Behavior Therapy For Patients Research Articles

Daily-life stress reactivity and recovery following virtual-reality-based cognitive behavioral therapy in patients with a psychotic disorder.

Studies have consistently demonstrated increased stress sensitivity in individuals with psychosis. Since stress sensitivity may play a role in the onset and maintenance of psychosis, this could potentially be a promising target for treatment. The current study was the first to investigate whether reactivity to and recovery from daily-life stressors in psychosis change in response to treatment, namely virtual-reality-based cognitive behavioral therapy (VR-CBT). 116 patients were randomized to either VR-CBT or the waiting list control group (WL). Pre-treatment and post-treatment participants completed a diary ten times a day during six to ten days. Multilevel analyses were used to model the time-lagged effects of daily stressful events on negative affect (NA) and paranoia symptoms to examine reactivity and recovery. There was a significant difference in NA reactivity. VR-CBT showed higher NA at post-treatment compared to pre-treatment than WL (bpre=0.14; bpost=0.19 vs bpre=0.18; bpost=0.14). There was a significant difference in NA recovery and paranoia recovery between the groups at lag 1: VR-CBT showed relatively lower negative affect (bpre=0.07; bpost=-0.06) and paranoia (bpre= 0.08; bpost=-0.10) at post-treatment compared to pre-treatment than WL (bpre=0.08; bpost=0.08; bpre=0.04; bpost=0.03). Negative affect and paranoia recovery improved in response to treatment. Increased NA reactivity may be explained by a decrease in safety behavior in the VR-CBT group. The discrepancy between reactivity and recovery findings may be explained by the inhibitory learning theory that suggests that an original threat reaction may not erase but can be inhibited as a consequence of exposure therapy.

Implementation of 'IBD-Specific Cognitive Behavioural Therapy' for Patients with Inflammatory Bowel Diseases with Poor Mental Quality of Life, Anxiety and Depression.

This paper describes the implementation of inflammatory bowel disease (IBD)-specific cognitive behavioural therapy (CBT) for IBD patients with poor quality of life (QoL), anxiety and depression, in four hospitals in the Netherlands. Treatment outcomes were compared with those of a previously published randomized control trial (RCT) of 'IBD-specific CBT', following a benchmark strategy. Primary outcome was IBD-specific QoL (IBDQ) completed before and after CBT, secondary outcomes were anxiety and depressive symptoms (HADS, CES-D). Semi-structured interviews were conducted among a pilot of gastroenterologists, nurse specialists and psychologists to evaluate 'IBD-specific CBT'. 94 patients started treatment (280 screened). At follow-up, 63 participants (67% compared to 81% in the RCT benchmark) completed the IBDQ. Treatment effect sizes of the implementation study were comparable and slightly larger than those of RCT benchmark. Gastroenterologists, IBD nurses and psychologists found CBT necessary for IBD patients with poor QoL, depression and/or anxiety disorders. 'IBD-specific CBT' can be successfully implemented. Regular supervision of psychologists performing 'IBD-specific CBT' treatment is needed.

Effects of cognitive behavioral therapy in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis.

Chronic obstructive pulmonary disease (COPD) causes airflow blockage and breathing-related issues. This chronic disease impacts people worldwide. Substantial evidence supports the use of cognitive behavioral therapy (CBT) to help patients with chronic illnesses cope with worrisome and painful symptoms. However, the impact of CBT on COPD outcomes is less understood. In this study, we systematically summarized the effects of CBT on lung function, anxiety and depressive symptoms, and quality of life of patients with COPD. Six English-language and four Chinese-language databases were systematically searched for relevant randomized controlled trials published through April 15, 2023. Studies in which CBT was the only difference in treatment administered to experimental and control groups were included in the review. The studies' risk of bias was evaluated using the Cochrane Criteria. Sixteen studies (1887 participants) were included. The meta-analysis showed that CBT improved the percent-predicted forced expiratory volume in 1 second (FEV1 %), forced vital capacity (FVC), FEV1 /FVC ratio, maximal voluntary ventilation, peak expiratory flow, treatment compliance, and World Health Organization abbreviated quality of life, Self-rating Anxiety and Depression Scale, and St George's Respiratory Questionnaire scores compared with the control (all p < .05). This review demonstrated that CBT improves the lung function, anxiety and depressive symptoms, treatment compliance, and quality of life of patients with COPD and can be used widely in the clinical treatment of this disease.

The application of cognitive behavioral therapy in patients with schizophrenia: A review.

The aim of this review is to explore the clinical nursing application of cognitive behavioral therapy (CBT) in patients with schizophrenia. A literature search was conducted using the CINAHL and MEDLINE databases. The database search occurred during the month of December 2022. This article comprehensively summarizes the theoretical basis of CBT in improving schizophrenia in clinical nursing, its application in managing symptoms and improving social function, as well as research progress in this field. There are still inconsistencies in the research results on CBT, but overall, psychological intervention combined with drug treatment is more effective than conventional treatment alone. If social function training can be added at the same time, it is believed that it will have better effects on clinical treatment and can maintain long-lasting effectiveness. Only in this way can patients truly understand and recognize the disease, improve treatment compliance, and ultimately achieve the goal of improving prognosis and quality of life.

Letter: Frailty-Based Prehabilitation for Patients Undergoing Intracranial Meningioma Resection.

To the Editor: Intracranial meningioma resection (IMR) carries significant morbidity and mortality despite being a benign tumor and less aggressive than malignant brain tumors.1,2 In recent years, moving beyond chronological age, baseline frailty status has been identified as a more robust predictor of postoperative outcomes of IMR.3-8 Frail patients undergoing IMR have been reported to have increased incidence of postoperative complications, increased length of hospital stay, and nonhome discharge destination.3-8 Cole et al3 reported that frail patients undergoing resection of intracranial meningiomas were approximately 11 times more likely to develop postoperative adverse events. Frailty affects how the body responds to the alteration of homeostasis during surgery,9 and frailty-based prehabilitation of patients at risk can lead to improved outcomes. Although this association has been extensively demonstrated using various frailty indices and preoperative risk stratification tools in spine surgery patients,10,11 frailty-based prehabilitation remains yet to be implemented for brain tumor resection patients in general and for IMR in particular. This remains relevant for IMR as most of these patients (apart from high-grade meningiomas with obstructive symptoms) do not require emergent/urgent surgery and can undergo frailty-based prehabilitation for improved outcomes (Figure).FIGURE.: A graphical representation of frailty-directed prehabilitation measures to improve postoperative outcomes.Several studies have reported on worse postoperative outcomes predicted by poor preoperative frailty status assessed by using different indices (Table), including the Risk Analysis Index (RAI) and the Modified Frailty Index (MFI).12,13 RAI is a robust frailty score based on 11 variables that captures the true phenotypic manifestation of frailty—sex, age, cancer diagnosis (excluding melanoma), unintentional weight loss, renal failure, congestive heart failure, poor appetite, shortness of breath at rest, residence defined as not independent living, cognitive deterioration, and activities of daily living (ADL) defined as functional status. Each component of RAI has significance in frailty assessment and serves as a guide to prehabilitation. For instance, interventions such as smoking cessation and inspiratory muscle training target shortness of breath and have been shown to reduce the overall LOS after elective surgical procedures.14 Exercise and physical therapy helps reduce functional dependence before surgery.15 Other frailty-specific interventions that have proven efficacy in enhancing postoperative outcomes include nutritional rehabilitation to target poor appetite and cognitive behavioral therapy in patients with excessive fear or cognitive deterioration.11 The 5-factor MFI assigns 1 point each based on the presence of diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status.13 It is largely made up on comorbid conditions that may not capture true frailty, thus compromising its effectiveness in determining prehabilitative measures. RAI has proven to be a better predictor of outcomes after surgery and could be a more useful tool during prehabilitation measures.16 TABLE. - Predictive Ability of Preoperative Frailty Score on Postoperative Outcomes of IMR Author Year FI Outcomes OR (95% CI) Thommen et al 6 2022 RAI Major complications 2.94 (1.39-6.20) Clavien IV complications 3.99 (1.68-9.46) LOS 15.73 (7.45-33.24) Nonhome discharge destination 13.61 (6.40-28.94) Cole et al 3 2022 mFI-5 Mortality 11.17 (3.45-36.19) Major complications 4.15 (2.46-6.99) Unplanned readmission 4.37 (2.68-7.12) Unplanned reoperation 2.31 (1.17-4.55) Extended LOS 4.28 (2.74-6.68) Nonhome discharge 9.34 (6.03-14.47) Dicpinigaitis et al 4 2021 mFI-11 LOS (1.20, 1.10-1.32) Life-threatening complications/mortality (1.40, 1.17- 1.68) Theriault et al 5 2020 mFI-11 Nonhome discharge 0.131 (0.022-0.773) Readmission 0.131 (0.022-0.773) Taricotti et al 7 2022 FI Early (14.752, 1.463-148.777) and late (35.457, 25.210-41.318) postoperative functional deterioration Ikawa et al 8 2022 mFI-5 Worsening Barthel Index score 1.4 (1.1-1.7) In-hospital mortality 5.0 (2.2-11.1) Complications 1.7 (1.4-2.0) FI, Frailty Index; IMR, intracranial meningioma resection; LOS, length of stay; OR, odds ratio; RAI, Risk Analysis Index. A recent study by our group has shown RAI's robust predictive ability for brain tumor resection outcomes including IMR,6 thus raising the possibility of using RAI-based prehabilitaion for IMR patients. Emphasizing on preoperative rehabilitation measures for IMR could improve a patient's physiological reserve and reduce postoperative adverse events.7 Unlike malignant tumors, intracranial meningiomas are associated with lower rates of mortality and recurrence.17 We believe that the less urgent need to proceed with surgical resection in patients harboring these tumors could allow for preoperative optimization of a patient's physiological reserve. This would guide clinical decision-making by allowing for a tailored approach to improving a patient's ability to cope with surgery.

Terapi Kognitif Perilaku Untuk Pasien Voyourisme: Laporan Kasus Berbasis Bukti Cognitive Behavior Therapy For Voyourisme: An Evidence Based Case Report

The problem of sexual deviance has become a social problem among the people. Several forms of sexual deviance include sexual development which results in type identity disorder, paraphilia, psychosexual dysfunction and others. voyourism becomes sexually aroused by watching an unsuspecting person undress, get naked or have sex, voyourism disorder involves voyouristic urges or fantasies or is distressed by or unable to function because of these urges. This study aims to determine the effectiveness of Cognitive Behavior Therapy to reduce symptoms in patients with Voyourism. The search method is carried out from trusted journal sources and is often used to search for scientific journals, including PubMed, Cochrane, MedlinePlus, Proquest, and Science Direct. The keywords used are "Paraphilic Disorder" AND "Cognitive Behavior Therapy" AND "Symptoms Reduction", journal publications in 2017-2022 with the type of randomized controlled trial, systematic review, meta-analysis. Human research subjects, with English option. The results of the study showed that cognitive behavioral therapy in patients with voyourism disorder has moderate effectiveness in reducing voyourism symptoms and preventing recurrences. The conclusion in this study is that cognitive behavioral therapy can be a therapy and is useful in preventing recurrence of voyourism in patients.

Emerging and alternative solutions to smoking addiction in the patient with a respiratory pathology

Smoking is the leading cause of morbidity and mortality worldwide and exposure to tobacco smoke is a risk factor in developing a respiratory pathology. Given the lack of success of pharmacological treatment and behavioural therapy in patients who cannot or do not want to quit smoking, emerging strategies are an alternative to conventional cigarette use. These strategies, such as electronic cigarettes and heated tobacco products, could be presented as an option to reduce, at least partially, the damage caused by tobacco, thanks to the absence of combustion of organic matter. This review shows how the use of these devices presents both an objective and a subjective improvement in COPD patients, reducing the development and progression of the disease, and reducing the biomarkers of exposure to toxic substances compared to continuing with the smoking habit.

Cognitive behavioral therapy in patients with deep brain stimulation for obsessive-compulsive disorder: a matched controlled study.

Deep brain stimulation (DBS) is effective for refractory obsessive-compulsive disorder (OCD). Post-operative cognitive behavioral therapy (CBT) may augment the effects of DBS, but previous results are conflicting. Here, we investigated whether CBT augments the effect of DBS for OCD. Patients with and without CBT following DBS of the ventral anterior limb of the internal capsule were included. First, we analyzed Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D) scores before, during and after CBT in all patients with CBT. Second, we matched patients with and without CBT based on clinical baseline variables and initial response to DBS and compared the course of Y-BOCS and HAM-D scores over the same timeframe. In total, 36 patients with and 16 patients without CBT were included. Average duration of CBT was 10.4 months (s.d. 6.4). In the 36 patients with CBT, Y-BOCS scores decreased on average by 3.8 points (14.8%) from start until end of CBT (p = 0.043). HAM-D scores did not decrease following CBT. Second, 10 patients with CBT were matched to 10 patients without CBT. In both groups, Y-BOCS scores decreased equally from start until end of CBT or over a similar timeframe (10% in CBT group v. 13.1% in no-CBT group, p = 0.741). Obsessive-compulsive symptoms decreased over time in patients with and without post-operative CBT. Therefore, further improvement may be attributed to late effects of DBS itself. The present study emphasizes the need for prospective randomized controlled studies, examining the effects of CBT.

Application of computerized cognitive behavioral therapy in patients with persistent postural-perceptual dizziness

Objective:A computerized cognitive behavioral therapy intervention program was constructed for patients with persistent postural-perception dizziness（PPPD） and its effects on dizziness symptoms, negative emotions and balance function were investigated. Methods:A randomized controlled trial design was used to select 86 patients with PPPD who were seen in the Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University from July 2020 to July 2021. Randomly assigned to the control group（43 patients） and the experimental group（43 patients）. The control group was routinely treated with medication and vestibular rehabilitation, while the experimental group underwent computerized cognitive behavioral therapy for a total of 9 sessions over 8 weeks; their dizziness symptoms（DHI）, negative affect（GAD-7, PHQ-9） and balance function（BBS） were compared at baseline, 4 and 8 weeks later. Results:After 4 and 8 weeks of intervention, the improvement of dizziness symptoms and negative mood in both groups had a between-group effect, time effect, and interaction effect（P<0.05）. The improvement of balance function had only a time effect and interaction effect（P<0.05）, and no difference in between-group effect was seen（P>0.05）. Conclusion:Computerized cognitive behavioral therapy can be used as an adjunctive treatment to alleviate patients' dizziness, negative affect, and balance function, but no additional benefit has been seen in terms of balance function improvement.

Valproate Adjuvant Cognitive Behavioral Therapy in Panic Disorder Patients With Comorbid Bipolar Disorder: Case Series and Review of the Literature.

Anxiety disorders are the most common comorbid psychiatric disorders in patients with bipolar disorder. Managing anxiety symptoms in comorbid conditions is challenging and has received little research interest. The findings from preclinical research on fear conditioning, an animal model of anxiety disorder, have suggested that memory reconsolidation updating (exposure-based therapy) combined with valproate might facilitate the amelioration of fear memories. Here, three cases of successful amelioration of agoraphobia and panic symptoms through valproate adjuvant therapy for cognitive behavioral therapy in patients who failed to respond to two to three consecutive standard pharmacotherapy trials over several years are described. To the best of the author’s knowledge, this is the first attempt to combine CBT with valproate in patients with panic disorder, agoraphobia, and comorbid bipolar disorder. Additionally, the background preclinical research on this combination therapy based on the reconsolidation-updating mechanism, the inhibition of histone deacetylase 2, and critical period reopening, off-label use of valproate in panic disorder, plasticity-augmented psychotherapy, and how to combine valproate with CBT is discussed.

Impact of preference for yoga or cognitive behavioral therapy in patients with generalized anxiety disorder on treatment outcomes and engagement

There is some, but inconsistent, evidence to suggest that matching patient treatment preference enhances treatment engagement and outcome. The current study examined differential preferences and factors associated with treatment preference for 12-week group cognitive behavioral therapy (CBT), yoga, or stress education in 226 adults with generalized anxiety disorder (GAD; 70% female, Mean age = 33 ± 13.5). In a subsample of 165 patients who reported an intervention preference and were randomized to yoga or CBT, we further examined whether match to preferred intervention improved the primary treatment outcome (responder status on Clinical Global Impressions Scale) and engagement (dropout, homework compliance). Preferences for CBT (44%) and yoga (40%) were similar among patients. Women tended to prefer yoga (OR = 2.75, p = .01) and CBT preference was associated with higher baseline perceived stress (OR = 0.92, p = .04) and self-consciousness meta-cognitions (OR = 0.90, p = .02). Among those not matched to their preference, treatment response was higher for those receiving CBT than yoga (OR = 11.73, p = .013); there were no group differences for those matched to their treatment preference. In yoga, those who received their preference were more likely to drop than those who did not (OR = 3.02, 95% CI = [1.20, 7.58], p = .037). This was not the case for CBT (OR = 0.37, 95% CI = [0.13, 1.03], p = .076). Preference match did not predict homework compliance. Overall, results suggest that treatment preference may be important to consider to optimize outcome and engagement; however, it may vary by treatment modality. Future research incorporating preference, especially with yoga for anxiety, is aligned with personalized medicine. Trial registrationclinicaltrials.gov: NCT01912287; https://clinicaltrials.gov/ct2/show/NCT01912287.

Cost-effectiveness of Internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The Swedish Research Council and the Medical Research of Southeast Sweden Introduction Cost-effectiveness evaluations of psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT) programs, in patients with cardiovascular disease (CVD) are rare. In a recent study we reported that a 9-week iCBT program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients. Purpose To evaluate the cost-effectiveness of this intervention. Methods Cost-effectiveness analysis of a RCT, using an incremental cost-effectiveness ratio (ICER). The costs and effects included in the ICER are from baseline to one year post intervention, but also costs for guidance and support to patients in iCBT and ODF groups. Data on healthcare costs were retrieved from healthcare registries, and the EQ-5D-3L was used to calculate the quality-adjusted life years (QALYs). The ICER can be seen as the additional costs needed to gain an additional QALY by the iCBT compared to ODF. Results At 12-month follow-up, the QALY was significantly higher in iCBT compared to the ODF group (0.713 vs.0.598, p=.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of one year. The ICER for iCBT versus ODF was €18,865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared to ODF. Conclusions The ICER of €18,865 was lower than the cost-effectiveness threshold range of €23,400-€35,100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.

Changes in specific and nonspecific psychopathology network structure after intensive cognitive behavior therapy in patients with anorexia nervosa.

This study aimed to compare eating disorder-specific and nonspecific clinical features in patients with anorexia nervosa before and after intensive enhanced cognitive behavior therapy (CBT-E) via network analysis. All consecutive patients admitted to intensive CBT-E were eligible, and the sample comprised patients aged ≥16 years who completed a 20-week intensive CBT-E program. Body mass index (BMI), Eating Disorder Examination Questionnaire and Brief Symptoms Inventory responses were gathered at baseline and end of treatment, and used to generate statistical networks of the connections between symptoms (nodes) and the strength and centrality thereof. A total of 214 patients were included. Most nodes had relatively similar centrality compared to other nodes in the networks. "Eating concern" and "phobic anxiety" showed the greatest bridge centrality at both time points. No differences were found between baseline and the end of treatment in either global network or individual connection strengths. These findings suggest that some clinical expressions not specific to eating-disorder psychopathology remain strongly connected in the generalized network of patients with anorexia nervosa after CBT-E. Future research should examine whether additional procedures specifically designed to target these symptoms should be integrated into this and other treatments.

Internet-Delivered Cognitive Behavioral Therapy in Patients With Irritable Bowel Syndrome: Systematic Review and Meta-Analysis

BackgroundIrritable bowel syndrome is a common functional gastrointestinal disorder that negatively affects all aspects of life. With the widespread use of the internet, internet-delivered cognitive behavioral therapy has been developed and applied to control symptoms and improve the quality of life of those with irritable bowel syndrome. However, few studies have systematically reviewed the effectiveness of internet-delivered cognitive behavioral therapy on irritable bowel syndrome.ObjectiveThis study aimed to systematically review studies that examined the use of internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome and to evaluate the effects of internet-delivered cognitive behavioral therapy on the improvement of symptom severity, quality of life, psychological status, and cost-effectiveness.MethodsThis meta-analysis involved the search of 6 databases for relevant publications. From the 1224 publications identified through database searches, 9 randomized controlled trials were finally included in the analysis.ResultsThe internet-delivered cognitive behavioral therapies including exposure-based cognitive behavioral therapy, cognitive behavioral therapy for self-management, and cognitive behavioral therapy for stress management were provided in 5 to 13 sessions for 5 to 10 weeks. Internet-delivered cognitive behavioral therapy had medium-to-large effects on symptom severity (standardized mean difference [SMD] –0.633; 95% CI –0.861 to –0.4304), quality of life (SMD 0.582; 95% CI 0.396-0.769), and cost-effectiveness (–0.372; 95% CI –0.704 to –0.039) at postintervention. The effects on symptom severity remained over time even after the intervention, short-term follow-up (SMD –0.391; 95% CI –0.560 to –0.221), and long-term follow-up (SMD –0.357; 95% CI –0.541 to –0.172). There was no significant difference in psychological status, including anxiety and depression, in those with irritable bowel syndrome compared to the controls during the postintervention period.ConclusionsThis review demonstrates that internet-delivered cognitive behavioral therapy could be a cost-effective intervention for improving symptoms and the quality of life in patients with irritable bowel syndrome. However, studies are still insufficient regarding the use of internet-delivered cognitive behavioral therapy in these patients; therefore, more high-quality studies are required in the future.

44-LB: Evaluating the Effectiveness of a Novel Form of Online Cognitive Behavioural Therapy for Patients with Type 2 Diabetes and Comorbid Anxiety or Depression

Mental health disorders like depression and anxiety are highly prevalent in people with diabetes and are associated with poorer outcomes. The current study investigated the effect of a novel online cognitive behavioural therapy (CBT) based intervention derived from Acceptance and Commitment Therapy (ACT) for people with type 2 diabetes. A total of 102 patients with type 2 diabetes and a concomitant mental health disorder completed a course of the novel CBT-based intervention, delivered one-to-one over the internet, using text, by therapists who were specially trained in diabetes. Patients showed pre-treatment scores indicative of moderate to severe depression and anxiety and clinically significant diabetes distress. The treatment paradigm caused statistically significant and clinically meaningful decreases in depression, anxiety and diabetes distress scores. Changes in patient activation further illustrated the degree of improvement seen, with the proportion of patients at the lowest level of activation decreasing from 44.1% to 23.5%, pre- to post-treatment, and half of patients increasing by at least one level of activation. Comparisons between the study group and different synthetic control groups, derived from real-world data obtained using the same online platform as used for the trial, underlined the marked improvements achieved - recovery rates of 76% in the study group compared to 56% and 68% in the synthetic control arms. This study demonstrates that this novel CBT-based treatment, delivered by therapists who have specialism in the disease, provides an integrated therapy which can deliver substantial clinical benefit to patients with diabetes and comorbid mental health problems. Moreover, because it is delivered online, it can be given at a time and place that is convenient to both patients and therapists. Disclosure A. G. Hayes: Consultant; Ieso Digital Health Ltd. A. Catarino: Employee; ieso. S. Mehew: None. A. Blackwell: Employee; IESO. Funding Roche Diabetes Care Limited

Cost-effectiveness of internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms: secondary analysis of an RCT

IntroductionCost-effectiveness evaluations of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programmes, in patients with cardiovascular disease (CVD) are rare. We recently reported moderate to large effect sizes on...

Application of rational emotive behavior therapy in patients with colorectal cancer undergoing adjuvant chemotherapy

ObjectiveThis study aimed to explore the effects of our rational emotive behavior therapy (REBT) program on symptoms, anxiety, depression, and sleep state in patients with colorectal cancer (CRC) undergoing chemotherapy. MethodsFrom October 2020 to May 2021, fifty-six patients with CRC in a hospital in the Hunan Province were randomly divided into an intervention group (n = 28) and a control group (n = 28). The patients in the intervention group completed a 6-week REBT program based on routine nursing care, including four courses: 1) establish a relationship and formulate health files; 2) group communications and study symptom management; 3) continuously provide health knowledge and strengthen healthy behavior; and 4) review the treatment and summary. The control group maintained routine nursing care. The simplified Chinese version of the Memorial Symptom Assessment Scale Short Form (MSAS–SF–SC), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI) scale were used to investigate and compare the intervention effects of the two groups at baseline (T1, before the intervention), four weeks (T2), and six weeks (T3) after the intervention. ResultsThe intervention group was significantly improved in symptoms, anxiety, depression, and sleep state, compared with the control group. At T2, MSAS–SF–SC (24.43 ± 4.26 vs.28.07 ± 3.91), symptom distress (17.29 ± 4.04 vs. 19.39 ± 3.59), symptom frequency (7.14 ± 1.51 vs. 8.68 ± 1.42), HADS (13.68 ± 3.38 vs. 15.86 ± 3.79), anxiety (3.89 ± 1.85 vs. 5.18 ± 2.18), and depression (9.79 ± 2.06 vs. 10.68 ± 2.23), showed that the difference between the two groups was statistically significant (P < 0.05). At T3, MSAS–SF–SC (23.89 ± 3.54 vs. 30.14 ± 3.94), symptom distress (17.61 ± 3.52 vs. 21.32 ± 3.57), symptom frequency (6.29 ± 1.49 vs. 8.82 ± 1.47), HADS (11.82 ± 2.57 vs. 16.29 ± 3.13), anxiety (3.21 ± 1.64 vs. 5.61 ± 1.77), and depression (8.61 ± 1.52 vs. 10.68 ± 1.81), showed that the difference between the two groups was statistically significant (P < 0.05). The sleep state of the intervention group was better than the control group at T3, with decreased score of PSQI [4.00 (3.00,8.00) vs. 9.00 (7.00,12.50), Z = −3.706, P < 0.001]. ConclusionThe 6-week REBT program can effectively improve the symptom, anxiety, depression, and sleep state of patients with CRC undergoing chemotherapy, which could as a care plan for patients with CRC who are repeatedly admitted to the hospital for chemotherapy.

Effectiveness and feasibility of intensive versus regular cognitive behaviour therapy in patients with anxiety and obsessive-compulsive disorders: A meta-analysis

• Relative effectiveness of intensive CBT formats is an understudied area of research. • Intensive CBT did not differ from regular CBT in reducing anxiety and obsessive-compulsive symptoms. • Intensive CBT was better than regular CBT in reducing comorbid depressive symptoms. • Dropout was understudied but is significant to gain insight into feasibility. • Intensive CBT achieves faster results due to shorter lead time and is promising. Since the introduction of cognitive behaviour therapy (CBT), researchers are searching for the optimum schedule of sessions to maximize the effectiveness. In the last decades, intensive treatments - multiple long sessions in a few weeks - became popular in patients with anxiety disorders and obsessive-compulsive disorder (OCD). However, it is still unknown whether intensive CBT is superior to regular CBT (short weekly sessions for several months). This meta-analysis examined whether intensive CBT is superior to regular CBT in patients with anxiety disorders and OCD in reducing anxiety, obsessive-compulsive (OC) and comorbid depressive symptoms, and in reducing dropout. A systematic literature search was performed in PubMed, PsycINFO and Embase in which words indicative of an anxiety disorder or OCD were combined with intensive treatment and CBT. We identified 5012 unique studies. Two randomised controlled trials (RCTs) and four non-RCTs were included, pertaining to 393 subjects. Intensive CBT and regular CBT did not statistically differ in reducing anxiety or OC symptoms from pre- to post-treatment and from post-treatment to follow-up. However, intensive CBT was significantly better in reducing depressive symptoms from pre- to post-treatment ( g = 0.25; 95% CI: (0.04, 0.45)). Dropout was only reported in two studies and could thus not be meta-analysed. The included studies were limited in number and quality. High-quality RCTs are needed to assess both effectivity and feasibility of intensive CBT. Meanwhile, intensive CBT might be preferable for patients with comorbid depression or for those needing fast improvement, due to its shorter lead time.

Vajinismus Tedavisinde Hipnoterapi ve Bilişsel Davranışçı Terapi Etkinliğinin Karşılaştırılması

Objective: This study compared the therapeutic effectiveness of hypnotherapy and cognitive behavioral therapy in patients with primary vaginismus previously assessed by a psychiatrist and a gynecologist&#x0D; Methods: We performed as a single-center, cross-sectional study in 35 patients with primary vaginismus&#x0D; Results: Successful coitus was achieved by 19 (95%) individuals in the hypnotherapy group and by 14 (93.3%) members of the cognitive behavioral therapy group. These success rates were similar (p=0.681). The mean number of sessions until successful coitus was significantly lower in the hypnotherapy group (p=0.000).&#x0D; Conclusions: hypnotherapy and cognitive behavioral therapy can be applied with similar high success rates in the treatment of vaginismus. However, success may be achieved with fewer sessions with hypnotherapy.

Performance Validity and Outcome of Cognitive Behavior Therapy in Patients with Chronic Fatigue Syndrome

There is limited research examining the impact of the validity of cognitive test performance on treatment outcome. All known studies to date have operationalized performance validity dichotomously, leading to the loss of predictive information. Using the range of scores on a performance validity test (PVT), we hypothesized that lower performance at baseline was related to a worse treatment outcome following cognitive behavioral therapy (CBT) in patients with Chronic Fatigue Syndrome (CFS) and to lower adherence to treatment. Archival data of 1081 outpatients treated with CBT for CFS were used in this study. At baseline, all patients were assessed with a PVT, the Amsterdam Short-Term Memory test (ASTM). Questionnaires assessing fatigue, physical disabilities, psychological distress, and level of functional impairment were administered before and after CBT. Our main hypothesis was not confirmed: the total ASTM score was not significantly associated with outcomes at follow-up. However, patients with a missing follow-up assessment had a lower ASTM performance at baseline, reported higher levels of physical limitations, and completed fewer therapy sessions. CFS patients who scored low on the ASTM during baseline assessment are more likely to complete fewer therapy sessions and not to complete follow-up assessment, indicative of limited adherence to treatment. However, if these patients were retained in the intervention, their response to CBT for CFS was comparable with subjects who score high on the ASTM. This finding calls for more research to better understand the impact of performance validity on engagement with treatment and outcomes.