Cognitive-behavioral Therapy Condition Research Articles

Client predictors of dropouts and outcomes in psychotherapy for generalized anxiety disorder: an exploratory study

ABSTRACT This study is a secondary analysis exploring client predictors of dropouts and outcomes in the treatment of generalized anxiety disorder (GAD). Data was taken from a feasibility randomized control trial (RCT) exploring the relative efficacy of emotion-focused therapy (EFT) compared with cognitive-behavioral therapy (CBT). Relationships between client characteristics and dropouts were explored using logistic regression analysis. Relationships between client characteristics and psychotherapy outcomes were explored using hierarchical linear regression analyses. For the full dataset (n = 58), a comorbid personality disorder predicted a higher number of dropouts. Eleven participants dropped out of therapy. Having a disability predicted less improvement in symptoms of depression and general distress. Being male-identified predicted a greater reduction in symptoms of anxiety and general distress, and comorbid agoraphobia predicted a greater reduction in symptoms of depression for the CBT condition (n = 21 completers). For the EFT condition (n = 26 completers), being older predicted greater improvements in symptoms of anxiety and comorbid panic disorder predicted a lower reduction in symptoms of depression. Caution should be taken in interpreting these findings given the small number of participants. However, they provide useful insights for the generation of hypotheses in relation to predictors of dropouts and outcomes for future studies.

The effectiveness of cognitive behavioural therapy for depression in women with breast cancer: a systematic review and meta-analysis.

Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions. To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer. Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck's protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures. Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = -0.93 [95% CI -1.47, -0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer. CBT aligned to Beck's protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck's CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly.

Preliminary Study of Efficacy and Safety of Self-Administered Virtual Exposure Therapy for Social Anxiety Disorder vs. Cognitive-Behavioral Therapy

Social anxiety disorder (SAD) is one of the most frequent mental disorders. Exposure to virtual reality can be a solution complementing standard CBT (cognitive-behavioral therapy) or can be used as an independent therapeutic tool. The study’s objective was to assess the safety and efficacy of using self-administered virtual reality exposure vs. CBT and CBT with virtual exposure. We assessed the efficacy of the applied intervention with the Leibowitz Social Anxiety Scale (LSAS). We compared three groups: CBT (n = 25), CBT + VR (n = 29), and self-administered therapy without aid of a therapist (n = 19). The results indicated that all three groups showed changes on the LSAS. The simple effect analysis showed that there were no differences between experimental conditions at T0 (session 1) and T1 (session 9) and that the only significant difference occurred at T2 (session 14). The pairwise comparisons showed that the participants in the VR condition scored higher on the LSAS score during the measurement at T2 than participants in CBT condition. Our study has several limitations. The presented initial study shows that the methods of CBT for social anxiety used so far are also effective, while the VR tool for self-therapy requires further research.

The Effectiveness of Virtual Reality Exposure-Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis.

BackgroundIn recent years, virtual reality exposure–based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders.ObjectiveThe objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared.MethodsStudies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions.ResultsA total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=−0.490, 95% CI −0.82 to −0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI −0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias.ConclusionsThe results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings.

Two-year follow-up of trauma-focused cognitive behavior therapy for posttraumatic stress disorder in emergency service personnel: A randomized clinical trial.

Emergency service personnel experience elevated rates of posttraumatic stress disorder (PTSD). There are few controlled trials for PTSD in this population, and none report longer term effects of treatment. This study evaluated the benefits of cognitive behavior therapy (CBT) for PTSD in emergency service personnel who received either brief exposure (CBT-B) to trauma memories or prolonged exposure (CBT-L) 2 years following treatment. One hundred emergency service personnel with PTSD were randomized to CBT-L, CBT-B, or Wait-List (WL). Following posttreatment assessment, WL participants were randomized to an active treatment. Participants randomized to CBT-L or CBT-B were assessed at baseline, posttreatment, 6-month, and 2-year follow-up. Both CBT conditions involved 12 weekly individual sessions comprising education, CBT skills building, imaginal exposure, in vivo exposure, cognitive restructuring, and relapse prevention. Reliving trauma memories occurred for 40 min per session in CBT-L and for 10 min in CBT-B. At the 2-year follow-up, there were no differences in PTSD severity (Clinician Administered PTSD Scale) between CBT-L and CBT-B. There were very large effect sizes for CBT-L (1.28, 95% confidence interval [CI] = 0.90-1.64) and CBT-B (1.28, 95% CI = 0.05-1.63) from baseline to 2-year follow-up. This study highlights that CBT can be an effective treatment of PTSD in emergency service personnel using either prolonged or brief periods of reliving the trauma memory, and that these benefits can last for at least 2 years after treatment.

Reductions of Anxiety Symptoms, State Anxiety, and Anxious Arousal in Youth Playing the Videogame MindLight Compared to Online Cognitive Behavioral Therapy.

Objective: Anxiety disorders are the most prevalent form of psychopathology among youth. Because demand for treatment far exceeds availability, there is a need for alternative approaches that are accessible, engaging, and incorporate practice to reach as many youth as possible. MindLight is a novel videogame intervention that combines evidence-based anxiety reduction techniques with neurofeedback mechanics that has been shown to reduce anxiety symptoms in youth. This study examined the effectiveness of MindLight compared with online cognitive behavioral therapy (CBT) to replicate and extend those findings by testing the reduction of reactivity to anxiety-eliciting laboratory stressors. Materials and Methods: A randomized controlled trial was conducted with laboratory assessments at pre-intervention, post-intervention, and 3-month follow-up. Participants were 117 anxious youth (66.7% female, 33.3% male; age range: 8.05-15.93 years) who were randomized into MindLight (n = 56) and CBT (n = 60) conditions. Both interventions were completed in five 1-hour sessions within a 3-week period. At each time point, anxiety symptoms were assessed through self-report, and state anxiety and anxious arousal were measured during laboratory stress tasks. Results: All measures of anxiety significantly decreased over time in both conditions (P < 0.05). Moreover, youth in the MindLight condition showed greater pre-to-post reductions in anxiety symptoms compared with youth in the CBT condition (P < 0.05). Conclusion: Findings demonstrate that the effects of MindLight and online CBT are not only associated with reductions in anxiety symptoms, but also impact how youth react to laboratory stressors in the moment. ClinicalTrials.gov Identifier: NCT02326545.

Minimal-Contact Versus Standard Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Cost-Effectiveness Results of a Multisite Trial.

Irritable bowel syndrome (IBS) is a common, often disabling gastrointestinal (GI) disorder for which there is no satisfactory medical treatment but is responsive to cognitive behavior therapy (CBT). To evaluate the costs and cost-effectiveness of a minimal contact version of CBT (MC-CBT) condition for N = 145 for IBS relative to a standard, clinic-based CBT (S-CBT; N = 146) and a nonspecific comparator emphasizing education/support (EDU; N = 145). We estimated the per-patient cost of each treatment condition using an activity-based costing approach that allowed us to identify and estimate costs for specific components of each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of MC-CBT relative to S-CBT and EDU. We then evaluated the cost-effectiveness of MC-CBT relative to these alternatives for selected outcomes at immediate posttreatment and 6 months posttreatment, using both an intent-to-treatment and per-protocol methodology. Key outcomes included scores on the Clinical Global Impressions-Improvement Scale and the percentage of patients who positively responded to treatment. The average per-patient cost of delivering MC-CBT was $348, which was significantly less than the cost of S-CBT ($644) and EDU ($457) (p < .01). Furthermore, MC-CBT produced better average patient outcomes at immediate and 6 months posttreatment relative to S-CBT and EDU (p < .01). The current findings indicated that MC-CBT is a cost-effective option relative to S-CBT and EDU. As predicted, MC-CBT was delivered at a lower cost per patient than S-CBT and performed better over time on the primary outcome of global IBS symptom improvement.

Modular cognitive behavioral therapy for autism-related symptoms in children: A randomized controlled trial.

To date, no one-on-one psychotherapy protocol for elementary and middle school-aged children with autism spectrum disorder (ASD) has been found to be efficacious for treating autism-related symptoms such as failure to initiate social interactions. This study compared modular cognitive behavioral therapy (CBT) with enhanced standard community treatment (ESCT) in terms of impact on the severity of autism-related symptoms. Children with ASD (N = 107; aged 6-13 years) were randomly assigned to a treatment condition (CBT or ESCT). Both treatments provided 32 therapy sessions. The CBT condition utilized a modular design, matching specific evidence-based treatment elements to each child's clinical needs (e.g., social-communication symptoms). The ESCT condition provided social skills training and cognitive behavioral training in a structured and linear group therapy format. The primary outcome measure was independent evaluator ratings of peer engagement during school recess using a structured and validated observation system. Parents also made session-by-session ratings on personalized autism-related symptom profiles throughout treatment. CBT outperformed ESCT on the primary outcome measure (p < .001; d = .50; 95% CI [.06, .93]) and the secondary outcome measure (p = .003; d = .87; 95% CI [.45, 1.27]). The modular one-on-one CBT program evaluated in this study may be beneficial for reducing the severity of autism-related symptoms in some children with ASD. Further research is needed to clarify the extent of the treatment effect and the feasibility of implementation for therapists in the community. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predictors and moderators of treatment efficacy in reducing custodial grandmothers’ psychological distress

It is increasingly recommended that hypothesis-generating studies be conducted after initial RCTs in order to identify moderators of differential treatment efficacy on individual outcomes. Such analyses are important because they help clarify the best inclusion and exclusion criteria or choice of stratification for maximizing power in subsequent RCTs, reduce the chances of discarding interventions that may appear to lack efficacy when only average treatment effects are taken into consideration, and facilitate the matching of individual clients to treatment alternatives. We identified predictors and moderators of treatment-related change in psychological distress among custodial grandmothers (n = 343) assigned within a prior RCT to behavior parent training (BPT), cognitive behavior therapy (CBT), or information only control (IOC) conditions. Latent change scores in psychological distress were estimated for each grandmother across pre-test to post-test and pre-test to six months, as indicated by self-reported and clinical ratings of depression and anxiety symptoms. These estimates served as outcomes in classification and regression tree analyses conducted separately within the CBT and BPT conditions to identify predictors of treatment efficacy. Matched groups based upon identified predictors were then formed across all RCT conditions, and Predictor × RCT Condition interactions were computed to test for moderation of differential treatment efficacy. Grandmother age was the only predictor and moderator of BPT efficacy at both measurement points, whereas multifaceted predictors and moderators emerged for CBT which varied by time since treatment.

Effect of Group Cognitive Behavioural Therapy on Loneliness in a Community Sample of Older Adults: A Secondary Analysis of a Randomized Controlled Trial

ABSTRACT Objectives Research suggests a link between loneliness, depression, and anxiety. Multiple studies have examined treatment programs for loneliness; however, none have examined the efficacy of Cognitive Behavioral Therapy (CBT) for depression and anxiety in reducing loneliness. Methods Change in loneliness in sixty-two older adults (≥60 yrs; 65% female) who took part in a previously reported randomized controlled trial for the treatment of comorbid depression and anxiety was examined. Older adults were randomized to a 12-week group CBT or waitlist control condition. Participants who took part in CBT were followed-up three months later. Results Linear Mixed Model analyses indicated that after controlling for baseline cognition, depression, and anxiety, participants who completed CBT experienced a significant decrease in loneliness while the control group did not. This reduction was maintained at follow-up. Conclusions CBT programs for depression and anxiety are likely to be effective at reducing loneliness. This may be due to shared underlying cognitive and behavioral mechanisms between loneliness, depression, and anxiety such as sensitivity to perceived threat and social withdrawal. Further research is needed to understand if specific loneliness interventions are more effective. Clinical Implications CBT may be effective at reducing loneliness among older adults with depression and anxiety.

Online cognitive–behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial

IntroductionThe traumatic death of a loved one, such as death due to a traffic accident, can precipitate persistent complex bereavement disorder (PCBD) and comorbid post-traumatic stress disorder (PTSD) and depression....

Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia

Background and AimThe goal was to evaluate the moderators of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) to improve dyspareunia, reduce pain catastrophizing, and improve overall sexual function in women with provoked vestibulodynia (PVD). Both treatments effectively reduced self-reported pain, sexual dysfunction, and pain catastrophizing in women with PVD. MethodsA total of 130 women with PVD were assigned to CBT or MBCT. OutcomesPotential moderators included (i) PVD subtype (primary or secondary), (ii) baseline pain intensity, (iii) trait mindfulness, (iv) treatment credibility, (v) relationship duration, and (vi) age. Outcomes were pain intensity, sexual function, and pain catastrophizing at 4 time points: before and after treatment and 6- and 12-month follow-up. Moderation was tested using multilevel models, nesting 4 time points within participants. The interaction of the moderator, time effect, and treatment group was evaluated for significance, and a simple slope analysis of significant interactions was performed. ResultsPain reduction across 4 time points was the greatest in women who were younger, in relationships of shorter duration, and with greater baseline pain. Treatment credibility moderated pain intensity outcomes (B = 0.305, P < .01) where those with higher treatment credibility ratings (for that particular treatment) improved more in MBCT than CBT. PVD subtype moderated pain catastrophizing (B = 3.150, P < .05). Those with primary PVD improved more in the CBT condition, whereas women with secondary PVD improved more in the MBCT condition. Relationship length moderated sexual function (B = 0.195, P < .01). Women in shorter relationships improved more with MBCT, whereas women in longer relationships improved more on sexual function with CBT. No other tested variables moderated outcomes differentially across both treatment conditions. Clinical ImplicationsWomen who present with high credibility about mindfulness, in shorter relationships, and with secondary PVD might respond better to MBCT whereas those with primary PVD and longer relationships might respond better to CBT. Strengths & LimitationsClinical sample. Half the women who were not sexually active were omitted from analyses of sexual function. ConclusionOverall, treatment credibility, relationship length, and PVD subtype were found to moderate improvements differently in MBCT and CBT. These findings may assist clinicians in individualizing psychological treatment for women with PVD. Clinical Trial RegistrationThis clinical trial was registered with clinicaltrials.gov, NCT01704456.Brotto LA, Zdaniuk B, Rietchel L, et al. Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia. J Sex Med 2020;17:2247–2259.

Targeting fear of positive evaluation in patients with social anxiety disorder via a brief cognitive behavioural therapy protocol: a proof-of-principle study.

Our aim was to develop a brief cognitive behavioural therapy (CBT) protocol to augment treatment for social anxiety disorder (SAD). This protocol focused specifically upon fear of positive evaluation (FPE). To our knowledge, this is the first protocol that has been designed to systematically target FPE. To test the feasibility of a brief (two-session) CBT protocol for FPE and report proof-of-principle data in the form of effect sizes. Seven patients with a principal diagnosis of SAD were recruited to participate. Following a pre-treatment assessment, patients were randomized to either (a) an immediate CBT condition (n = 3), or (b) a comparable wait-list (WL) period (2 weeks; n = 4). Two WL patients also completed the CBT protocol following the WL period (delayed CBT condition). Patients completed follow-up assessments 1 week after completing the protocol. A total of five patients completed the brief, FPE-specific CBT protocol (two of the seven patients were wait-listed only and did not complete delayed CBT). All five patients completed the protocol and provided 1-week follow-up data. CBT patients demonstrated large reductions in FPE-related concerns as well as overall social anxiety symptoms, whereas WL patients demonstrated an increase in FPE-related concerns. Our brief FPE-specific CBT protocol is feasible to use and was associated with large FPE-specific and social anxiety symptom reductions. To our knowledge, this is the first treatment report that has focused on systematic treatment of FPE in patients with SAD. Our protocol warrants further controlled evaluation.

A meta-analysis of cognitive-behavioral therapy for depressive symptoms among college students, alone and in comparison with other interventions

Abstract This meta-analysis examines the effect of cognitive-behavioral therapy (CBT) for depressive symptoms among college students. Studies were identified through searches in five electronic databases (PubMed, EMBASE, Web of Science, PsycINFO and Cochrane Central). We included studies examining the effect of CBT compared with control conditions, alternative interventions, and multi-modal interventions that combined cognitive-behavioral and other therapeutic approaches. We combined effect sizes (Hedge's g) using random-effects models at post-intervention and three follow-up assessments. 20 trials (n = 2185) met our inclusion criteria, resulting in 23 comparisons between a CBT condition and a comparison condition. At post-intervention, CBT was found more effective than control conditions (g = 0.48; 95% CI: 0.31, 0.66). In particular, CBT administered to high-risk students produced a larger effect size than those administered to low-risk students. The effect of CBT was largely maintained at 6 months follow-up (g = 0.52; 95% CI: 0.06, 0.99), but not at 12 months follow-up (g = 0.09; 95% CI: −0.10, 0.27). There were few indications that CBT was more or less effective than alternative interventions. We did not find adding other components to CBT produced stronger effects than CBT alone. Despite few indications for the superiority of CBT to other interventions, CBT could be still proposed as a promising candidate for addressing depressive symptoms among college students in the short term, particularly for those endorsing higher risk. Further research applying rigorous methods is needed to confirm and extend the findings of this meta-analysis.

A preliminary test of a brief intervention to lessen young adults' cannabis use: Episode-level smartphone data highlights the role of protective behavioral strategies and exercise.

Brief interventions are increasingly being used to help young adults to moderate their cannabis use. We conducted a randomized clinical trial of a brief (4 weekly sessions), in-person intervention that included a smartphone application that reinforced the use of protective behavioral strategies (PBSs) to lessen cannabis use. Young adults (N = 37; 24 men) who regularly used cannabis were randomized to 2 intervention conditions rooted in cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET). Along with learning CBT + MET strategies, participants in 1 of the conditions were instructed to engage in exercise. All participants used smartphone-based ecological momentary assessment to provide episode-level reports about use of cannabis and PBSs. Two multilevel structural equation models were run to test the study hypotheses that (a) cannabis use would be reduced over the course of the 6-month study, (b) reductions would be moderated by intervention condition, and (c) episode-level PBS use would predict episode-level cannabis use. Participants reduced their cannabis use by approximately 1 half of a standard joint per time point. The MET + CBT + Exercise condition reduced cannabis use to a greater degree than did the MET + CBT condition. With episode-level PBS use in the model, reductions in cannabis use were independent of intervention condition. Our findings suggest that young adults will engage with a smartphone app that serves as a component of an in-person intervention to moderate their cannabis use. Intervention content that promotes the use of PBSs and exercise facilitates reductions in cannabis use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cognitive-behavior therapy with and without parental involvement for anxious Chinese adolescents: A randomized controlled trial.

This study evaluated the effectiveness of a culturally attuned group cognitive-behavior therapy (CBT) intervention for Chinese adolescents at risk for anxiety disorders in Hong Kong and the additive effects of parental involvement. A randomized controlled design was adopted. Assessments were gathered at pre- and posttreatment, and 6-month follow-up. Participants (N = 136) were randomly assigned to (a) CBT plus parental involvement (CBT-PI) (n = 46), (b) CBT (n = 45), and (c) social activity (n = 45) conditions. Data were analyzed according to the intention-to-treat principle using multilevel modeling. The CBT-PI condition showed a greater reduction in physical injury fears compared with the CBT condition. The current findings suggest that involving parents in CBT for Chinese adolescents with anxiety problems may provide a small improvement in treatment efficacy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A randomized controlled trial of a six-session cognitive behavioral treatment of emotional disorders in adolescents 14\u201317\u2009years old in child and adolescent mental health services (CAMHS)

BackgroundThis study aims to investigate effectiveness of a 6-week, transdiagnostic cognitive behavioral therapy (CBT) for anxiety and depression in adolescents, the Structured Material for Therapy (SMART), in naturalistic settings of child and adolescent mental health outpatient services (CAMHS).MethodsA randomized controlled trial with waiting list control (WLC) was performed at three community CAMHS in Norway. Referred adolescents (N = 163, age = 15.72, 90.3% girls) scoring 6 or more on the emotional disorders subscale of the Strengths and Difficulties Questionnaire (SDQ) were randomly assigned to SMART or to WLC.ResultsIn the treatment group (CBT), 32.9% improved in the main outcome measure (SDQ), compared to 11.6% in the WLC. Clinically significant and reliable change was experienced by 17.7% in the CBT condition, compared to 5.8% in the WLC. No patients deteriorated. Statistically significant treatment effects were achieved for internalization symptoms, anxiety symptoms and general functioning.ConclusionsThese promising findings indicate that SMART may be considered as a first step in a stepped care model for anxiety and/or depression treatment in CAMHS. The recovery rates imply that further investigations into the effectiveness of brief treatments should be made. Furthermore, there is a need for more comprehensive second-stage treatments for some of these patients.Trial registrationClinicalTrials.gov Identifier: NCT02150265. First registered May 292,014.

Treatment Satisfaction and Therapeutic Alliance in Three Different Treatment Groups for Test Anxiety

Three group treatments for university students (N = 81) with test anxiety were compared to test if treatment satisfaction and therapeutic alliance differed between groups, while taking into account the actual reduction of test anxiety and the perceived engagement of the group as possible confounding factors. Two groups offered cognitive behavioral therapy (CBT), one of them included Imagery Rescripting (CBT+ImRs; n = 30), the other relaxation techniques (CBT+R; n = 20). The third group was a therapist assisted self-help group (SH; n = 31). An covariate analysis of variance (ANCOVA) with planned contrasts, controlling for the covariates group engagement and symptom reduction, revealed that students in the CBT groups were significantly more satisfied than in the SH group (t(76) = −5.27, p = .001, r = .52). Furthermore, we could find in a second ANCOVA that the CBT+ImRs group showed higher therapeutic alliance scores compared to the CBT+R (t(78) = −2.05, p = .044, r = .23), while both CBT conditions showed higher alliance scores than the SH group (t(78) = −3.16, p = .002, r = .34).

Effectiveness of enhanced cognitive behavior therapy for eating disorders: A randomized controlled trial.

ObjectiveEnhanced cognitive behavior therapy (CBT‐E) is a transdiagnostic treatment suitable for the full range of eating disorders (EDs). Although the effectiveness of CBT(‐E) is clear, it is not being used as widely in clinical practice as guidelines recommend. The aim of the present study was to compare the effectiveness of CBT‐E with treatment as usual (TAU), which was largely based on CBT principles.MethodWe conducted a randomized controlled trial on a total of 143 adult patients with an ED who received either CBT‐E or TAU. The primary outcome was recovery from the ED. Secondary outcome measures were levels of ED psychopathology, anxiety, and depressive symptoms. Self‐esteem, perfectionism, and interpersonal problems were repeatedly measured to examine possible moderating effects. We explored differences in duration and intensity between conditions.ResultsAfter 80 weeks, there were no differences between conditions in decrease in ED psychopathology, or symptoms of anxiety and depression. However, in the first six weeks of treatment there was a larger decrease in ED psychopathology in the CBT‐E condition. Moreover, when the internationally most widely used definition of recovery was applied, the recovery rate at 20 weeks of CBT‐E was significantly higher (57.7%) than of TAU (36.0%). At 80 weeks, this difference was no longer significant (CBT‐E 60.9%; TAU 43.6%). Furthermore, CBT‐E was more effective in improving self‐esteem and was also the less intensive and shorter treatment.DiscussionWith broader use of CBT‐E, the efficiency, accessibility and effectivity (on self‐esteem) of treatment for EDs could be improved.

Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies.

ObjectiveTo compare effects of physical exercise and dietary therapy (PED‐t) to cognitive behavioral therapy (CBT) in treatment of bulimia nervosa (BN) and binge‐eating disorder (BED).MethodThe active sample (18–40 years of age) consisted of 76 women in the PED‐t condition and 73 in the CBT condition. Participants who chose not to initiate treatment immediately (n = 23) were put on a waiting list. Outcome measures were the eating disorder examination questionnaire (EDE‐Q), Clinical Impairment Assessment (CIA), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), and numbers in remission at posttreatment, and at 6‐, 12‐, and 24‐months follow‐up.ResultsBoth treatment conditions produced medium to strong significant improvements on all outcomes with long‐term effect. The PED‐t produced a faster improvement in EDE‐Q and CIA, but these differences vanished at follow‐ups. Only PED‐t provided improvements in BDI, still with no between‐group difference. Totally, 30–50% of participants responded favorable to treatments, with no statistical between‐group difference.DiscussionBoth treatments shared a focus on normalizing eating patterns, correcting basic self‐regulatory processes and reducing idealized aesthetic evaluations of self‐worth. The results point to the PED‐t as an alternative to CBT for BN and BED, although results are limited due to compliance and dropout rates. Replications are needed by independent research groups as well as in more clinical settings.