Cognitive-behavioral Skills Research Articles

Understanding female survivors of interpersonal trauma and their experience of the ‘Survive & Thrive’ course

The majority of publications have concentrated on individual psychological interventions with a limited focus on manualized group-based approaches for those presenting with mental health difficulties following a history of trauma. Survive & Thrive (S&T) is a psychoeducational course designed for survivors of interpersonal trauma which utilizes cognitive behavioural skills training while delivering psychoeducation on how a history of victimization can impact on the survivors’ life. This qualitative study was designed to gain an insight into female survivors of interpersonal trauma experience of S&T and the associated group dynamics component to evaluate this psychological intervention. The participants described their experience of S&T as a journey towards recovery. The study highlights the benefits of group-based interventions in regard to learning experience within a social context whilst also identifying areas for further development based on the participants’ feedback.

The impacts of Abecedarian and Head Start on educational attainment: Reasoning about unobserved mechanisms from temporal patterns of indirect effects

Mechanisms translating initial impacts of early childhood education (ECE) programs into longer-term effects are poorly understood. This article posits that the temporality of unobserved mediated effects are integral to our understanding of the pathways underlying ECE programs’ long-term impacts. Leveraging panel data, we examined the patterns of indirect effects from two ECE programs on educational attainment via bundled mediators measured at age 8 or 10, 12, and 15 (the Abecedarian Project: N =107; 97% Black; 3% White; 52% girls. Head Start: N = 1,251; 44% Black; 25% Hispanic; 31% White; 50% girls). Accounting for up to 50% of the impact, indirect effects in both studies revealed stable patterns of direct effects, suggesting that impacts on unmeasured mediators were present throughout the duration of the period after the end of ECE programs and before later outcomes were observed. These findings indicate that some of the mechanisms involved in Abecedarian's and Head Start's long-term impacts were substantial and independent from those typically captured by commonly used measures of cognitive and socioemotional or behavioral skills, which points to the need for new approaches to studying child-environment transactions.

THE STRUCTURE OF CROSS-CULTURAL COMPETENCE AND LEVELS OF ITS FORMATION

Introduction. The factors responsible for effective interactions between the representatives of different cultures have been investigated by numerous researchers. Such interest is caused by growing tendency for globalization as it means increasing in the number of contacts in many spheres such as international politics, business, trade, education and many others. Therefore, those who are involved in international communications due to their profession have to possess certain abilities and obtain essential knowledge, which help them to develop specific skills for successful communication. To analyze and structuralize these abilities, knowledge and skills is the purpose of the present research. Methods. To achieve the goal, the differences in theoretical definitions and conceptualizations of cross-cultural competence structure were analyzed. The generalization of its components was considered, and the conclusions were made about the interaction of these components, and how they influence and impact behavior, action, and outcomes. Research results and their discussion. A preliminary conceptual model of cross-cultural competence consisting of nine elements was offered. In different sources, similar structures were denominated with different terminologies. However, based on the numerous studies, it became possible to create a cross-cultural competence structure, which shows the correlation of cognitive knowledge, abilities, attitudes, traits, performing and behavioral skills while communicating cross-culturally. Cultural experience and foreign language knowledge also contribute to cross-cultural efficiency, which level can be measured. The measurement results are divided into external and internal. External outcomes include behavioral outcomes and outcomes of adapting to a cross-cultural environment, participating in it, and demonstrating appropriate behavior.

Vindicating pollyanna? An experimental test of cognitive restructuring and positive thinking interventions

Objective Despite its considerable potential, psychotherapy research has made limited use of small-scale experimental study designs to test intervention components. This study employs such a design to test the immediate effects on emotional experience of two approaches to changing negative thoughts, cognitive restructuring and fostering positive thinking. Cognitive restructuring draws on the strategies core to cognitive behavioral therapies. Fostering positive thinking has also received attention, though less so as a psychological intervention. Method We tested the benefits of these strategies over a brief interval by randomizing 230 participants to complete a worksheet introducing one of the two strategies. Participants reported their skills prior to exposure to these worksheets and affect was assessed immediately prior to and following use of worksheets. Results Participants’ negative affect reduced following both strategies. Conditions did not differ significantly in affect change. Analysis of potential moderators showed that, among those with higher levels of cognitive behavioral therapy skills, the positive thinking condition produced greater gains in positive affect than the cognitive restructuring condition. Conclusions These results indicate that both forms of brief interventions promote reductions in negative affect. Positive thinking interventions, which are not focused on the accuracy of one's thinking, appear to be particularly effective in promoting positive affect.

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

Evidence for validity, reliability and measurement invariance of the emotion regulation questionnaire for children and adolescents (ERQ-CA) in secondary students from Chile

Emotion regulation (ER) is associated with both healthy and unhealthy behavioral and affective responses, especially in adolescents. It is frequently assessed by self-report measures such as the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA), which has shown mixed psychometric properties when used in Spanish-speaking adolescents. The present study provides evidence for its validity and reliability in a sample of secondary students in Chile. Six-hundred and thirty-four students were recruited from ten educational institutions to complete the ERQ-CA, along with the Cognitive Behavioral Therapy Skills Questionnaire (CBTSQ), the Suicide Ideation Questionnaire Junior (SIQ-JR), the Multidimensional Adolescent Functioning Scale (MAFS) and the Patient Health Questionnaire-9 (PHQ-9). Confirmatory factor analysis (CFA) was performed on the ERQ-CA for two- and single-factor models. Convergent and discriminant validity as well as measurement invariance were also tested. The original ERQ-CA two-factor structure showed the best model fit and parsimony along with high internal consistency. It also demonstrated high convergent and discriminant validity, with reappraisal strategies positively correlating with cognitive-behavioral skills and psychosocial functioning and negatively with suicide ideation and depressive symptoms, while the opposite was true for suppression strategies. Partial scalar invariance was established when testing by biological sex (male/female) and psychiatric treatment history (past/current/no). We conclude that the ERQ-CA was found to be a valid and reliable self-report instrument for the assessment of ER strategies in secondary students, proving its utility as a research and clinical tool.

Youth voices and experiences regarding a school-based cognitive behavioral therapy skills intervention: lessons for future engagement and adaptation

BackgroundThe Cognitive Behavioral Therapy Skills Intervention (or CBTSI) aims to build mental health literacy and knowledge, allowing youth to build resilience and improve mental health broadly. In Ontario, Canada, youth voice is scant and European studies have largely reported on youth factors supporting stigma reduction, help-seeking intentions and overall satisfaction with a given intervention. Process evaluations and implementation that underpin what youth require to embrace mental health literacy interventions, particularly those that embed key learning principles in the everyday curriculum, have not been broached. The goal of this study is to understand both barriers and facilitators to engagement with the CBTSI (an intervention novel in itself because of the combined mental health plus cognitive behavior therapy (CBT) skills principles embedded in literacy) and the resources and structures that students report requiring, to fully engage with such an intervention.MethodsStudent focus groups were conducted utilizing qualitative interviews that were analyzed thematically. Analysis was informed using principles of pragmatism and analyzed inductively using thematic analysis (Braun and Clarke, Qual Res Psychol 3:77–101, 2006), first looking at the whole and then coding for themes, within an interpretivist framework. Youth were in middle school (grade 7 and 8) in Toronto, Canada who had received the CBTSI. Face to face interview guides with iterative questioning were conducted in February of 2020, and these interviews were audio-recorded and professionally transcribed. Teachers randomly chose a subset of youth whose parents consented to the research to ensure ethno-racial similarity to classroom demographics.ResultsThere were eight groups with sixty students who participated. Students were 12 to 14 years of age. Major themes were identified: maximizing the opportunities for involvement and self-determination created an atmosphere where confidence and self-compassion could flourish, signalling to the students that they understood and were able to deploy the strategies they were taught; students expressed that the intervention needs to be adapted to enhance personal dignity, respecting both individual wishes and goals in light of the variability in student reported mental health. A model explains the structures and adaptations required to maximize learning based on youth feedback.InterpretationMental health literacy incorporating CBT is a promising population-based health promotion intervention. Future adaptations and implementation decisions regarding the CBTSI need to address the wishes and experiences of these youth. Youth voice in this study explored factors that prevent and promote the uptake of the key lessons within the context of existing variability in student mental health that is often found within the context of a regular classroom. The results should be used to adapt the CBTSI as it is disseminated more broadly.

Opioid reduction and enhanced recovery in orthopaedic surgery (OREOS): A feasibility randomized controlled trial in knee replacement patients

ABSTRACT Background Total knee arthroplasties are the second most common surgery in Canada. Most patients recover well, but 20% or more still suffer from persistent pain and opioid use. Though opioids are an important part of perioperative pain management, their potential for long-term adverse effects is well recognized. Limiting opioids may be insufficient to overcome the issue of opioid overuse. Pain and opioid use are highly linked, so an effective alternative needs to address both issues. Objectives The principal objective of this pilot trial is to assess the feasibility. The clinical objectives are to determine the effects of a multicomponent care pathway on opioid-free pain control, persisting pain and opioid use, functional knee outcomes, quality of life, and return to function. Methods We will include adult patients scheduled for primary elective total knee arthroplasty. Patients in the intervention group will undergo a multicomponent intervention pathway that will be facilitated by an intervention coordinator linking each patient and their surgical/ perioperative team. The interventional pathway will include (1) preoperative education on pain and opioid use, (2) preoperative risk identification and mitigation using cognitive behavioral skills, (3) personalized postdischarge analgesic prescriptions, and (4) continued support for pain control and recovery up to 8 weeks. Patients in the control group will receive the usual care at their institution. Discussion The overarching goal is to implement and evaluate a coordinated approach to clinical care to improve pain control and reduce harms, with an emphasis on patient-centered care and shared decision making. Trial Registration Number: NCT04968132 (informed consent/ research ethics board statement).

Adapting, testing, and refining a resilience intervention for older women with HIV: An open pilot study

Half of persons with HIV in the United States (US), many of whom are women, are over age 50. Aging women with HIV (WWH) face unique biopsychosocial challenges, including stigma, the physiological effects of aging, and illness-associated stressors. Resilience interventions can build awareness of such stressors and aid in facilitating the relaxation response; however, no existing interventions specifically cater to the needs of older WWH. The content of the Relaxation Response Resiliency Program, which teaches positive psychology strategies, relaxation techniques, and cognitive behavioral skills, was adapted for older WWH. Thirteen WWH over 50 participated in an open pilot of the adapted intervention to iteratively refine the program and its procedures. Participants attended either 8 or 10 weekly group sessions; three groups were conducted in total. Pre- and post-intervention assessments and qualitative exit interviews were conducted. Among completers, an increase in resilience was observed. Though significance testing was not conducted, social support also increased, and depression, anxiety, and HIV stigma decreased from pre- to post-intervention. Over half of eligible women enrolled; completers reported high satisfaction with the program. However, retention was difficult; six participants withdrew or were lost to follow-up. Mean number of sessions attended was 3.5 in the 8-session group and 5 in the 10-session groups. In this small sample, the adapted intervention led to a clinically meaningful increase in resilience, though recruitment and retention were challenging. Further refinements to the intervention are needed to minimize attrition and increase acceptability before additional testing is initiated.

The Relationship Between Health System Functions and the Prevalence of Down Syndrome on a Global Scale

Objective: Down syndrome or trisomy 21 is one of the most common human chromosomal disorders that affect cognitive functions, communication and behavioral skills. At the macro level, various factors can contribute to the Down syndrome prevalence and mortality. This study aimed to investigate the association of health system functions with Down syndrome prevalence and mortality worldwide. Materials & Methods: The study was a cross-sectional study conducted based on the secondary analysis of existing data in 2019. Data from 202 countries in six different regions (African Region [AFRO], Eastern Mediterranean Region [EMRO], European Region [EURO], South-East Asia Region [SEARO], Western Pacific Region [WPRO], and Pan American Health Organization [PAHO]) were included in the study. Data were extracted from the World Health Organization (WHO), the World Bank and the Institute for Health Metrics and Evaluation databases. The adjusted linear regression analysis was used to examine the association between health system-related factors with prevalence of, and death due to Down syndrome as the outcome variables. In the present study, two functions of health financing (domestic general government health expenditure [GGHE-D] per capita in PPP [purchasing power parity] int$, domestic private health expenditure [PHE-D] per capita in PPP int$, external health expenditure [EXT] per capita in PPP int$) and health system resources (nurse and midwifery personnel, generalist medical practitioners [GMP], specialist medical practitioners [SMP], pharmacists, dentists, physiotherapists) were included in the study as independent variables. We used the Stata software version 14 to analyze Results: Africa and low-income countries had the highest deaths due to Down syndrome. On the other side, Europe and high-income countries had the highest prevalence of Down syndrome worldwide. According to the available data, Iran had a lower prevalence (29.31 vs 38.44 per 100,000 population) and higher deaths (0.34 vs 0.32 per 100,000 population) compared to high- income countries. The 20-year trend of prevalence of, and deaths due to Down syndrome in Iran has always been lower and higher than high-income countries, respectively. Linear regression analysis showed that GGHE-D per capita (β=0.385, P<0.001) and PHE-D per capita (β=0.354, P=0.02) could predict the prevalence of Down syndrome significantly in the study countries. On the other hand, nurse and midwifery personnel (β=-0.607, P=0.014) and number of SMP (β=0.420, P=0.025) were associated with increased deaths from Down syndrome in the included countries. Conclusion: Our findings showed GGHE-D and PHE-D are associated with a higher prevalence of Down syndrome in health systems. On the other hand, health system resources (nurses and SMP) were the main predictors of death due to Down syndrome in the included countries. International organizations and governments need to monitor and improve the equitable access of vulnerable groups to health services in low-income countries. Improving health insurance coverage and equitable distribution of health resources is suggested to reduce deaths due to Down syndrome in Iran.

Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study).

BackgroundAlthough clinically effective treatment is available for schizophrenia, recovery often is still hampered by persistent poor psychosocial functioning, which in turn is limited by impairments in neurocognition, social cognition, and social behavioral skills. Although cognitive remediation has shown general efficacy in improving cognition and social functioning, effects still need to be improved and replicated in appropriately powered, methodologically rigorous randomized controlled trials (RCTs). Existing evidence indicates that effects can most likely be optimized by combining treatment approaches to simultaneously address both social cognitive and social behavioral processes.ObjectivesTo assess whether Integrated Social Cognitive and Behavioral Skill Therapy (ISST) is more efficacious in improving functional outcome in schizophrenia than the active control treatment Neurocognitive Remediation Therapy (NCRT).MethodsThe present study is a multicenter, prospective, rater-blinded, two-arm RCT being conducted at six academic study sites in Germany. A sample of 180 at least partly remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST is a compensatory, strategy-based program that targets social cognitive processes and social behavioral skills. NCRT comprises mainly drill and practice-oriented neurocognitive training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause discontinuation over the 12-month study period; psychosocial functioning, quality of life, neurocognitive and social cognitive performance, and clinical symptoms are assessed as secondary outcomes at baseline before randomization (V1), at the end of the six-month treatment period (V6), and at the six-month follow-up (V12).DiscussionThis RCT is part of the German Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) research network, which aims at using innovative treatments to enhance prevention and recovery in patients with schizophrenia. Because this study is one of the largest and methodologically most rigorous RCTs on the efficacy of cognitive remediation approaches in schizophrenia, it will not only help to identify the optimal treatment options for improving psychosocial functioning and thus recovery in patients but also allow conclusions to be drawn about factors influencing and mediating the effects of cognitive remediation in these patients.Trial RegistrationClinicalTrials.gov NCT 02678858, German Study Register DRKS 00010033

A mobile-based pregaming drinking prevention intervention for college students: study protocol for a randomized controlled trial

BackgroundPregaming is a high-drink context popular among college students that often leads to elevated blood alcohol levels and negative consequences. Over 15 years of research studies have demonstrated that pregaming represents one of the riskiest known behaviors among college students, yet no pregaming-specific interventions have been developed to help prevent this behavior. General brief interventions for students do not reduce pregaming behavior and may not be appropriate, as they do not help students develop skills unique to the pregaming context that could help them drink less. We developed a brief, mobile-based intervention that is proposed to prevent heavy drinking during pregaming for college students, with the ultimate goal that behavioral reductions in this risky practice will ultimately affect global drinking and prevent consequences.Methods/DesignThe intervention, Pregaming Awareness in College Environments (PACE), was developed by combining two innovations to facilitate behavior change: (1) a mobile-based application that increases accessibility, is easy and engaging to use, and broadens the reach of the intervention content and (2) personalized pregaming-specific intervention content with harm reduction and cognitive behavioral skills proven to be mechanisms preventing and reducing heavy drinking among college students. After a develop and beta-test phase, we propose to test the efficacy of PACE in a preliminary randomized controlled trial with 500 college students who pregame at least once per week. Pregaming, general drinking, and alcohol-related consequences outcomes will be examined in the immediate (2 weeks post-intervention) and short-terms (six and 14-week post-intervention). We will also evaluate moderator effects for age, sex, and heaviness of drinking to allow for more refined information for a planned larger test of the intervention to follow this initial trial of PACE.DiscussionThis pregaming intervention clinical trial, if found to be efficacious, will culminate with an easily-disseminated mobile-based intervention for college student drinkers. It has the potential to reach millions of college students, perhaps as a clinical tool used by college counseling centers as an adjunct to formal care or as a preventive tool for first-year students or other high-risk groups on campus.Trial registration: ClinicalTrials.gov Identifier NCT04016766.

Feasibility and Effectiveness of a Psychosis-Specific Intensive Outpatient Program.

ObjectiveIntensive outpatient programs (IOPs) are rarely designed specifically to treat psychosis. In 2016 UCLA established the Thought Disorders Intensive Outpatient Program (TD IOP), combining a time‐limited, group‐based intervention called cognitive behavioral social skills training (CBSST) and medication management to treat individuals with psychosis. The purpose of this study is to assess the feasibility of developing an IOP for individuals with psychosis and the effectiveness of the program in improving psychotic symptom severity.MethodsAdults were referred to the TD IOP from inpatient and outpatient settings. Programming included 3 hours of CBSST and 6 hours of additional groups weekly as well as individual psychiatry and social work services. Primary outcomes were symptom changes as measured at intake and discharge by the Clinician‐Rated Dimensions of Psychosis Symptom Severity scale. Program feedback was solicited from a small subset of patients.ResultsOf the 92 enrolled subjects, 71 completed the program (77.2%). Average length of stay was 52 ± 30 days across all enrolled. Participants showed significant (p < 0.05) improvement with small‐moderate effect sizes across five of eight psychosis symptom domains (hallucinations, delusions, disorganized speech, depression, and mania). Patient‐reported program satisfaction was high (86.6 ± 12.7 score, range 0–100).ConclusionsThe current study indicates that targeted treatment for psychosis is successful within an IOP framework, with minimal additional training required for Master's level clinicians. Participants demonstrated significant symptomatic relief from group‐based, time‐limited treatment. Further work is needed to determine the full range of program benefits on patient well‐being and illness morbidity.

Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction

There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.

Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression

The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms.Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session.Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88–0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high.Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.

Peer specialists deliver cognitive behavioral social skills training compared to social skills training and treatment as usual to veterans with serious mental illness: study protocol for a randomized controlled trial

BackgroundSerious mental illness (SMI) affects 4.6% of the American population. While treatments are available, adherence to specific regimens is often suboptimal. Multiple organizations, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), have called for more options that improve accessibility and engagement to treatment among individuals with SMI. This study protocol answers such calls by testing the effectiveness of peer specialists—individuals with SMI trained to use their experience to help others with SMI—in delivering social skills training (SST) and cognitive behavioral social skills training (CBSST), evidence-based treatments effective at engaging individuals with SMI to make behavioral and cognitive changes. Peer specialists have been shown to be adept at engaging those with SMI in treatment; however, their ability to deliver these structured treatments is unknown.MethodsThis study is a randomized, hybrid 1, research assistant-blinded, superiority trial. A total of 252 veterans with SMI will be recruited and randomized to one of three arms: CBSST-Peer vs. SST-Peer vs. treatment as usual. Participants randomized to CBSST-Peer or SST-Peer will participate in a 20-week group-based intervention that meets weekly for a 60-min class. All participants will complete 4 study assessments at baseline, 10 weeks, 20 weeks, and 32 weeks. A multidimensional battery of functional outcomes will be used with the Independent Living Skills Survey (ILSS) as the primary outcome measure. Post-study completion, veterans who participated in the CBSST-Peer or SST-Peer arms will randomly be invited to participate in focus groups, and peer specialists will complete interviews to further assess the effectiveness of each intervention.DiscussionImproving care and outcomes for individuals with SMI is a national priority. To improve care, it is imperative to think about new ways to improve engagement and accessibility to care. This study provides an innovative solution to this problem by evaluating how two different types of treatment, delivered by peer specialists, compare to usual care. The results of the study will allow for the expansion of treatment options that improve access and engagement among veterans with SMI.

Cognitive-Behavioral Social Skills Training Adapted for Youth at Clinical High Risk for Psychosis.

Interventions for functional impairments in adolescents and young adults at clinical high risk (CHR) for psychosis are needed. Cognitive-Behavioral Social Skills Training (CBSST) has been found to improve functioning in patients with schizophrenia. The CBSST manual was adapted for CHR and implemented across 3 sites. The key changes that were made were to present a focus of normalization and destigmatization of attenuated psychotic symptoms and since CBSST has a major focus on role plays, problem solving and challenging thoughts, examples of these were changed to be more appropriate for this young CHR population. We describe the manual modifications and present fidelity data to examine the success of training and supervision methods in a multi-site randomized controlled trial of CBSST in CHR youth. Fidelity was high and comparable across sites. Case vignettes are presented to demonstrate how CBSST techniques were adapted for UHR individuals to target functional impairments.

The Effect of Social Skills Training by Teacher on Mental Health of Female Primary School Students

Background: Social skills play an important role in children’s emotional health and well-being. Therefore, Social Skills Training (SST) of children is very important. Objective This study was to determine the effect of SST by teacher on mental health of female primary school students. Methods: This is a quasi-experimental study with a pre-test/post-test design conducted on 24 female primary school students (third grade) in Rasht, Iran in 2017-2018. Their parents and teachers completed questionnaires before and after SST intervention. The sessions were held during the school year. For SST of students, intervention was provided to their teacher who was in daily contact with them. Methods of cognitive behavioral skills and positive reinforcement were used for SST. The Strengths and Difficulties Questionnaire (SDQ) and the Matson Evaluation of Social Skills with Youngsters (MESSY) were used to assess mental health and social skills, respectively. Data were analyzed using statistical tests including Wilcoxon test and paired t-test in SPSS V.21 software. Results: The mean total score of MESSY decreased significantly from 225.54±13.65 to 219.12± 18.59 after the intervention (P=0.033). Among the subscales of SDQ, the mean of hyperactivity-attention deficit decreased only from 3.95±2.49 to 2.62±1.55 after the intervention, which was significant (P=0.020). Conclusion: The SST of female primary school students by the teacher do not lead to significant changes in their social skills and mental health.

Effects of a cognitive-behavioral skills building program on the mental health outcomes and healthy lifestyle behaviors of veterinary medicine students.

To evaluate the effects of a cognitive-behavioral skills building program (ie, MINDSTRONG; The Ohio State University) on the mental health outcomes and healthy lifestyle beliefs and behaviors of Doctor of Veterinary Medicine (DVM) students. DVM students (n = 62) before beginning their program at a large public Midwest land-grant university. All 171 incoming DVM students (class of 2024) were required to take the cognitive-behavioral skills building program (7 weeks in length) before starting their 2020 school year. Students were given the option to consent to the study portion of the program. Consenting participants completed a pre- and postsurvey containing demographic questions and 5 valid and reliable scales, including the Patient Health Questionnaire-9 that assesses depressive symptoms, the Generalized Anxiety Disorder-7 that evaluates anxiety, the Brief Inventory of Perceived Stress that measures stress, and the Healthy Lifestyle Beliefs and Healthy Lifestyle Behaviors scales. Descriptive statistics described sample characteristics, paired t tests assessed changes over time in the outcomes Personal Wellness Assessment, and Cohen's d determined effect sizes. 62 DVM students completed both surveys. Postintervention, students had significant improvements in depressive symptoms, anxiety, and healthy lifestyle beliefs and behaviors. Although this study used a small convenience sample of DVM students from a single university, a cognitive-behavioral skills building program demonstrated the ability to decrease rates of depression, anxiety, and suicidal ideation and improve healthy lifestyle beliefs and behaviors. Requiring DVM students to participate in such programming could provide benefit during their professional education and throughout their careers.

Economic Evaluation: A Randomized Pragmatic Trial of a Primary Care-based Cognitive Behavioral Intervention for Adults Receiving Long-term Opioids for Chronic Pain.

Chronic pain is prevalent and costly; cost-effective nonpharmacological approaches that reduce pain and improve patient functioning are needed. Report the incremental cost-effectiveness ratio (ICER), compared with usual care, of cognitive behavioral therapy aimed at improving functioning and pain among patients with chronic pain on long-term opioid treatment. Economic evaluation conducted alongside a pragmatic cluster randomized trial. Adults with chronic pain on long-term opioid treatment (N=814). A cognitive behavioral therapy intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (behaviorists, nurses) with additional support from physical therapists, and pharmacists. Cost per quality adjusted life year (QALY) gained, and cost per additional responder (≥30% improvement on standard scale assessment of Pain, Enjoyment, General Activity, and Sleep). Costs were estimated as-delivered, and replication. Per patient intervention replication costs were $2145 ($2574 as-delivered). Those costs were completely offset by lower medical care costs; inclusive of the intervention, total medical care over follow-up was $1841 lower for intervention patients. Intervention group patients also had greater QALY and responder gains than did controls. Supplemental analyses using pain-related medical care costs revealed ICERs of $35,000, and $53,000 per QALY (for replication, and as-delivered intervention costs, respectively); the ICER when excluding patients with outlier follow-up costs was $106,000. Limited to 1-year follow-up; identification of pain-related utilization potentially incomplete. The intervention was the optimal choice at commonly accepted levels of willingness-to-pay for QALY gains; this finding was robust to sensitivity analyses.