CBT Components Research Articles

Early reduction in anxiety sensitivity predicts greater reduction in disordered eating and trait anxiety during treatment for bulimia nervosa.

Anxiety sensitivity (AS), the trait-like fear of symptoms of anxiety, has been associated with eating disorder (ED) pathology broadly, bulimia nervosa (BN) symptoms specifically, and the anxiety disorders that are commonly comorbid with BN. AS, especially for physical symptoms specifically, maybe a risk and maintenance factor for BN and comorbid anxiety. Adult participants with BN (n = 44) in a clinical trial comparing CBT to mindfulness and acceptance-based treatment (MABT) reported ED symptoms, trait anxiety, and AS through treatment and follow-up. We predicted that greater early reduction (i.e., within the first month of treatment) in AS would predict greater reductions in ED symptoms and trait anxiety at post-treatment and follow-up. Early reductions in AS for physical concerns predicted lower ED symptoms and trait anxiety at post-treatment but not follow-up. Exploratory analyses indicated that treatment groups did not differ in either early or total change in AS, controlling for baseline AS. Early reductions in AS may be an important treatment target for BN, and may additionally support reductions in anxiety. Future research should identify which components of CBT and MABT best target AS, to deliver these components early in treatment, when they can have maximum effect. Anxiety sensitivity, the fear of symptoms of anxiety, is associated with eating disorders (ED). In this study, participants in treatment for bulimia nervosa reported ED symptoms, trait anxiety, and anxiety sensitivity through treatment and follow-up. Greater early reductions in anxiety sensitivity predicted lower ED symptoms and trait anxiety at post-treatment. Future research should identify which elements of treatment best target anxiety sensitivity, to deliver them early in treatment.

P058 Dissecting Sleep Restriction: Defining and Empirically testing a two-stage Build-Maintain model of Sleep Restriction Therapy for Insomnia

Abstract Introduction Sleep Restriction Therapy (SRT) is one of the core components of CBT for Insomnia (CBT-I). However, there is little empirical evidence regarding how SRT implementation evolves over the course of therapy. Here, we propose a conceptual model for defining stages of SRT and assess the applicability of the model in a recently completed clinical trial. Methods Our proposed two-stage Build-Maintain model of SRT is: 1) The Build stage starts with SRT implementation. The primary goal is building homeostatic pressure until average weekly sleep efficiency (SE) is high enough to increase time-in-bed (e.g., 85% or 90%). 2) The Maintain stage starts with the first increase of time-in-bed after the target SE is reached. The goal is to maintain sleep pressure sufficiently high that one can maintain SE in the desired range. We assessed the model in 83 adults (age=48.3±14.8 years; 50F) undergoing CBT-I in a RCT. SRT was introduced in week 2. We explored the extent to which age, sex, psychiatric comorbidities, use of hypnotics, and baseline insomnia severity predicted progression through the SRT stages. Results Participants were in the Build stage 2.1±1.3 weeks (41.8% were in Build for only one week; 84% for ≤3 weeks). Higher baseline ISI (r=.238,p=.036) and lower baseline SE (r=-.365,p=.001) predicted spending more weeks in the Build stage before transitioning to the Maintain stage. Discussion The two-stage Build-Maintain model of SRT may inform: a) setting empirically-based expectations for client progress; b) examining adherence to CBT-I; c) evaluating shortened versions of CBT-I.

Multilevel associations of emotion regulation strategy use during psychotherapy for depression: A longitudinal study

BackgroundPeople with depression select avoidant emotion regulation (ER) strategies more often than engagement strategies. While psychotherapy improves ER strategies, examining the week-to-week changes in ER and their relationship to clinical outcomes is warranted to understand how these interventions work. This study examined the changes in six ER strategies and depressive symptoms during virtual psychotherapy. MethodsTreatment-seeking adults (N = 56) with moderate depression severity completed a baseline diagnostic interview and questionnaires and were followed for up to 3 months as they completed virtual psychotherapy in an unrestricted format (e.g., individual) and orientation (e.g., cognitive-behavioral therapy; CBT). Participants completed weekly assessments of depression and six ER strategies along with assessments of CBT skills and participant-rated CBT components for each psychotherapy session. Multilevel modeling was used to examine associations between within-person changes in ER strategy use and weekly depression scores, controlling for between-person effects and time. ResultsDepressive symptoms, rumination, and experiential avoidance decreased non-linearly over time while cognitive reappraisal and acceptance increased non-linearly. Controlling for CBT skills, within-person increases in acceptance and cognitive reappraisal, as well as within-person decreases in experiential avoidance, were associated with fewer depressive symptoms over time. People who reported greater CBT components in their sessions also reported fewer depressive symptoms over time. LimitationsThe study was unable to make more causal inferences or standardize the type, baseline, or length of psychotherapy received. ConclusionsImprovements in ER strategies were associated with depression symptom reduction during psychotherapy. Future research to elucidate ER strategies as mediators of treatment response is warranted.

Dismantling cognitive–behavioural therapy components for attention-deficit hyperactivity disorder in adolescents and adults: protocol for a network meta-analysis

IntroductionCognitive–behavioural therapy (CBT) consists of multiple treatment techniques for each treatment model and is tailored to the patient’s characteristics. Randomised controlled trials (RCTs) have reported that CBT is effective for...

Early intervention in post-traumatic stress disorder without exposure to trauma memories using internet-delivered cognitive therapy: A pilot case series.

Trauma-focussed psychological interventions are the treatments of choice for post-traumatic stress disorder (PTSD). As many clinical services receive high demand for PTSD interventions, strategies to improve treatment efficiency are needed. Some people seek help in the early phase post-trauma, including as soon as the first few months. It is unclear whether all components of trauma-focussed CBT are needed in this initial stage. Providing brief intervention in this early phase without work on trauma memories may be feasible and effective. This service evaluation study describes a case series of five participants experiencing PTSD following recent traumas. Participants completed a shortened 6-week form of Internet-delivered Cognitive Therapy for PTSD (iCT-PTSD), which used fewer treatment modules and focussed primarily on psychoeducation about PTSD, and two key treatment components, 'reclaiming your life' and trigger discrimination. Unlike the full course of iCT-PTSD, this format did not include working directly with trauma memories. The intervention was associated with large reductions in symptoms of PTSD, depression and anxiety at the 6-week timepoint, which were maintained at 3-month follow-up. Scores on the composite PTSD measure showed an average reduction of 91% between baseline and end of follow-up. One client required an extension to the weekly phase of treatment and received further treatment modules. All were discharged after follow-up and did not require further treatment. The findings provide preliminary evidence that this briefer format of iCT-PTSD was of benefit for those seeking support following recent traumas. Further examination in a larger controlled study is required.

Mindfulness-Based Pain Management (MBPM) for Chronic Pain: a Randomized Clinical Trial

ObjectivesChronic pain affects 1 in 5 Europeans, with a prevalence in Spain of 11%. It is one of the main causes of medical consultation and is associated with high personal, social, and economic costs with diverse psychological repercussions. Several studies have shown the effectiveness of psychological therapies in the treatment of chronic pain, including mindfulness-based therapies. In this regard, mindfulness-based pain management (MBPM) has evidenced significant positive changes in patients with chronic pain, but so far, no RCT study has been conducted. Therefore, the main purpose of this study is to explore the results of the MBPM program with chronic pain patients. Additionally, we will analyze the differential efficacy of the MBPM program on fibromyalgia versus non-fibromyalgia chronic pain patients.MethodsNinety patients with chronic pain were randomized to experimental group MBPM (50 patients) and wait-list control group (40 patients) and assessed at pre- and post-treatment in demographic and pain-related variables, psychopathological symptoms, cognitive variables, resilience, and quality of life.ResultsFindings showed moderate to large effects in favor of the experimental group in pain management and acceptance, use of analgesics, psychopathological symptoms, general negative thoughts, self-blame, mental-health-related quality of life, and resilience. Non-fibromyalgia chronic pain patients benefited significantly more than participants with fibromyalgia.ConclusionsThe positive impact of the MBPM program on critical variables related to chronic pain provides evidence of its efficacy, which could be enhanced with the inclusion of complementary therapeutic CBT components to address sleep problems, need for control, and rumination.Trial RegistrationClinicalTrials.gov (NCT03992612).

Reducing Anxiety and Stress among Youth in a CBT-Based Equine-Assisted Adaptive Riding Program.

Simple SummaryReining in Anxiety (RiA) is a therapeutic program for youth with mild-to-moderate anxiety delivered in a therapeutic riding setting by Certified Therapeutic Riding Instructors. RiA is based on five foundational components of Cognitive Behavioral Therapy (CBT): in vivo exposure, cognitive restructuring, youth psychoeducation, relaxation, and caregiver psychoeducation about anxiety. The intervention sought to support youth between the ages of 6–17 with self-identified anxiety. Due to global pandemic trauma, in the second iteration of the protocol, researchers also included two evidence-based trauma components: maintenance and personal safety skills. All instructors were trained in the RiA curriculum and delivered the same lessons. In addition to assessing the youth’s perception and changes over time, the researchers also assessed changes in the horses, both through saliva sampling. The authors learned that RiA may be a promising approach for reducing anxiety and stress among youth and that the intervention can be delivered by adaptive/therapeutic horseback riding instructors in a non-clinic setting.Reining in Anxiety (RiA) is a therapeutic program for youth with mild to moderate anxiety delivered in a therapeutic riding setting by Certified Therapeutic Riding Instructors. RiA was developed after a review of the evidence base for youth anxiety, is manualized, and includes five core CBT components: in vivo exposure, cognitive restructuring, youth psychoeducation, relaxation, and caregiver psychoeducation about anxiety. This study extended findings from a prior RCT that examined (1) the feasibility of collecting saliva samples from horses and children to measure stress (cortisol) and relaxation (oxytocin); (2) whether changes in stress and relaxation occurred both during each lesson and over the course of the 10-week intervention for horses and youth; (3) whether changes in anxiety symptoms, emotional regulation, and self-efficacy found in the first trial were comparable; and (4) if fidelity to the program was reliable. Youth participants (n = 39) ages 6–17 with caregiver-identified mild-to-moderate anxiety participated in a ten-week therapeutic intervention (RiA), which combined adaptive riding and components of CBT. Physiological data and self-report measures were taken at weeks one, four, seven, and ten for the youth and horses. Saliva assays assessed cortisol as a physiological marker of stress and anxiety, and oxytocin as a measure of relaxation. Fidelity data were recorded per session. Anxiety, as measured by caregiver self-reporting, significantly decreased from pre- to post-test, while emotional regulation scores increased. No significant changes in self-efficacy from pre- to post-test were observed. Saliva samples obtained from participants before and after riding sessions showed a consistent decrease in cortisol and a significant increase in oxytocin at two of the four timepoints (Week 1 and Week 7), but no overall pre- to post-test changes. Horse saliva data were collected using a modified bit; there were no significant changes in oxytocin or cortisol, suggesting that the horses did not have an increase in stress from the intervention. RiA may be a promising approach for reducing anxiety and stress among youth, as measured both by self-reported and by physiological measures. Collection of salivary assays for both youth and horses is feasible, and the intervention does not increase stress in the horses. Importantly, RiA can be delivered by adaptive/therapeutic horseback riding instructors in naturalistic (e.g., non-clinic-based) settings. As youth anxiety is a growing public health problem, novel interventions, such as RiA, that can be delivered naturalistically may have the potential to reach more youth and thus improve their quality of life. Further research is needed to examine the comparative value of RiA with other animal-assisted interventions and to assess its cost-effectiveness.

24.3 CBT FOR CHILDHOOD SEXUAL ABUSE: EVIDENCE-BASED APPROACHES

CBT is the gold standard treatment for many psychological problems, including PTSD symptoms resulting from childhood sexual abuse. Trauma-focused CBT and CBT for problematic sexual behavior in youth are classified as evidence-based therapies (EBT) for childhood sexual abuse and have been shown to have significant positive impacts on children and their families. However, as clinicians and referral sources, it is important to understand the similarities and differences between the 2 approaches in order to provide families with the most appropriate services. This presentation will introduce participants to the theory, outcome data, and major components of trauma-focused CBT and CBT for problematic sexual behavior in youth. While it is important to utilize evidence-based approaches, it is also important to select the most appropriate course of therapy for the individual child and family. As such, participants will compare and contrast trauma-focused CBT and CBT for problematic sexual behavior in youth. Case studies will be used to illustrate appropriate treatment selection and referral. Participants will become familiar with the development, outcome data, and components of 2 cognitive behavioral treatments for childhood sexual abuse. Case studies will illustrate important similarities and differences between the 2 approaches so that participants will be able to determine the most appropriate course of therapy based on symptom presentation. It should be understood that some therapy interventions for abused children and their families must be sequenced and prioritized by the providing clinician. Consulting with your referral source and making a collaborative decision that involves the provider, the child, and the family likely will result in greater engagement and completion of therapy, even those that are evidence-based.

Bleuler revisited: on persecutory delusions and their resistance to therapy

Bleuler revisited: on persecutory delusions and their resistance to therapy

Integrating internet CBT into clinical practice: a practical guide for clinicians

ABSTRACT Objective: This paper offers clinical insights and practical guidelines for clinicians about how internet-delivered cognitive behaviour therapy (iCBT) can be safely and effectively integrated into routine psychological therapy practice, in a 'blended' care model. Method: For over a decade, the Clinical Research Unit for Anxiety and Depression (CRUfAD) has developed, tested, and disseminated iCBT programs for anxiety and depression, into routine care settings. This paper outlines examples of the available iCBT options for clinicians and details the advantages of integrating iCBT for anxiety and/or depression into psychological practice. We address common barriers to using iCBT, offer practical solutions based on our research and clinical experience, and present the lived experiences of ‘real-world’ clinicians using iCBT in their private practises and specialist clinics. Considerations associated with risk management, funding arrangements, and flexible models of care (e.g., stepped, blended and adjunct care) are discussed. Results: Flexible and judicious use of iCBT in our outpatient routine care clinic has reduced treatment waitlists and enabled clinicians to dedicate more time to sophisticated therapeutic interventions (e.g., experiential work) and to support clients with complex needs. Conclusion: iCBT can be safely and effectively integrated into routine psychological practice, and enhance client care. KEY POINTS What is already known about this topic: (1) Internet cognitive behavioural therapy (iCBT) is effective for treating anxiety and depression. (2) iCBT includes psychoeducation and core CBT components (e.g., thought challenging) delivered over the internet. (3) To date, most iCBT programs have been used as stand-alone interventions, either as self-help or under guidance from a clinician. What this paper adds: (1) Outlines examples of iCBT options, their advantages and disadvantages, indications and contraindications. (2) Outlines a variety of ways to integrate iCBT into routine clinical practice settings, including prequel to therapy, as an adjunct, and relapse prevention tool. (3) Offers practical solutions to address common barriers and concerns to using iCBT in routine practice.

Knowledge gain and usage of knowledge learned during internet-based CBT treatment for adolescent depression - a qualitative study

BackgroundThe role of explicit learning of treatment content in internet-based cognitive-behavioural treatment (ICBT) is an emerging field of research. The objective of this study was to explore clients experiences of their ICBT treatment for depression with a focus on knowledge gain and usage of knowledge learned during treatment.MethodsA strategic sample of ten adolescents, aged between 15 and 19 years, who had received ICBT for major depression within a clinical controlled trial were recruited for the study. Semi-structured interviews were conducted 6 months following trial completion. Data were transcribed and analysed using thematic analysis. The participants had a general adherence rate of 6–8 opened modules out of 8 possible.ResultsTwo main themes were identified; “Active agents of CBT” and “Passive agents of CBT”, with each theme consisting of three and two sub-themes. Active agents of CBT reflect a tendency to specifically remember and actively apply specific CBT principles in present life situations. Passive agents of CBT reflect a tendency to remember CBT treatment principles vaguely and express a passive or reactive usage of learned therapy content.ConclusionThe findings suggest that young clients can remember and apply CBT principles 6 months after their treatment. However, while experiencing benefits of treatment, clients recall and application of treatment strategies vary. The study emphasizes the importance of exploring client recall of CBT components and how valuable it is to explicitly remember contents of a treatment in order to improve and maintain improvement. Further studies on the role of knowledge and memory of ICBT for adolescent populations are warranted.

Examination of the Influence of Cognitive Behavior Therapy Components, Consumer Satisfaction and Engagement in Mothers Referred for Drug Abuse and Child Neglect on Treatment Outcomes.

Psychological interventions for child maltreatment have predominately been limited to family-supported, multi-component behavioral therapies. Although these comprehensive programs have resulted in positive outcomes, they are relatively costly and there is limited information available as to how the components of these programs influence treatment outcomes. In this study, the CBT components of an evidence-based treatment for child neglect and drug abuse (Family Behavior Therapy) were examined in regards to consumer preferences, consumer engagement and treatment outcomes. Thirty-five mothers identified for child neglect and drug abuse were administered various CBT components successively and cumulatively based on their preferences. Repeated measure ANOVAs indicated that participants chose to receive components that were specific to managing antecedents to drug abuse and child neglect most frequently, followed by parenting skills training, communication skills training, and job/financial skills training. No differences were found in treatment providers' ratings of the participants' engagement across intervention components throughout treatment. Participants rated the intervention components as similarly helpful. Partial correlations revealed that participants' ratings of helpfulness and provider ratings of participants' engagement were not associated with improved drug use outcomes at 6- and 10-months post baseline. Participants' ratings of helpfulness were associated with child maltreatment outcomes at 10-month post baseline, and provider ratings of participants' engagement were associated with child maltreatment outcomes at both 6- and 10-month post baseline. Participants identified for neglect not related to drug exposure in utero improved at a higher percentage than did participants identified for in utero drug exposure, and receiving behavioral intervention components more frequently led to greater percentages of participants improving in both drug use and child maltreatment outcomes.

Variability in clinician intentions to implement specific cognitive-behavioral therapy components

BackgroundCBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depression, and clients with anxiety.MethodsClinicians (n = 107) trained in CBT completed a one-time electronic survey. Clinicians’ intentions were measured using established item stems from social psychology adapted to examine intentions to use six specific CBT components: exposure therapy, cognitive restructuring, behavioral activation, planning homework, reviewing homework, and agenda-setting.ResultsIntentions were weakest, on average, for exposure. They were strongest, on average, for reviewing homework. A series of ANOVAs with Tukey’s post-hoc tests revealed that participants intended to use exposure with clients receiving CBT (p = .015) and clients with anxiety (p < .001) significantly more than for clients with depression. Participants intended to use behavioral activation with clients with depression (p = .01) significantly more than for clients with anxiety. No other intentions to use CBT components differed among these three clinical populations.ConclusionsWhen studying determinants of CBT use and designing interventions to increase use, implementers should consider that different CBT components may require different implementation strategies.Trial registrationNot applicable.

Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis

BackgroundCognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects. MethodsA systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT. ResultsWe included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term. ConclusionsThere is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.

Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis.

Cognitive-behaviour therapy (CBT) for panic disorder may consist of different combinations of several therapeutic components such as relaxation, breathing retraining, cognitive restructuring, interoceptive exposure and/or in vivo exposure. It is therefore important both theoretically and clinically to examine whether specific components of CBT or their combinations are superior to others in the treatment of panic disorder. Component network meta-analysis (NMA) is an extension of standard NMA that can be used to disentangle the treatment effects of different components included in composite interventions. We searched MEDLINE, EMBASE, PsycINFO and Cochrane Central, with supplementary searches of reference lists and clinical trial registries, for all randomized controlled trials comparing different CBT-based psychological therapies for panic disorder with each other or with control interventions. We applied component NMA to disentangle the treatment effects of different components included in these interventions. After reviewing 2526 references, we included 72 studies with 4064 participants. Interoceptive exposure and face-to-face setting were associated with better treatment efficacy and acceptability. Muscle relaxation and virtual-reality exposure were associated with significantly lower efficacy. Components such as breathing retraining and in vivo exposure appeared to improve treatment acceptability while having small effects on efficacy. The comparison of the most v. the least efficacious combination, both of which may be provided as 'evidence-based CBT,' yielded an odds ratio for the remission of 7.69 (95% credible interval: 1.75 to 33.33). Effective CBT packages for panic disorder would include face-to-face and interoceptive exposure components, while excluding muscle relaxation and virtual-reality exposure.

Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change.

Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

Effects of Group Functional Behavior-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Behavior in a Youth With Autism Spectrum Disorder

ABSTRACTIndividuals with Autism Spectrum Disorder (ASD) often present with comorbid Obsessive Compulsive Behaviors (OCBs), but little research exists on effective intervention for OCBs. Using a single-case experimental design, this study highlights the efficacy of a Group Functional Behavior-based Cognitive-Behavior Therapy (Fb-CBT) to reduce OCBs in an 11-year-old youth with ASD. Tailored to the individual needs of this youth, Fb-CBT included traditional CBT components (e.g., psychoeducation, cognitive-behavioral skills training, and exposure and response prevention) coupled with functional behavior assessment and intervention. Time-series parent report data and standardized measures showed clinically significant decreases in OCBs, an increase in psychosocial functioning, and high consumer satisfaction.

Efficacy of a Transdiagnostic internet-based treatment for emotional disorders with a specific component to address positive affect: Study protocol for a randomized controlled trial

BackgroundEmotional disorders (ED) are among the most prevalent mental disorders. However, less than 50% of people suffering from ED receive the appropriate treatment. This situation has led to the development of new intervention proposals based on the transdiagnostic perspective, which tries to address the underlying processes common to ED. Most of these programs focus primarily on down-regulating negative affectivity, rather than increasing strengths and up-regulating positive affectivity. The data suggest the existence of disturbances in positive affectivity in these disorders, and so new interventions focusing on these problems are greatly needed. It is also essential to provide assistance to all the people in need. Information and Communication Technologies can be very useful. This study aims to evaluate the efficacy of a transdiagnostic Internet-based treatment for ED in a community sample. The protocol includes traditional CBT components, as well as a specific component to address positive affect. We intend to test this protocol, including this specific component or not, versus a waiting list control group. Moreover, we aim to test the differential effect of this specific component, and study the effectiveness (in terms of patients’ acceptance) of using a self-applied Internet-based program. This paper presents the study protocol.MethodsThe study is a randomized controlled trial. 207 participants will be randomly assigned to: a)Transdiagnostic Internet-based protocol (TIBP), b)Transdiagnostic Internet-based protocol + positive affect component (TIBP + PA), or c)a Waiting List control group (WL). Primary outcomes measures will be the BDI-II, the BAI, and the PANAS. Secondary outcomes will include diagnosis-specific measures of the principal disorder. Participants’ treatment acceptance will also be measured. Participants will be assessed at pre-, post-treatment, and 3- and 12- month follow-ups. The data will be analyzed based on the Intention-to-treat principle. Per protocol analyses will also be performed.DiscussionTo the best of our knowledge, this is the first study of a transdiagnostic Internet-based treatment for ED with a specific component to up-regulate positive affectivity. This intervention could contribute to improve the efficiency and effectiveness of current treatment programs for ED, promote the dissemination of EBTs, and help to decrease the high prevalence of ED.Trial registrationClinicalTrial.gov: NCT02578758. Registered 15 October 2015.

Therapist-guided internet-based cognitive-behavioural therapy for adult obsessive-compulsive disorder: A meta-analysis

IntroductionCognitive-behavioural therapy (CBT) is the first-line psychological treatment for obsessive-compulsive disorder (OCD). However, most individuals suffering from OCD do not receive CBT. An innovative approach to improve access to evidence-based care is the use of the Internet to deliver effective treatments. Therapist-guided Internet-based cognitive-behavioural therapy (iCBT) involves the administration of structured online lessons that provide the same information and skills typically taught in clinician-administered CBT, often with email support from a therapist. Accumulating evidence on iCBT for OCD has been produced, but a meta-analysis has not been conducted.ObjectivesThrough meta-analytic methods, the present study summarized evidence on iCBT for OCD.AimsEfficacy on OCD symptoms and comorbid depression versus control conditions at post-treatment and follow-up was evaluated.MethodsA PRISMA meta-analysis was performed on randomized controlled trials. Treatments were classified as iCBT if they included CBT components for OCD (eg, exposure and response prevention) delivered through the Internet with or without email/phone support from a therapist.ResultsFour trials were included (n = 238), which were classified at low bias risk. At post-treatment iCBT outperformed control conditions with a high effect size on OCD symptoms (d = 0.85, P&lt;.05) and a medium on comorbid depression (d = 0.52, P&lt;.05). Treatment effects were stable at 4-month follow-up with a high effect size on OCD (d = 1.45, P&lt;.05), but not on comorbid depression (d = 0.33, P&lt;.05).ConclusionsiCBT seems a promising treatment modality for OCD. Further trials should assess log-term outcomes and effects on quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Patients' experiences of a behavioural intervention for migraine headache: a qualitative study.

BackgroundMigraine headache has a high prevalence and a severe impact on personal, social and work life, forming a significant burden on patients, service providers and society. There is some evidence of the effectiveness of behavioural interventions to supplement drug therapy but a recognised need to identify an effective minimal contact approach to enhance access and provide a model for use in publicly funded health systems. This study uses in-depth interviews to examine patients’ experience and responses to a behavioural intervention with relaxation and CBT components delivered in three individual therapist sessions with follow-up.MethodsQualitative study of 20 adults aged 18–75 years in London, UK, with clinically diagnosed migraine and at least four headache days per month. Semi-structured and tape recorded interviews were held post intervention based on a topic guide. Transcripts were coded and charted for all participants and analysed thematically.ResultsThe majority of participants cited the impacts of migraine and a desire for additional non-drug treatment as their main reasons for taking part and almost all completed the course. They valued contact with the therapist and almost all reported benefiting from the therapy. Post intervention they used those techniques they found most beneficial and implemented them flexibly in their daily life to reduce stress and risks of migraine or to respond to migraine. Relaxation training (deep breathing) was easily adopted and often used post intervention. The CBT components were mainly viewed positively but regarded as more challenging to learn and implement.ConclusionsPatients’ selectively identified and employed the techniques learned as ‘tools’ to assist in preventing and managing their migraines, with reported benefits supporting the development of minimal contact behavioural therapy to increase accessibility for adults with migraine headache and the conduct of a definitive trial.