Group Cognitive Behavioral Therapy Research Articles

The effect of cognitive-behavioral therapy and sexual health education on sexual assertiveness of newly married women

BackgroundThe present study aimed at investigating the effect of sexual health education and cognitive-behavioral therapy (CBT) on sexual assertiveness (primary outcome) and sexual satisfaction (secondary outcome) of newly married women.MethodThis RCT was conducted on 66 newly married women with cases in pre-marriage counseling centers in Tabriz, Iran. Participants were assigned into three groups using block randomization. Eight group sessions of CBT were held for one of the intervention groups (n = 22) and 5–7 sessions of sexual health education for other intervention group (n = 22). The control group (n = 22) received neither education nor counseling during the research. The data were collected using the demographic and obstetric characteristics, Hulbert sexual assertiveness index, and Larson sexual satisfaction questionnaires, and analyzed using ANOVA and ANCOVA tests.ResultsThe mean (standard deviation: SD) score of the sexual assertiveness and sexual satisfaction in the CBT group enhanced from 48.77 (13.94) and 73.13 (13.53) before the intervention to 69.37 (7.28) and 86.57 (7.5) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the sexual health education group increased from 48.9(11.39) and 74.95 (8.30) before the intervention to 66. 94 (7.42) and 84.93 (6.34) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the control group changed from 45.04 (15.87) and 69.04 (10.75) before the intervention to 42.74 (14.11) and 66.44 (10.11) after the intervention, respectively. Eight weeks after the intervention, the mean scores of sexual assertiveness and sexual satisfaction in two intervention groups were more than that in the control group (P < 0.001), However, there was no significant difference between the two intervention groups (P > 0.05).ConclusionThe results of this research indicated that CBT and sexual health education are effective in improving women’s sexual assertiveness and sexual satisfaction. Considering that sexual health education, does not require complex counseling skills compared to CBT, it can be used as a preferred intervention in promoting sexual assertiveness and satisfaction of newly married women.Trial registrationIranian Registry of Clinical Trials: IRCT20170506033834N8. Date of registration: 11.09.2021. URL: http://en.irct.ir.

Efficacy of Cognitive Behavior Therapy in Reducing Depression among Patients with Coronary Heart Disease: An Updated Systematic Review and Meta-Analysis of RCTs.

The aim of this review is to identify the efficacy of cognitive behavior therapy (CBT) and the characteristics of CBT therapy that effectively improve depression among patients with coronary heart disease (CHD). Studies that assessed CBT efficacy in decreasing depression among CHD patients with randomized controlled trials (RCTs) were searched through PsycINFO, PubMed, CINAHL, Academic Search Complete, Scopus, and Google Scholar. Two reviewers independently screened and critically appraised them using the Cochrane risk-of-bias tool. The fixed- and random-effect models were applied to pool standardized mean differences. Fourteen RCTs were included in the quantitative analysis. Depression was significantly lower in the CBT group (SMD -0.37; 95% CI: -0.44 to -0.31; p < 0.00001; I2 = 46%). Depression in the CBT group was significantly lower in the short-term follow-up (SMD -0.46; 95% CI: -0.69 to -0.23; p < 0.0001; I2 = 52%). Moreover, the subsequent therapy approaches were effective in reducing depression, including face-to-face and remote CBT, CBT alone or combination therapy (individual or mixed with a group), and frequent meetings. CBT therapy effectively reduces depression, particularly in short-term follow-up. The application of CBT therapy in CHD patients should consider these findings to increase the efficacy and efficiency of therapy. Future research is needed to address generalizability.

Effectiveness of Cognitive-Behavioral Therapy on Body Shaming and Self-Criticism of Obese Adolescents Referred to Nutrition Clinics in Tehran in 2019

Objective: Obesity is one of the most frequent concerns among teenagers, and it may lead to a variety of chronic disorders including heart disease and cancer. The present study aimed to assess the effectiveness of cognitive-behavioral therapy (CBT) on body shay and self-criticism of obese adolescents referred to nutrition clinics in Tehran in 2019.&#x0D; Materials and Methods: This study used a quasi-experimental method and a pre-test-post-test with a control group. Twenty-four obese volunteer adolescents were selected and assigned to an experimental group (n=12) and a control group (n=12). The experimental group received 90-minute weekly sessions for 2.5 months (10 sessions), while the control group did not receive any intervention. Before and after the training phase, all the participants completed the body image shame scale (BISS ) and the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS). Data were analyzed through multivariate analysis of variance (ANCOVA) by using SPSS 22 software.&#x0D; Results: The CBT group decreased significantly more in body shaming and self-criticism of obese adolescents compared with the control group (P&lt; 0.001).&#x0D; Conclusion: In general, the findings revealed a substantial difference in body shaming and self-criticism among obese teenagers between the experimental groups. In obese teens, CBT reduced body shaming and self-criticism. Furthermore, this research showed that CBT could help obese teenagers with body shaming and self-criticism.

Cognitive-behavioral therapy and exercise training in adolescent females with elevated depression symptoms and at-risk for type 2 diabetes: Protocol for a randomized controlled trial

BackgroundAdolescent-onset type 2 diabetes (T2D) is a major public health concern of growing proportions. Prevention, therefore, is critical. Unfortunately, standard-of-care treatment for T2D prevention (e.g., exercise training) show insufficient effectiveness and do not address key modifiable barriers (e.g., depression symptoms) to exercise engagement. Depression symptoms are associated with both poorer physical fitness and greater insulin resistance, the key risk factor in adolescent-onset T2D. Thus, a targeted prevention approach that addresses depression symptoms in combination with exercise training may offer a novel approach to mitigating T2D risk. MethodsThis manuscript describes the design and study protocol for a multi-site, four-arm randomized controlled trial comparing the efficacy of group cognitive-behavioral therapy, group exercise training, and their combinations for the targeted prevention of worsening insulin resistance in N = 300 adolescent females at-risk for T2D with BMI ≥85th percentile and elevated depression symptoms. All four intervention arms will run in parallel and meet weekly for 1 h per week for 6-week to 6-week segments (12 weeks total). Outcomes are assessed at baseline, 6-week mid-treatment, 12-week follow-up, and 1-year follow-up. ResultsThe primary outcome is insulin resistance. Key secondary outcomes include insulin sensitivity, cardiorespiratory fitness, physical activity, depression symptoms, and body measurements. ConclusionStudy findings will guide the ideal sequencing of two brief T2D prevention interventions for ameliorating the course of insulin resistance and lessening T2D risk in vulnerable adolescents. These interventions will likely be cost-effective and scalable for dissemination, having the potential for significant public health impact on communities at risk for T2D.

Cognitive Behavioral Group Therapy for Chronic Tinnitus in a German Tertiary Clinical Real-World Setting.

Cognitive behavioral therapy (CBT) was shown to be effective in reducing tinnitus-related distress in numerous controlled trials. Real-world data from tinnitus treatment centers are an important addition to controlled trials for demonstrating the ecological validity of the results from the randomized controlled trials. Thus, we provided the real-world data of 52 patients participating in CBT group therapies during the time period from 2010 to 2019. The groups consisted of five to eight patients with typical CBT content such as counseling, relaxation, cognitive restructuring, attention training, etc. applied through 10-12 weekly sessions. The mini tinnitus questionnaire, different tinnitus numeric rating scales and the clinical global impression were assessed in a standardized way and were analyzed retrospectively. All outcome variables showed clinically relevant changes from before to after the group therapy, which were still evident in the follow-up visit after three months. Amelioration of distress was correlated to all numeric rating scales, including tinnitus loudness but not annoyance. The observed positive effects were in a similar range as effects of controlled and uncontrolled studies. Somewhat unexpected was the observed reduction in loudness, which was associated with distress and the missing association of changes in distress with annoyance as it is generally assumed that standard CBT concepts reduce annoyance and distress, but not tinnitus loudness. Apart from confirming the therapeutic effectiveness of CBT in real-world settings, our results highlight the need for a clear definition/operationalization of outcome measures when investigating psychological interventions of tinnitus.

Group cognitive behavioural therapy for insomnia: impact on psychiatric symptoms and insomnia severity in a psychiatric outpatient setting

ABSTRACT Objective Insomnia, even when comorbid with other diagnoses is an independent health issue that warrants treatment. Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment. Although the science is clear that CBT-I supports outcomes for those with mental ill health, the routine use of CBT-I in mental health contexts is rare. Implementation research on CBT-I in the psychiatric context is urgently needed. This study evaluated group CBT-I as routinely delivered in a psychiatric hospital service. Methods Adult outpatients (N = 76; M age = 50.20 years; female = 57; psychiatric comorbidity = 69.74%; using sleep medication = 76%) referred for insomnia treatment attended four sessions of group CBT-I. Standardised questionnaires were administered pre- and post-treatment. Results Intent-to-treat analysis revealed statistically significant and clinically meaningful improvements with large effect sizes in insomnia severity (d = 2.5, r = 0.8), depression (d = 1.4, r = 0.5), anxiety (d = 1.2, r = 0.5) and stress (d = 1.2, r = 0.5) symptoms, quality of life (d = 1.4, r = 0.6), and functional impairment (d = 2.2, r = 0.7). Regression analyses indicated pre-post changes in dysfunctional beliefs about sleep accounted for significant variance in post-treatment insomnia severity. Conclusions Results supported feasibility of implementation and real-world effectiveness of CBT-I in a psychiatric setting. Cognitive models of insomnia, emphasising the role of unhelpful beliefs about sleep in insomnia treatment were supported. Future directions include the dissemination of CBT-Insomnia to improve its uptake in psychiatric care.

Effects of a online brief modified mindfulness-based stress reduction therapy for anxiety among Chinese adults: A randomized clinical trial

The COVID-19 pandemic has exacerbated anxiety and related symptoms among the general population. In order to cope with the mental health burden, we developed an online brief modified mindfulness-based stress reduction (mMBSR) therapy. We performed a parallel-group randomized controlled trial to evaluate the efficacy of the mMBSR for adult anxiety with cognitive-behavioral therapy (CBT) as an active control. Participants were randomized to mMBSR, CBT or waitlist group. Those in the intervention arms performed each therapy for 6 sections in 3 weeks. Measurements were conducted at baseline, post-treatment and 6 months post-treatment by Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Patient Health Questionnaire-15, reverse scored Cohen Perceived Stress scale, Insomnia Severity Index, and Snaith-Hamilton Pleasure Scale. 150 participants with anxiety symptoms were randomized to mMBSR, CBT or waitlist group. Post intervention assessments showed that mMBSR improved the scores of all the six mental problem dimensions (anxiety, depression, somatization, stress, insomnia, and the experience of pleasure) significantly compared to the waitlist group. During 6-month post treatment assessment, the scores of all six mental problem dimensions in the mMBSR group still showed improvement compared to baseline and showed no significant difference with the CBT group. Our results provide positive evidence for the efficacy and feasibility of an online brief modified MBSR program to alleviate anxiety and related symptoms of individuals from the general population, and the therapeutic benefits of mMBSR persisted for up to six months. This low resource-consuming intervention could facilitate the challenges of supplying psychological health therapy to large scale of population.

A COMPARISON OF EIDETIC IMAGE THERAPY WITH COGNITIVE BEHAVIOR THERAPY FOR TREATING DEPRESSIVE AND ANXIETY DISORDERS IN ADULTS: A RANDOMIZED CONTROLLED TRIAL

Background &amp; Objectives: Depression and anxiety are common mental health disorders around the world. This study aims to examine efficacy of eidetic image therapy in comparison to cognitive behavior therapy for treating depressive and anxiety disorders, and to compare the patients' dropout ratio in these therapies.&#x0D; Methods: This was a randomized controlled trial conducted from January through June 2021 in psychiatry department of Sir Ganga Ram hospital Lahore. Using DSM-5 diagnostic criteria, 60 adult patients with depressive and anxiety disorders were recruited and were randomly and equally assigned to experimental (eidetic image therapy) and control (cognitive behavior therapy) groups. These participants received respective therapies and followed. Beck Depression Inventory and Beck Anxiety Inventory were used at baseline and after conducting five therapy sessions. Paired t-test was used to compare the mean difference and p-value of &lt;0.05 was considered statistically significant.&#x0D; Results: Descriptive analysis demonstrated a major difference in dropout numbers of eidetic image therapy (9; 30 %) and cognitive behavior therapy (25; 83 %). The efficacy of both interventions was statistically incomparable due to this excessive number of dropouts in control group. However, eidetic image therapy showed a significant difference (p&lt;0.001) in pre and post therapy ratings; each patient exhibited a marked decline in depression/anxiety symptoms after taking 5 sessions.&#x0D; Conclusion: Eidetic imagery is a promising therapeutic utility for depressive and anxiety disorders. Cognitive behavior therapy is also an effective treatment methodology but this narrative is based on analysis of few cases.

Effectiveness of a cognitive-behavioral group therapy for complicated grief in relatives of patients with cancer: A randomized clinical trial.

Complicated grief can affect a large number of individuals who have lost a relative due to cancer. To assess the efficacy of a cognitive-behavioral grief therapy (CBGT) group for complicated grief (CG) in those who have lost a relative due to cancer in comparison with a psychoeducational and emotional expression intervention group (PSDEEI). A randomized clinical trial was used, in which 249 relatives of deceased cancer patients with CG were randomly assigned to CBGT or PSDEEI. Complicated grief (Inventory of Complicated Grief [ICG]), depression (Beck Depression Inventory [BDI-II]), hopelessness (Beck Hopelessness Scale [BHS]), anxiety (Beck Anxiety Inventory [BAI]) symptoms, and general health (Goldberg's General Health Questionnaire [GHQ28]) were assessed at pretreatment, posttreatment, and follow-up at 6 and 12months. The CBGT group improved significantly (p<0.001), with the scores in ICG, BDI-II, BAI, BHS, and GHQ28 (p<0.001) being higher than those for the PSDEEI group in each of the assessed moments, with high effect sizes: ICG (η2=0.16), BDI (η2=0.10), BAI (η2=0.06), BHS (η2=0.21), and GHQ28 (η2=0.21). At the 12-month follow-up, the number of cases of CG decreased by 81.1% for the CBGT group vs. 31.7% in the PSDEEI group. The CBGT treatment was effective for CG, depression, anxiety, and hopelessness symptoms and for mental health and was superior to the PSDEEI treatment.

CBT + Exercise vs Treatment as Usual in Treating Anxiety and Depression in University Students: A Pilot Study

ABSTRACT The current pilot study tested the feasibility and preliminary efficacy of a combined group cognitive behavioral therapy and exercise intervention (CBT+E), as compared to treatment as usual (TAU) for managing anxiety and mood symptoms in university students. Participants were 16 undergraduate students with at least mild anxiety, depression, or stress symptoms. Participants were randomly assigned to group CBT+E or TAU. CBT+E ran for seven weeks with group sessions held twice weekly. The first weekly session consisted of group CBT followed by 30 minutes of running and the second weekly session consisted of only group running. Findings suggest that the group CBT+E intervention is feasible in terms of retention and participation, but that recruitment strategies need to be improved. Suggestions to improve recruitment in future research are provided. Preliminary efficacy data show positive trends suggesting further pursuit of this type of intervention is important.

The Therapy Process Observational Coding System: Group cohesion scale in youth anxiety treatment: Psychometric properties.

There are no well-established measures of group cohesion, defined as the collaborative bond between group members, in group cognitive behavioral therapy (GCBT) with youth. We therefore examined the Therapy Process Observational Coding System for Child Psychotherapy-Group Cohesion Scale (TPOCS-GC), which has previously only been used with adult samples, in a youth sample. Observers coded 32 sessions from 16 groups with 83 youth aged 8 to 15 years (90.7% European White). Youth had anxiety disorders and received manualized GCBT in community clinics. We examined psychometric properties of the TPOCS-GC and its' construct validity in terms ofrelations with pretreatment variables, alliance and fidelity during treatment, and post-treatment variables. Group cohesion was measured twice during treatment (early and late). The TPOCS-GC was internally consistent (α = 0.72) and was reliably coded (M ICC = 0.61). Higher clinical severity at pretreatment predicted lower early group cohesion. Higher youth age, higher clinical severity at pretreatment, and higher youth-rated early alliance predicted lower late group cohesion. Higher therapist-rated early alliance predicted higher early group cohesion. Higher therapist-rated late alliance predicted higher late group cohesion. Higher late group cohesion predicted lower clinical severity and higher client treatment satisfaction at post-treatment. Early group cohesion did not predict any post-treatment variables. A four-item version of the TPOCS-GC can be reliably used in youth GCBT. The TPOCS-GC is distinct from, but associated with, multiple clinical variables.

Group Cognitive Behavioural Therapy for Non-Rapid Eye Movement Parasomnias: Long-Term Outcomes and Impact of COVID-19 Lockdown

Prior to the COVID-19 pandemic, we demonstrated the efficacy of a novel Cognitive Behavioural Therapy programme for the treatment of Non-Rapid Eye Movement Parasomnias (CBT-NREMP) in reducing NREM parasomnia events, insomnia and associated mood severities. Given the increased prevalence and worsening of sleep and affective disorders during the pandemic, we examined the sustainability of CBT-NREMP following the U.K.'s longest COVID-19 lockdown (6 January 2021-19 July 2021) by repeating the investigations via a mail survey in the same 46 patient cohort, of which 12 responded. The survey included validated clinical questionnaires relating to NREM parasomnia (Paris Arousal Disorder Severity Scale), insomnia (Insomnia Severity Index) and anxiety and depression (Hospital Anxiety and Depression Scale). Patients also completed a targeted questionnaire (i.e., Impact of COVID-19 Lockdown Questionnaire, ICLQ) to assess the impact of COVID-19 lockdown on NREM parasomnia severity, mental health, general well-being and lifestyle. Clinical measures of NREM parasomnia, insomnia, anxiety and depression remained stable, with no significant changes demonstrated in questionnaire scores by comparison to the previous investigatory period prior to the COVID-19 pandemic: p (ISI) = 1.0; p (HADS) = 0.816; p (PADSS) = 0.194. These findings support the longitudinal effectiveness of CBT-NREMP for up to three years following the clinical intervention, and despite of the COVID-19 pandemic.

Remote cognitive behavioral therapy for older adults with anxiety symptoms: A systematic review and meta-analysis

Introduction In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults. Methods We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire – Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively. Results Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: −0.63; 95% CI: −0.99 to −0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: −0.74; 95% CI: −1.24 to −0.25). Discussion Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults.

Cognitive behavioral therapy achieves better benefits in relieving postoperative pain and improving joint function: A systematic review and meta-analysis of randomized controlled trials

BackgroundCognitive behavioral therapy (CBT) is a structured, short-term psychotherapy approach that may have positive effects in terms of relieving postoperative pain. The main objective of this study was to determine the effect of CBT on pain and joint function in patients after total joint arthroplasty. MethodsWe searched 3 electronic databases including randomized controlled studies (RCTs) using CBT as an intervention. The main results of this study were to determine pain intensity by NRS, VAS, WOMAC pain Scale, PCS, and joint function by HHS, OKS, EQ-5D, ROM. Data extraction and quality assessment of included RCTs were independently performed by the authors and date analysis was performed by RevMan V.5.4. ResultsAmong the 605 studies, 9 RCTS were included in this systematic review and meta-analysis. The study showed that the difference between CBT and usual care groups in PCS (≤3months), NRS, VAS (≤3months) were statistically significant (P < 0.05); the difference between CBT and usual care groups in PCS (≥12months), WOMAC Pain Scale, and VAS (≥12months) were not statistically significant (P > 0.05), indicating that CBT can improve pain in patients after arthroplasty in the early term. In addition, the difference between CBT and usual care groups in OKS (≤3months), HSS, ROM (≤3months), EQ-5D (≤3months) were not statistically significant (P > 0.05); the difference between CBT and usual care groups in EQ-5D (≥12months) were statistically significant (P < 0.05), indicating that the quality of life in patients after total joint arthroplasty were improved with the extension of follow-up time. ConclusionsThis study shows that CBT can relieve pain in patients with total joint arthroplasty in the early postoperative period and improve quality of life to some extent over time.

Association between Intention to Quit School and Youth Depression: A Cluster Randomized Controlled Trial of the Effects of a Group CBT Course

ABSTRACT We investigated changes in youths’ intentions to quit school after following a group-based cognitive behaviour therapy (CBT) based intervention for depressed adolescents in upper secondary school: the Adolescent Coping with Depression Course (ACDC). Data were collected from 228 youths, 133 of whom received the 14-week ACDC intervention and 95 who received usual care (UC). Structural equation models showed that symptoms of depression at post-test positively predicted intention to quit school at six-month follow-up after the intervention ended (β = .291, p < .001). Furthermore, ACDC, which showed a decrease in depressive symptoms post-test, had an indirect effect on adolescents’ intention to quit school at six-month follow-up (indirect β = −0.117 p = .018). Hence, targeting depression and implementing effective preventive programmes may prevent dropout from upper secondary school. Such interventions should thus be investigated in future studies.

Effect of group cognitive behavioural therapy on self-efficacy and anthropometric indices among overweight and obese postpartum women

Objective: While usually associated with weight gain, pregnancy and the postpartum period are also considered as an opportunity to prevent weight gain and its complications. Therefore, the prevention of ‘excessive/unnecessary’ weight gain is a necessary issue. The aim of this study was to determine the effect of group cognitive behavioural therapy (CBT) on self-efficacy and lifestyle to control weight and anthropometric indices among overweight and obese postpartum women. Design: Quasi-experimental study. Setting: Public health centres in Izeh, Iran. Subjects: Sixty eligible women were divided into two groups of intervention (n = 30) and control (n = 30) using a simple randomisation method. A demographic questionnaire, a checklist and Weight Efficacy Lifestyle Questionnaire (WELQ) were used to collect the data. The intervention group received eight sessions of group CBT, while the control group received routine care. All variables were measured at baseline and four weeks after the completion of the intervention. Data were analysed using an independent t-test, paired t-test, chi-square and analysis of covariance using SPSS version 24. Outcomes measures: Self-efficacy, weight, height, body mass index, waist, hip, and arm circumference, waist/hip ratio,and body fat percentage were measured at baseline and 12 weeks after intervention. Results: The results showed that in the CBT group, there was a significant increase in the total score of self-efficacy and its components, while weight, body mass index, waist circumference, hip circumference, waist/hip ratio, mid-upper arm circumference and body fat percentage significantly reduced in comparison with the control group (p < 0.05). Conclusion: Cognitive behavioural therapy can improve self-efficacy, affecting weight and anthropometric indices in overweight and obese postpartum women. Therefore, CBT can be used as an adjunct to weight-loss intervention such as physical activity and diet or it can be used as a sole form of therapy to facilitate weight loss among overweight/obese postpartum women.

What explains the failure to identify replicable moderators of symptom change in social anxiety disorder?

Trials of cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) have struggled to identify replicable moderators of treatment outcome. This could be due to a genuine lack of effects, or a spurious finding caused by methodological factors such as inadequate testing of theory-driven moderators, use of small homogenous samples, failure to model non-linear relationships, and over-reliance on significance testing. We probed explanations for the field’s failure to detect moderators by testing whether 15 theory-driven and atheoretical variables moderated treatment outcome in a large heterogeneous sample treated with group CBT for SAD. Moderation was not assessed by only using p-values for linear models, but also by considering effect sizes, plots, and non-linear relationships. Despite using a comprehensive approach to assess moderation, only two variables – the baseline severity of SAD symptoms and fear of negative evaluation (FNE) – were found to moderate social anxiety symptom trajectories. FNE had a non-linear relationship with symptom change that would have been missed using common research methods. Our findings suggest both a genuine lack of effects and limitations of research methods have contributed to the field’s inability to identify moderators. We provide suggestions that may increase the likelihood of future researchers detecting genuine effects.

Current evidence for various inpatient psychotherapy programs in the treatment of psychoses-A narrative review article

The analysis of the efficacy of evidence-based psychotherapy for patients with psychotic disorders has mostly been carried out in the outpatient field. In the inpatient field the efficacy is sometimes difficult to assess due to different healthcare systems. The aim of this narrative review is to summarize international guidelines and meta-analyses on the efficacy of inpatient psychotherapeutic treatment strategies for patients with psychotic disorders. Based on this, recommendations for disorder-specific ward concepts for acute and postacute fields are formulated. The German S3 guidelines, international guidelines, current meta-analyses and primary studies on psychological interventions in the treatment of psychotic disorders were included. Based on the results, recommendations for the inpatient psychotherapeutic treatment in various phases of treatment were formulated (acute phase and postacute phase). In the acute phase a combination of cognitive behavioral therapy (CBTp) in the individual setting and family interventions in the group setting as well as metacognitive training (MCT acute) is effective and recommended. In the postacute phase, in addition to individual and group CBTp and family interventions, psychoeducation, social skills training and cognitive remediation have been shown to be effective and are recommended. The suggested recommendations for concrete interventions in various treatment phases and the evidence base are critically discussed and recommendations for the structure of wards are presented.

Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data.

This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone. This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included. Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness. From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.

The effect of cognitive behavioral therapy on future thinking in patients with major depressive disorder: A randomized controlled trial.

Pessimistic thinking about the future is one of the cardinal symptoms of major depression. Few studies have assessed changes in pessimistic thinking after undergoing cognitive behavioral therapy (CBT). A randomized clinical trial (RCT) was conducted with patients diagnosed with major depressive disorder (MDD) to determine whether receiving a course of CBT affects pessimistic future thinking using a future thinking task. Thirty-one patients with MDD were randomly assigned to either CBT (n = 16) or a talking control (TC) (n = 15) for a 16-week intervention. The main outcomes were the change in response time (RT) and the ratio of the responses for positive valence, measured by the future thinking task. Secondary outcomes included the GRID-Hamilton Depression Rating Scale, the Beck Depression Inventory-Second Edition (BDI-II), the Dysfunctional Attitude Scale (DAS), and the word fluency test (WFT). Regarding the main outcomes, the CBT group showed reduced RT for the positive valence (within-group Cohen's d = 0.7, p = 0.012) and negative valence (within-group Cohen's d = 0.6, p = 0.03) in the distant future condition. The ratio of positive valence responses in both groups for all temporal conditions except for the distant past condition increased within group (distant future: CBT: Cohen's d = 0.5, p = 0.04; TC: Cohen's d = 0.8, p = 0.008; near future: CBT: Cohen's d = 1.0, p < 0.001; TC: Cohen's d = 1.1, p = 0.001; near past: CBT: Cohen's d = 0.8, p = 0.005; TC: Cohen's d = 1.0, p = 0.002). As for secondary outcomes, the CBT group showed greater improvement than the TC group regarding the need for social approval as measured by the DAS (p = 0.012). Patients with MDD who received CBT showed a reduced RT for the positive and negative valence in the distant future condition. RT in the future thinking task for depressed patients may be a potential objective measure for the CBT treatment process. Because the present RCT is positioned as a pilot RCT, a confirmatory trial with a larger number of patients is warranted to elucidate the CBT treatment process that influences future thinking. https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000021028, identifier UMIN000018155.