-year follow-up study evaluated the long-term outcomes of two early interventions that aimed at reducing social and test anxiety in young adolescents at risk for developing social anxiety disorder. MethodsIn this RCT, moderately socially anxious adolescents (N=240, mean age 13.6 years) were randomly assigned to a 10-week internet-based multifaceted cognitive bias modification training (CBM), a 10-week school-based cognitive behavioral group training (CBT), or a no-intervention control condition. Using multiple imputation, this study examined the changes in primary and secondary outcome measures from pretest to follow-up in a repeated measures design. ResultsPrimary outcome: Self-reported social and test anxiety generally decreased from pre-test to two-year follow-up, regardless of treatment condition. The percentage of adolescents who developed a social anxiety disorder was very low (6%) and similar across conditions. Secondary outcome: There were beneficial changes in self-esteem, self-reported prosocial behaviors, and fear of negative evaluation, but none of these were related to treatment condition. Automatic social-threat associations did not significantly change. The CBM intervention was effective in changing interpretative bias as indexed by the Recognition Task but this long-term effect did not transfer to the Adolescent Interpretation and Belief Questionnaire. LimitationsThere was a substantial (50%) though seemingly non-selective attrition at follow-up. ConclusionsThis RCT does not support the longer-term efficacy of school-based CBT or CBM as an early intervention for social and test anxiety. Rather, it emphasizes the positive 'natural' course of highly socially anxious adolescents over two years.

Cognitive Behavioral Group Training for Welfare Recipients: A Psychoeducational Approach to Improving Employment Outcomes

Cognitive Behavioral Group Training for Welfare Recipients: A Psychoeducational Approach to Improving Employment Outcomes

The Effectiveness of Cognitive Behavioral Group Training on Stress Management Style Resiliency and Glycemic Hemoglobin Levels in Diabetic Patients

The purpose of this study was to determine the effectiveness of Cognitive Behavioral Group Training on Stress Management Style Resiliency and Hemoglobin Levels in diabetic patients of Shiraz city has been done. Research method was experimental and the design of pretest-posttest-with-control group kind been. Statistical population consisted of nearly nine hundred and fifty diabetic patients from the Diabetic Center of the City of Shiraz one year before and filling the case. The research community consisted of 60 people was randomly selected from the member patients of Shiraz diabetic association who were available from the sample. They were randomly bringing in two groups of experimental and control. At first pre-tests were performed by both groups and then the experiment group were trained stress management, cognitive - behavioral therapy with relaxation in 10 sessions of two hours and a half every week and during this term control group was under training other unrelated stress management programs such as drug educations. After the end of the term, both groups completed the questionnaires again. Also glycemic control index (HbA1c) test was repeated after 3 months from the first test. The research tools include resiliency questionnaires and glycemic control index (HbA1c) testing. Also, data obtained from research using descriptive statistics (mean, standard deviation, frequency, maximum and minimum) and the covariance method Manova inferential statistics and independent T-test and analysis software SPSS-18 case. The findings indicate that cognitive style group training, stress management - treated diabetic patients by increasing resiliency and decrease of the glycemic hemoglobin in the blood of diabetic patients.

Cognitive Bias Modification versus CBT in Reducing Adolescent Social Anxiety: A Randomized Controlled Trial

Social anxiety is a common mental disorder among adolescents and is associated with detrimental long term outcomes. Therefore, this study investigated the efficacy of two possible early interventions for adolescent social anxiety and test anxiety. An internet-based cognitive bias modification (CBM; n = 86) was compared to a school-based cognitive behavioral group training (CBT; n = 84) and a control group (n = 70) in reducing symptoms of social and test anxiety in high socially and/or test anxious adolescents aged 13–15 years. Participants (n = 240) were randomized at school level over the three conditions. CBM consisted of a 20-session at home internet-delivered training; CBT was a 10-session at school group training with homework assignments; the control group received no training. Participants were assessed before and after the intervention and at 6 and 12 month follow-up. At 6 month follow-up CBT resulted in lower social anxiety than the control condition, while for CBM, this effect was only trend-significant. At 12 month follow-up this initial benefit was no longer present. Test anxiety decreased more in the CBT condition relative to the control condition in both short and long term. Interestingly, in the long term, participants in the CBM condition improved more with regard to automatic threat-related associations than both other conditions. The results indicate that the interventions resulted in a faster decline of social anxiety symptoms, whereas the eventual end point of social anxiety was not affected. Test anxiety was influenced in the long term by the CBT intervention, and CBM lead to increased positive automatic threat-related associations.Trial RegistrationTrialRegister.nl NTR965

Reducing stress and supporting positive relations in families of young children with type 1 diabetes: a randomized controlled study for evaluating the effects of the DELFIN parenting program.

BackgroundTo assess initial efficacy and feasibility of a structured behavioural group training (DELFIN) for parents of children with diabetes type 1, in order to reduce parenting stress and to improve parenting skills.MethodsA randomized controlled study was conducted between July 2008 and September 2010, at a children’s hospital in Hannover with parents of children with type 1 diabetes (2–10 yrs) (intervention group n = 37; control group n = 28). Parenting skills, parents’ psychological burden, children’s behavioural difficulties and quality of metabolic control were assessed before, 3 months after and 12 months after participating in the training program.ResultsIn the intervention group parenting behaviour in conflict situations improved significantly after 3 months (Z = −3.28; p ≤ 0.001). It remained stable over 12 months (Z = −2.94; p ≤ 0.01). Depression and anxiety scores of parents decreased (Z = −1.93; p ≤ .05; Z = −2.02; p ≤ .05). Even though the outcome in the intervention group was more positive, the differences between both study arms failed to reach statistical significance. Unexpectedly parenting behaviour in the control group improved also (Z = −2.45; p ≤ .05). Anxiety as well as stress scores decreased in this group (Z = −2.02; p ≤ .05 and Z = −2.11; p ≤ .05). In both groups the initial metabolic control was good and without significant differences (A1c 7.2±0.8% vs. 7.1±0.4%; p > 0.5). It remained stable in the DELFIN group (A1c 7.1±0.8%; p > 0.5), but it increased slightly in controls (A1c 7.3±0.5%; Z = −2.79; p = .005).ConclusionsThis study has brought first evidence for the efficacy and feasibility of the program. A multicentre study with a larger sample is necessary to confirm these first results.

Studying The Effect of Cognitive Behavioral Group Training on Depression in Hemodialysis Patients

This study aimed to investigate the effect of cognitive behavioral training on depression in Hemodialysis patients selected hospitals in Mashhad was. For this purpose the number of cases in 1210 haemodialysis patients in 12hospitals in Mashhad dialysis with random (cluster) from 12 hospitals, four hospitals selected from among 40 cases of patients selected for the study and random assignment in the two groups…. (20 patients) and control (n= 20) groups. Training patterns of cognitive behavior therapy for experimental group and control group were not given training in this study significant amount of pre-test and post test results from t-test Msql criteria. Results indicate the experimental group had reduced depression and cognitive behavior training effect on haemodialysis patients was felt depressed.Recent research results highly consistent with results Sylvyra Priscilla Dvarth et al (2009) has a total of this study indicate Asrgzary cognitive behavioral patterns in hemodialysis patients is to reduce depression.

The effectiveness of motivational interviewing in improving health outcomes in adults with type 2 diabetes

Diabetes is one of the most serious, threatening, developing, and costly health problems. This disease can influence the psychological and especially physical dimensions of people. The aim of current study was investigation of the effects of group Motivational Interviewing (MI) and Cognitive Behavioral Group Training (CBGT) in improving physical health outcomes among adults with diabetes type 2. Ninety- three Patients with type 2 diabetes were selected from Iranian Diabetes Society and Institute of Endocrinology and Metabolism. The participants were randomly allocated to the MI group, CBGT group, and the control group and were tested before and after intervention. Each of interventions consisted of four 90minutes group sessions. The findings showed that in the MI and CBGT groups, mean of BMI was significantly lower than control group. Also, it was found that, in the MI, the mean of HbA1c was significantly lower than CBGT intervention group. The results indicated that in helping adults with type 2 diabetes, CBGT and MI in group format may be useful interventions to improve their weight loss, and MI may be a useful intervention to improve their glycemic control than CBGT. Theoretical and practical implications of results are discussed.

The effectiveness of a training for patients with unexplained physical symptoms: protocol of a cognitive behavioral group training and randomized controlled trial

BackgroundIn primary care, up to 74% of physical symptoms is classified as unexplained. These symptoms can cause high levels of distress and healthcare utilization. Cognitive behavioral therapy has shown to be effective, but does not seem to be attractive to patients. An exception herein is a therapy based on the consequences model, which distinguishes itself by its labeling of psychosocial distress in terms of consequences rather than as causes of physical symptoms. In secondary care, 81% of the patients accepts this therapy, but in primary care the outcome is poor. We assume that positive outcome can also be reached in primary care, when the consequences model is modified and used bottom-up in an easily accessible group training, in which patients are relieved of being blamed for their symptoms. Our aim is to investigate the (cost-)effectiveness of this training.Methods and designA randomized controlled trial is designed. One hundred patients are randomized to either the group training or the waiting list.Physicians in general practices and outpatients clinics of general hospitals refer patients. Referral leads to inclusion if patients are between 18 and 65 years old, understand Dutch, have no handicaps impeding participation and the principal DSM-IV-TR classification is undifferentiated somatoform disorder or chronic pain disorder. In contrast to other treatment effect studies, the co-morbidity of a personality disorder does not lead to exclusion. By this, we optimize the comparability between the study population and patients in daily practice enlarging the generalization possibilities.Also in contrast to other effect studies, we chose quality of life (SF-36) instead of physical symptoms as the primary outcome measure. The SF-6D is used to estimate Quality Adjusted Life Years (QALYs). Costs are measured with the Trimbos/iMTA Questionnaire for Costs associated with Psychiatric Illness. Measurements are scheduled at baseline, after the training or waiting list, three and twelve months after the training. The differences between measurements are analyzed according to the intention-to-treat principle. The cost-effectiveness is expressed as costs per QALY, using multiple sensitivity analyses on the basis of a probabilistic model of the trial.DiscussionIf we show that our group training is (cost-)effective, more patients could be served, their quality of life could be improved while costs might be reduced. As the training is investigated in a heterogeneous patient group in the daily practice of a mental healthcare institution, its transfer to practice should be relatively easy.Trial registrationNederlands Trial Register, NTR1609

The impact of cognitive behavioral group training on event-free survival in patients with myocardial infarction: The ENRICHD experience

Objective Although the Enhancing Recovery in Coronary Heart Disease (ENRICHD) treatment was designed to include individual therapy and cognitive behavioral group training for patients with depression and/or low perceived social support, only 31% of treated participants received group training. Secondary analyses classified intervention participants into two subgroups, (1) individual therapy only or (2) group training (i.e., coping skills training) plus individual therapy, to determine whether medical outcomes differed in participants who received the combination of group training and individual therapy compared to participants who received individual therapy only or usual care. Methods Secondary analyses of 1243 usual care, 781 individual therapy only, and 356 group plus individual therapy myocardial infarction (MI) patients were performed. Depression was diagnosed using modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria; low perceived social support was determined by the ENRICHD Social Support Instrument. Psychosocial treatment followed MI, and for participants with severe or unremitting depression, was supplemented with a selective serotonin reuptake inhibitor. Cox proportional hazards regression was used to estimate intervention effects on time to first occurrence of the composite end point of death plus nonfatal MI. To control for confounding of group participation with survival (because individual sessions preceded group), we used risk set sampling to match minimal survival time of those receiving or not receiving group training. Results Analyses correcting for differential survival among comparison groups showed that group plus individual therapy was associated with a 33% reduction (hazard ratio=0.67; 95% confidence interval, 0.49–0.92, P=.01) in medical outcome compared to usual care. No significant effect on event-free survival was associated with individual therapy alone. The group training benefit was reduced to 23% (hazard ratio=0.77; 95% confidence interval: 0.56–1.07, P=.11) in the multivariate-adjusted model. Conclusions Findings suggest that adding group training to individual therapy may be associated with reduction in the composite end point. A randomized controlled trial is warranted to definitively resolve this issue.

Lay Trainers With Migraine for a Home‐Based Behavioral Training: A 6‐Month Follow‐Up Study

To evaluate the changes at 6-month follow-up after a home-based behavioral training (BT) provided by lay trainers with migraine to small groups of fellow patients. The need for self-management programs and cost-effective treatments gave rise to this study. In a previous randomized controlled trial, we compared the BT group with a waitlist-control group, receiving usual care. The control group was trained directly after their waitlist period. The present study examined the follow-up results in both groups and measurements were held pre BT, post BT, and at 6-month follow-up. Six months after BT, 42% was categorized as responders (>or=-50% decrease in attack frequency), 42% did not change (-49 to 49%), and 16% responded adversely (>or=50% increase). In the group as a whole (n = 95), attack frequency significantly decreased from 3.0 attacks at baseline to 2.5 post BT and to 2.3 at 6-month follow-up (-23%, medium effect size 0.6). The strong improvements of perceived control over and self-confidence in attack prevention were maintained at follow-up. Disability and health status were unchanged but quality of life significantly improved over time (P = .007). BT was more beneficial for patients who entered the training with a high attack frequency. Linear regression analysis demonstrated that a stronger belief at baseline that the occurrence of migraine is due to chance (external control) significantly predicted a lower attack frequency at follow-up. Lay trainers with migraine can train small groups of fellow patients at home in behavioral attack prevention. At 6-month follow-up, attack frequency and quality of life were significantly but modestly improved and feelings of control and self-confidence remained strongly improved.

Use of CBT to Treat Depression Among Patients on Hemodialysis

Use of CBT to Treat Depression Among Patients on Hemodialysis

Use of CBT to Treat Depression Among Patients on Hemodialysis

Use of CBT to Treat Depression Among Patients on Hemodialysis

Short‐term effects of cognitive behavioural group training (CBGT) in adult Type 1 diabetes patients in prolonged poor glycaemic control. A randomized controlled trial

To assess the effects of cognitive behavioural group training (CBGT) on glycaemic control, diabetes self-efficacy and well-being in Type 1 diabetes patients in persistent poor glycaemic control. In a randomized controlled trial, a total of 107 patients with Type 1 diabetes in poor glycaemic control (HbA(1c) > or = 8%) were assigned to a 6-week CBGT or blood glucose awareness training (BGAT) as control condition. The intervention was preceded by a 3-month run-in period. Glycaemic control (HbA(1c)), diabetes-specific self-efficacy (CIDS), diabetes-related distress (PAID) and depressive symptoms (CES-D), were assessed at baseline (T1), directly before (T2) and 3 months after (T3) the intervention. No significant changes in HbA(1c) were found after CBGT, whilst diabetes self-efficacy increased (mean CIDS score 71.6 +/- 14.0 to 74.3 +/- 12.2) and diabetes-related distress (mean PAID score 47.0 +/- 21.6 to 42.6 +/- 20.8) and depressive symptoms decreased (mean CES-D score 16.9 +/- 12.8 to 13.5 +/- 12.6). Changes in psychological outcomes were similar for both treatment groups. Diabetes self-care behaviours improved equally. Drop-out rate, which was higher among CBGT participants, was relatively low overall (total n = 15, 17.05%), and both interventions were well-appreciated by the participants. CBGT was successful in improving self-efficacy, diabetes-related distress and mood at 3 months' follow-up, but not in improving glycaemic control.

Cognitive behavioural group training (CBGT) for patients with type 1 diabetes in persistent poor glycaemic control: who do we reach?

Approximately a quarter of adults with type 1 diabetes do not succeed in achieving satisfactory glycaemic control, partly due to problems with the demanding self-management regimen. To improve glycaemic control, interventions with a cognitive behavioural approach, aimed at modifying dysfunctional beliefs, reducing negative emotions and enhancing self-care practices are a potentially successful tool. Little is known about the reach of such an approach. This article describes characteristics of participants in a randomized, controlled trial of cognitive behavioural group training for patients with type 1 diabetes in poor glycaemic control. Results show that outpatients from seven hospitals in the area of Amsterdam, selected on long-standing high HbA1c and volunteering to participate, report high levels of psychological distress and depressive symptoms. Furthermore, self-care behaviours were perceived as important, but burdensome. Diabetes-specific self-efficacy was relatively low. It is concluded that this selected group of adults with type 1 diabetes would potentially benefit from a cognitive-behavioural intervention in order to reduce negative emotions, enhance diabetes self-efficacy, self-care behaviour and glycaemic outcomes.

The management of chronic tinnitus: Comparison of an outpatient cognitive–behavioral group training to minimal-contact interventions

Objective: Using a randomized group design, the efficacy of an outpatient cognitive–behavioral Tinnitus Coping Training (TCT) was compared to two minimal-contact (MC) interventions. Methods: TCT was conducted in a group format with 11 sessions (total n=43). One MC [MC-E (education), n=16] consisted of two group sessions in which education on tinnitus was presented and self-help strategies were introduced. The second MC [MC-R (relaxation), n=16] comprised four sessions. Besides education, music-supported relaxation was suggested as self-help strategy and audiotapes with relaxing music were provided. Furthermore, a waiting-list control group was installed (WC, n=20). Data were assessed at baseline (pretherapy) and at posttherapy period. Only TCT was additionally evaluated at a 6-month and a 12-month follow-up. Several outcome variables (e.g., awareness of tinnitus) were recorded in a tinnitus diary. Tinnitus coping and disability due to tinnitus were assessed by questionnaires. Subjective ratings of improvement were also requested from the patients. Furthermore, inventories of psychopathology were given to the patients. Results: Findings reveal highly significant improvements in TCT in comparison to the control group (WC). MC interventions do not differ significantly from each other, but are superior to WC in a few domains of outcome. Outcome in TCT is somewhat superior to combined MC interventions in two domains of data, but not regarding disability reduction. Effect sizes, nevertheless, indicate distinct differences in degree of improvement, with TCT achieving the best results. Conclusions: A sequential scheme for the treatment of chronic tinnitus is discussed on the basis of cost-effectiveness considerations.