Cognitive Behavioural Therapy For People Research Articles

Cost-utility analysis of transdiagnostic cognitive behavioural therapy for people with persistent physical symptoms in contact with specialist services evaluated in the PRINCE secondary trial

ObjectiveTo compare the cost-utility of transdiagnostic cognitive behavioural therapy (TDT-CBT) plus standardised medical care (SMC) to SMC alone to support people with persistent physical symptoms in contact with specialist services. MethodsThis study compared the cost-utility of TDT-CBT. A two-arm randomised controlled trial was conducted in secondary care settings. Participants received either TDT-CBT + SMC or SMC alone. Measures were taken at baseline and at 9-, 20-, 40-, and 52-week follow-up. Service use was measured, and costs calculated. Costs were combined with quality-adjusted life years (QALYs) based on the EQ-5D-5L using incremental cost-utility ratios with uncertainty addressed using cost-effectiveness planes and acceptability curves. ResultsThe costs during the follow-up period were £3473 for TDT-CBT + SMC and £3104 for SMC alone. The incremental cost for TDT-CBT + SMC adjusting for baseline was £482 (95 % CI, −£399 to £1233). QALYs over the follow-up were 0.578 for TDT-CBT + SMC and 0.542 for SMC alone. The incremental QALY was 0.038 (95 % CI, −0.005 to 0.080). The incremental cost per QALY was £12,684 for TDT-CBT + SMC. There was a 68.3 % likelihood that TDT-CBT + SMC was the most cost-effective option at a threshold of £20,000 per QALY. ConclusionAdding TDT-CTB to SMC results in slightly increased costs and slightly better outcomes in terms of QALYs. This represents a cost-effective option based on the conventional QALY threshold value.

Patient-Oriented Research to Improve Internet-Delivered Cognitive Behavioural Therapy for People of Diverse Ethnocultural Groups in Routine Practice.

There has been limited research on improving Internet-delivered Cognitive Behavioural Therapy (ICBT) in routine online therapy clinics that serve people from diverse ethnocultural groups (PDEGs). This article describes a patient-oriented adaptation approach used to address this gap in research. A working group consisting of people with lived experience, community representatives, ICBT clinicians, managers, and researchers was formed. The working group examined archival feedback on ICBT from past patients who self-identified as being from diverse ethnocultural backgrounds (N = 278) and the results of interviews with current patients (N = 16), community representatives (N = 6), and clinicians (N = 3). The archival data and interviews revealed the majority of the patients reported being satisfied with and benefitting from ICBT. Suggestions for improvement were not related to the cognitive-behavioural model and techniques, but rather to making treatment materials more inclusive. Consequently, the ICBT adaptation focused on adding content related to cultural influences on mental health, addressing stigma, diversifying case stories, examples, and imagery, adding audiovisual introductions, and replacing English idioms with more descriptive language. Moreover, further training was offered to clinicians, and efforts were made to improve community outreach. This study demonstrates a process for using patient-oriented research to improve ICBT within routine care serving patients of diverse backgrounds.

Online cognitive behavioral therapy for prolonged grief after traumatic loss: a randomized waitlist-controlled trial

ABSTRACT Prolonged grief disorder, a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Prolonged grief symptoms can be effectively treated with face-to-face or internet-delivered cognitive behavioral therapy. Traumatic losses may elicit higher prevalence of severe grief reactions. While face-to-face cognitive behavioral therapy appears efficacious in treating prolonged grief symptoms in traumatically bereaved individuals, it is not yet clear if internet-based cognitive behavioral therapy is efficacious for this population. Therefore, we investigated the efficacy of a 12-week internet-delivered cognitive behavioral therapy for people bereaved through traffic accidents in a randomized waitlist-controlled trial (registration number: NL7497, Dutch Trial Register). Forty adults bereaved though a traffic accident were randomized to internet-based cognitive behavioral therapy (n = 19) or a waitlist control condition (n = 21). Prolonged grief, post-traumatic stress, and depression symptoms were assessed at baseline, post-treatment, and 8-week follow-up. Dropout in the treatment condition was relatively high (42%) compared to the control condition (19%). Nevertheless, multilevel analyses showed that internet-based cognitive behavioral therapy strongly reduced prolonged grief, post-traumatic stress, and depression symptoms relative to the control condition at post-treatment and follow-up. We conclude that internet-based cognitive behavioral therapy appears a promising treatment for traumatically bereaved adults.

The Clinical Impact and Cost-Effectiveness of Clinic-Based Cognitive Behavioral Therapy for People With HIV, Depression, and Virologic Failure in South Africa.

Depression affects 25%-30% of people with HIV (PWH) in the Republic of South Africa (RSA) and is associated with both antiretroviral therapy (ART) nonadherence and increased mortality. We evaluated the cost-effectiveness of task-shifted, cognitive behavioral therapy (CBT) for PWH with diagnosed depression and virologic failure from a randomized trial in RSA. RSA. Using the Cost-Effectiveness of Preventing AIDS Complications model, we simulated both trial strategies: enhanced treatment as usual (ETAU) and ETAU plus CBT for ART adherence and depression (CBT-AD; 8 sessions plus 2 follow-ups). In the trial, viral suppression at 1 year was 20% with ETAU and 32% with CBT-AD. Model inputs included mean initial age (39 years) and CD4 count (214/μL), ART costs ($7.5-22/mo), and CBT costs ($29/session). We projected 5- and 10-year viral suppression, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs: $/QALY [discounted 3%/yr]; cost-effectiveness threshold: ≤$2545/QALY [0.5× per capita GDP]). In sensitivity analyses, we determined how input parameter variation affected cost-effectiveness. Model-projected 5- and 10-year viral suppression were 18.9% and 8.7% with ETAU and 21.2% and 9.7% with CBT-AD, respectively. Compared with ETAU, CBT-AD would increase discounted life expectancy from 4.12 to 4.68 QALYs and costs from $6210/person to $6670/person (incremental cost-effectiveness ratio: $840/QALY). CBT-AD would remain cost-effective unless CBT-AD cost >$70/session and simultaneously improved 1-year viral suppression by ≤4% compared with ETAU. CBT for PWH with depression and virologic failure in RSA could improve life expectancy and be cost-effective. Such targeted mental health interventions should be integrated into HIV care.

Linguistic predictors of symptom change in an internet-based cognitive behavioural intervention for prolonged grief symptoms.

This study investigates linguistic predictors of reduction in prolonged grief symptoms following a writing intervention in an internet-based cognitive behavioural therapy for people bereaved by cancer. Data stem from a randomized control clinical trial with 70 people. The Linguistic Inquiry and Word Count program was used to analyse patient language. Absolute change scores and reliable change index were used to calculate reduction in grief symptoms and clinical significant change. Best subset regression and Mann-Whitney U tests were conducted. A higher reduction of prolonged grief symptoms was correlated with more social words in the first module (β = -.22, p = .042), less risk (β = .33, p = .002) and body words (β = .22, p = .048) in the second module and more time words in the third module (β = -.26, p = .018). Patients with clinically significant change showed a higher median in function words in the first module (p = .019), a lower median in risk words in the second module (p = .019) and a higher median in assent words in the last module (p = .014) compared to patients without clinically significant change. Findings suggest that it may be beneficial for therapists to encourage a more detailed description of patients' relationship with their deceased relative during the first module, a change in perspective during the second module and a summary of past, present and future aspects at the end of therapy. Future studies should include mediation analyses to allow causal attribution of the studied effects.

Adapting cognitive behaviour therapy for people with intellectual disabilities: an overview for therapist working in mainstream or specialist services

Abstract This paper is an introduction to adaptations to make cognitive behaviour therapy (CBT) more accessible to people with intellectual disabilities. It is intended to inform therapists who may work with people with intellectual disabilities in mainstream services. The paper describes adaptations that consider neuropsychological processes, such as memory, and executive functions, such as planning, problem solving and self-regulation, and identifies that these factors are not unique to people with intellectual disabilities. We describe adaptations based on a review of literature describing CBT for people with intellectual disabilities (Surley and Dagnan, 2019) and draw on clinical experience to give examples of adaptations where possible. The paper particularly emphasises the generalisability of adaptations used with people with intellectual disabilities to therapy with wider populations and suggests that CBT therapists working in mainstream services will have the skills to be able to adapt therapy for people with intellectual disabilities. Key learning aims (1) To overview the evidence base supporting the use of CBT with people with intellectual disabilities. (2) To describe the epidemiology of intellectual disability and discuss its implications for the generalisability of adaptations discussed in this paper. (3) To describe a range of adaptations to make CBT more accessible people with intellectual disabilities. (4) To consider whether such adaptations are part of the skill set of CBT therapists mainly working with people without intellectual disabilities.

Cognitive behavioural therapy (group) for schizophrenia.

Cognitive behavioural therapy (group) for schizophrenia.

Telephone-Supported Internet-Based Cognitive Behavioral Therapy for People With Depression: Users’ Perspective

Background Little is known from the perspective of service users on the quality and benefits of receiving telephone counseling in a guided Internet-based Cognitive Behavioral Therapy (iCBT). Purpose This study aimed to investigate, from the user’s perspective, the feasibility, quality, and benefits of a telephone-supported iCBT which provided eight self-learned online modules and weekly telephone counseling from a social worker for people with depression. Research design This study adopted interpretive qualitative research, involving semi-structural in-depth individual interviews with participants. Study sample Purposive sampling method was adopted, involving ten adults receiving a diagnosis of depression and completing the telephone-supported iCBT. Data collection and/or analysis Qualitative content analysis was adopted, involving coding data and identifying themes. Results The telephone-supported iCBT was appreciated by service users by offering convenience, efficiency, anonymity, privacy, synchronous and asynchronous support. Additionally, the counselor demonstrated competence in counseling via telephone, and provided various support, including: delivering CBT, handling personal issues outside the scope of iCBT, encouragement, guiding & monitoring learning progress, and solving technical difficulties. Perceived outcomes included improved abilities in cognitive restructuring, emotion regulation, and self-awareness. Conclusions The guided iCBT with telephone-supported is a feasible, effective, and preferable intervention for people with depression in Chinese societies.

Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network

ObjectiveCritical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change. MethodFour case examples illustrate how MHTTCs employ the Exploration-Preparation-Implementation-Sustainment (EPIS) implementation framework and intensive implementation strategies to educate clinicians, manage change, and improve processes. These examples include implementing motivational interviewing, cognitive-behavioral therapy for people with psychosis, strategies to decrease the no show rate for virtual appointments, and school mental health systems development. ResultsFrom Preparation through Sustainment, MHTTCs successfully employed implementation strategies including learning communities, audit and feedback, and coaching to bring about change. Each project attended to inner and outer contexts to eliminate barriers. The examples also show the benefit of integrating process improvement alongside implementation. ConclusionsThe MHTTCs are a model for using implementation science to design technical assistance that leads to more successful practical execution of EBPs; thus reducing the gap between research and practice.

Mindfulness-based therapy versus cognitive behavioral therapy for people with anxiety symptoms: a systematic review and meta-analysis of random controlled trials.

Mindfulness-based interventions (MBIs) and cognitive behavioral therapy (CBT) have both been shown to be effective treatment approaches for anxiety. The purpose of this paper was to directly investigate the ability of MBIs and CBT to improve anxiety symptoms (primary outcome), as well as depression symptoms and sleep quality (second outcome). We searched the following electronic databases from 1st December, 2019 to 14th January 2021: English databases including PubMed, PsycINFO, Web of Science, the Cochrane Library, Elsevier, Springer Link, Wiley Online Library, ClinicalTrails, and Embase, and Chinese database including CNKI, WANFANG, and CQVIP. The eligibility criteria included the following: (I) patients with anxiety disorders or symptoms of anxiety; and those with physical or mental disorders with comorbid anxiety symptoms; (II) randomized controlled trial (RCT) design; (III) the treatment group received MBIs; (IV) the control group received CBT; and (V) the treatment outcomes were anxiety, depression, and sleep quality. In total, 4,095 abstracts were reviewed. Of these, the full-texts of 45 articles were read in detail; and 11 RCTs were finally included in the analysis. Upon completion of MBIs and CBT group sessions, the study outcomes (mean anxiety, depression, and sleep quality scores) revealed no difference between MBIs and CBT with regards to anxiety, depression, and sleep quality post-intervention. Subgroup analysis was also performed, and the results indicated that MBIs may provide a small advantage for people with anxiety symptoms compared to CBT [standard mean difference (SMD): -0.36, 95% confidence interval (CI): -0.66 to -0.06], while the CBT group demonstrated a small comparative advantage for anxiety in the Liebowitz Social Anxiety Scale (LSAS) and Social Phobia Inventory (SPIN) scales, as well as mindfulness-based stress reduction (MBSR) in the types of MBIs (LSAS: SMD: 0.35, 95% CI: 0.08 to 0.63; SPIN: SMD: 0.51, 95% CI: 0.11 to 0.92; MBSR: SMD: 0.41, 95% CI: 0.07 to 0.74). There was no significant difference between MBIs and CBT in terms of the treatment outcomes of anxiety, depression, and sleep quality. MBIs could be used as an alternative intervention to CBT for anxiety symptoms. This meta-analysis was conducted in line with the PRISMA guideline and was registered at PROSPERO https://www.crd.york.ac.uk/PROSPERO/ (CRD42021219822).

Video games for people with schizophrenia.

Video games for people with schizophrenia.

Cognitive Behaviour Therapy for People with Intellectual Disabilities—How Far Have We Come?

This review paper reflects on the existing literature on cognitive behaviour therapy for adults, adolescents and children with intellectual disabilities. People with intellectual disabilities have high rates of comorbid mental health disorders, but low rates of accessing treatments with limited treatment options available to them. Historically, they have been excluded from cognitive-based therapies such as cognitive behaviour therapy. However, recent research has shown that people with mild to moderate intellectual disabilities do have the capacity to engage in cognitive-based interventions. The review highlights the progress that has been made in the field of adapting CBT for people with intellectual disabilities, as well as the current gaps in the literature and suggestions for future research.

Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review.

Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from −0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from −0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resource-intensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.

Feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy for people with persistent dizziness

PurposeTo evaluate the feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy (VR-CBT) for people with persistent dizziness in primary care.DesignProspective single-group pre- and post-test study.ParticipantsAdults (aged 18–70) with acute onset of dizziness and symptoms lasting a minimum 3 months, recruited from Bergen municipality.MethodsParticipants attended eight weekly group sessions of VR-CBT intervention. Feasibility outcomes consisted of recruitment and testing procedures, intervention adherence, and participant feedback, besides change in primary outcomes. The primary outcomes were Dizziness Handicap Inventory (DHI) and preferred gait velocity.ResultsSeven participants were recruited for the study. All participants completed the pre-treatment tests, five participants completed the intervention and answered post-treatment questionnaires, and three completed post-treatment testing. Of the five participants, three attended at least 75% of the VR-CBT sessions, and two 50% of the sessions. Participants reported that the VR-CBT was relevant and led to improvement in function. DHI scores improved beyond minimal important change in two out of five participants, and preferred gait velocity increased beyond minimal important change in two out of three participants.ConclusionThe current tests and VR-CBT treatment protocols were feasible. Some changes are suggested to optimise the protocols, before conducting a randomised controlled trial.Trial registrationNCT02655575. Registered 14 January 2016—retrospectively registered

The Effectiveness of Cognitive Behavioral Therapy for People with Depression Following Stroke: A Systematic Review and Meta-Analysis

Post-stroke depression (PSD) is a common psychiatric manifestation of stroke, which has a devastating impact on survivors’ quality of life with an increasing burden on caregivers and the public medical system. Even so, no meta-analysis on specific psychotherapeutic treatment has been conducted. How effective is cognitive behavioral therapy (CBT) in reducing depressive symptoms in randomized-controlled trials (RCTs) targeting community-dwelling stroke survivors with PSD? Through systematic procedures of screening and data extraction, four RCTs were synthesized for meta-analysis (N= 270) on effect size estimates. Overall, CBT groups showed significant improvement in depression compared with controls. Methodological quality, intensity of CBT, and duration of post-treatment follow-up proved critical to treatment effects. Despite the potential threat of external validity, this paper had reviewed their content comprehensively with the implication of facilitating public understanding, research, and service development of PSD using CBT. To fill the knowledge gap, standardized protocol and further subgroup analyses are necessary.

Research Watch: therapists’ working conditions and their implications for service users’ social inclusion

Purpose The purpose of this paper is to highlight possible implications of therapists’ working conditions on social inclusion of service users. Design/methodology/approach A search was carried out for recent papers on cognitive behaviour therapy (CBT) therapists. Findings One study highlighted that over half of their sample of 201 UK therapists in Improving Access to Psychological Therapy (IAPT) services reported burnout. In a second study, in interviews with ten IAPT workers in inner London services, therapists said they had to fight for extra time to adapt CBT for people who had learning disabilities, and the additional stress made them feel less positive about working with these clients. A third study, on therapists working with people with multiple sclerosis, highlights the importance of adapting CBT for people with physical conditions. Originality/value Taken together, these three papers highlight concerning implications of current working conditions for many therapists working in IAPT services. They highlight that sources of stress include services’ rigid focus on targets and inability to make expected adjustments. With regard to the UK, this may be due to the current national service model, but it has implications for the social inclusion of some service users.

Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia.

Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to help individuals re-evaluate their appraisals of their experiences that can affect their level of distress and problematic behaviour. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. Other psychosocial therapies that are often less expensive are also available as an add-on treatment for people with schizophrenia. This review is also part of a family of Cochrane Reviews on CBT for people with schizophrenia. To assess the effects of CBT compared with other psychosocial therapies as add-on treatments for people with schizophrenia. We searched the Cochrane Schizophrenia Group's Study Based Register of Trials (latest 6 March, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. We selected randomised controlled trials (RCTs) involving people with schizophrenia who were randomly allocated to receive, in addition to their standard care, either CBT or any other psychosocial therapy. Outcomes of interest included relapse, global state, mental state, adverse events, social functioning, quality of life and satisfaction with treatment. We included trials meeting our inclusion criteria and reporting useable data. We reliably screened references and selected trials. Review authors, working independently, assessed trials for methodological quality and extracted data from included studies. We analysed dichotomous data on an intention-to-treat basis and continuous data with 60% completion rate. Where possible, for binary data we calculated risk ratio (RR), for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CIs). We used a fixed-effect model for analyses unless there was unexplained high heterogeneity. We assessed risk of bias for the included studies and used the GRADE approach to produce a 'Summary of findings' table for our main outcomes of interest. The review now includes 36 trials with 3542 participants, comparing CBT with a range of other psychosocial therapies that we classified as either active (A) (n = 14) or non active (NA) (n = 14). Trials were often small and at high or unclear risk of bias. When CBT was compared with other psychosocial therapies, no difference in long-term relapse was observed (RR 1.05, 95% CI 0.85 to 1.29; participants = 375; studies = 5, low-quality evidence). Clinically important change in global state data were not available but data for rehospitalisation were reported. Results showed no clear difference in long term rehospitalisation (RR 0.96, 95% CI 0.82 to 1.14; participants = 943; studies = 8, low-quality evidence) nor in long term mental state (RR 0.82, 95% CI 0.67 to 1.01; participants = 249; studies = 4, low-quality evidence). No long-term differences were observed for death (RR 1.57, 95% CI 0.62 to 3.98; participants = 627; studies = 6, low-quality evidence). Only average endpoint scale scores were available for social functioning and quality of life. Social functioning scores were similar between groups (long term Social Functioning Scale (SFS): MD 8.80, 95% CI -4.07 to 21.67; participants = 65; studies = 1, very low-quality evidence), and quality of life scores were also similar (medium term Modular System for Quality of Life (MSQOL): MD -4.50, 95% CI -15.66 to 6.66; participants = 64; studies = 1, very low-quality evidence). There was a modest but clear difference favouring CBT for satisfaction with treatment - measured as leaving the study early (RR 0.86, 95% CI 0.75 to 0.99; participants = 2392; studies = 26, low quality evidence). Evidence based on data from randomised controlled trials indicates there is no clear and convincing advantage for cognitive behavioural therapy over other - and sometimes much less sophisticated and expensive - psychosocial therapies for people with schizophrenia. It should be noted that although much research has been carried out in this area, the quality of evidence available is mostly low or of very low quality. Good quality research is needed before firm conclusions can be made.

Book review: Cognitive Behaviour Therapy for People with Intellectual Disability: Thinking Creatively

Book review: Cognitive Behaviour Therapy for People with Intellectual Disability: Thinking Creatively

Cognitive Behaviour Therapy for People with Intellectual Disabilities

Cognitive Behaviour Therapy for People with Intellectual Disabilities

Video games for schizophrenia

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To review the effects of video games as a comparison for standard care or other interventions including, but not limited to, cognitive remediation or cognitive behavioural therapy for people with schizophrenia or schizophrenia-like illnesses.