Cognitive-behavioral Coping Skills Training Research Articles

Hybrid-delivered cognitive behavioral symptom management and activity coaching intervention for patients undergoing hematopoietic stem cell transplant: Findings from intervention development and a pilot randomized trial

Objective Develop and pilot test a mobile health (mHealth) cognitive behavioral coping skills training and activity coaching protocol (HCT Symptoms and Steps) for hematopoietic stem cell transplant (HCT) patients. Design Two-phase, mixed methods study. Sample HCT patients and healthcare providers. Methods Phase I was patient (n = 5) and provider (n = 1) focus groups and user testing (N = 5) to develop the HCT Symptoms and Steps protocol. Phase II was a pilot randomized trial (N = 40) to evaluate feasibility, acceptability, and pre-to-post outcomes (e.g., physical disability, pain, fatigue, distress, physical activity, symptom self-efficacy) compared to an education control. Findings Qualitative feedback on symptoms, recruitment strategies, coping skills, and mHealth components (e.g., Fitbit, mobile app) were integrated into the protocol. HCT Symptoms and Steps were feasible and acceptable. Pre-post changes suggest physical disability and activity improved while symptoms (e.g., fatigue, distress) decreased. Conclusions HCT Symptoms and Steps have strong feasibility and acceptability and shows promise for benefits. Larger, fully-powered randomized trials are needed to examine intervention efficacy. Implications HCT Symptoms and Steps may reduce physical disability and improve health outcomes post-transplant. Clinical Trial Registration Number NCT03859765

The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial.

Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months. The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.

Determinants of Pain Treatment Response and Nonresponse: Identification of TMD Patient Subgroups

The purpose of the present study was to determine if we could identify a specific subtype of temporomandibular disorder (TMD) pain patients that does not respond to treatment. Patients were 101 men and women with chronic TMD pain recruited from the community and randomly assigned to 1 of 2 treatment conditions: a standard conservative care (STD) condition or a standard care plus cognitive-behavioral therapy condition (STD + CBT) in which patients received all elements of STD but also received cognitive-behavioral coping skills training. Growth mixture modeling, incorporating a series of treatment-related predictors, was used to distinguish several distinct classes of responders or nonresponders to treatment based on reported pain over a 1-year follow-up period. Results indicated that treatment nonresponders accounted for 16% of the sample and did not differ from treatment responders on demographics or temporomandibular joint pathology, but that they reported more psychiatric symptoms, poorer coping, and higher levels of catastrophizing. Treatment-related predictors of membership in treatment responder groups versus the nonresponder group included the addition of CBT to STD, treatment attendance, and decreasing catastrophization. It was concluded that CBT may be made more efficacious for TMD patients by placing further emphasis on decreasing catastrophization and on individualizing care. PerspectiveThis article provides evidence that the TMD chronic pain population is heterogeneous and that a subsample of patients will be unresponsive to standard or psychosocial approaches. The addition of CBT to treatment may be helpful for this group, but new individualized approaches will be needed to treat all patients effectively.

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: Cochrane Reviewa

BackgroundProblem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts progression to hepatic cirrhosis or opiate overdose in opioid users. The aim of this systematic review was to assess the effects of psychosocial interventions for problem alcohol use in adult illicit drug users with concurrent problem alcohol use (principally, problem drug users of opiates and stimulants).MethodsWe searched the following databases (November 2011): Cochrane Library, PUBMED, EMBASE, CINAHL, PsycINFO and reference list of articles. We also searched conference proceedings and online registers of clinical trials. Two reviewers independently assessed risk of bias and extracted data from included randomized controlled trials.ResultsFour studies (594 participants) were included in this review. Half of the trials were rated as having a high or unclear risk of bias. The four studies considered six different psychosocial interventions grouped into four comparisons: 1) cognitive-behavioral coping skills training versus 12-step facilitation (N = 41), 2) brief intervention versus treatment as usual (N = 110), 3) hepatitis health promotion versus motivational interviewing (N = 256), and 4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually. Most findings were not statistically significant except for comparison 2: decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment-as-usual group and comparison 4: reduced alcohol use in the brief motivational intervention (RR 1.67; 95% CI 1.08 to 2.60).ConclusionsNo conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.

Coping skills training and contingency management treatments for marijuana dependence: exploring mechanisms of behavior change

Achieving abstinence in the treatment of marijuana dependence has been difficult. To date the most successful treatments have included combinations of motivation enhancement treatment (MET) plus cognitive-behavioral coping skills training (CBT) and/or contingency management (ContM) approaches. Although these treatment approaches are theoretically based, their mechanisms of action have not been explored fully. The purpose of the present study was to explore mechanisms of behavior change from a marijuana treatment trial in which CBT and ContM were evaluated separately and in combination. A dismantling design was used in the context of a randomized clinical trial. The setting was an out-patient treatment research facility located in a university medical center. Participants were 240 adult marijuana smokers, meeting criteria for cannabis dependence. Participants were assigned to one of four 9-week treatment conditions: a case management control condition, MET/CBT coping skills training, ContM and MET/CBT + ContM. Outcome measures were total 90-day abstinence, recorded every 90 days for 12 months post-treatment. Regardless of treatment condition, abstinence in near-term follow-ups was predicted most clearly by abstinence during treatment, but long-term abstinence was predicted by use of coping skills and especially by post-treatment self-efficacy for abstinence. It was concluded that the most efficacious treatments for marijuana dependence are likely to be those that increase self-efficacy.

Expanding Health Educators' Roles to Meet Critical Needs in Stress Management and Mental Health

Stress and stress-related mental disorders in the United States are widespread, costly, and largely preventable. This article describes the association between stress and maladaptive coping and stress-related mental disorders, the severity of the problems due to stress and stress-related mental disorders, and the need for primary preventive efforts which teach coping skills. It is asserted that health educators are uniquely situated to provide such preventive efforts, and are critically needed. Finally, specific recommendations are given for providing cognitive-behavioral coping skills training and providing critically needed information to consumers regarding the recognition and treatment of stress-related mental disorders.

Changes in premenstrual symptoms and irrational thinking following cognitive-behavioral coping skills training.

Changes in premenstrual symptoms and irrational thinking following cognitive-behavioral coping skills training.

Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial

Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: 1. (1) hypnosis training (HYP); 2. (2) cognitive behavioral coping skills training (CB); 3. (3) therapist contact control (TC); or 4. (4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. Biodemographic variables included gender, age and a risk variable based on diagnosis and number of remissions or relapses. Patients in the HYP, CB and TC groups met with a clinical psychologist for two pre-transplant training sessions and ten in-hospital “booster” sessions during the course of transplantation. Forty-five patients completed the study and provided all covariate data, and 80% of the time series outcome data. Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation. Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured.

Effects of coping skills training on generalized self-efficacy and locus of control.

A number of studies have shown that mastery experiences strengthen self-efficacy expectancies that are specific to the mastery situation. In this study I assessed the effects of cognitive-behavioral coping skills training on generalized expectancies concerning self-efficacy and locus of control in test-anxious college students. Compared with a waiting-list control group, the trained subjects exhibited significant decreases on trait and state measures of test anxiety and a higher level of academic performance on classroom tests, as well as changes in specific self-efficacy expectancies relating to test-anxiety management and academic performance. Consistent with generalization predictions derived from self-efficacy theory, the coping skills group also exhibited decreases in general trait anxiety and increased scores on a trait measure of generalized self-efficacy. Locus of control was unaffected by the program, and changes in general self-efficacy were unrelated to changes in locus of control, suggesting the possibility that different parameters of experience are related to changes in the two types of generalized expectancies.

Social work and the treatment of chronic pain.

The severity and prevalence of chronic pain is a growing concern for all health care professionals. An outpatient program that offered cognitive-behavioral coping skills training in a group setting was studied as a possible social work treatment for chronic pain patients, and the results were encouraging. Such treatments usually are available only in hospital pain clinics and research centers, which reduce treatment availability to patients in other settings. Social workers could provide services in a wider variety of settings to a large and growing population. As social workers realize the continuous interplay of physical, emotional, and cognitive factors in the experience of pain, they will identify appropriate practice roles for working with chronic pain patients.

A School-Based Approach to Stress Management Education of Students

Stress in children and adolescents has been linked to a variety of physical and emotional problems as well as to poor school performance. Because of these negative effects, school-based special services providers need to implement stress management education programs it optimal learning and development are to occur. Behavioral and cognitive-behavioral coping skills training have been effective in helping students deal with school-related stressors. An approach for stress management education is presented which addresses curriculum content, target trainees, environmental supports, and identification of trainers.