Cognitive Behavioral Therapy Protocol Research Articles

Cognitive Behavioral Therapy for Symptom Preoccupation Among Patients With Premature Ventricular Contractions: Nonrandomized Pretest-Posttest Study.

Premature ventricular contractions (PVCs) are a common cardiac condition often associated with disabling symptoms and impaired quality of life (QoL). Current treatment strategies have limited effectiveness in reducing symptoms and restoring QoL for patients with PVCs. Symptom preoccupation, involving cardiac-related fear, hypervigilance, and avoidance behavior, is associated with disability in other cardiac conditions and can be effectively targeted by cognitive behavioral therapy (CBT). The aim of this study was to evaluate the effect of a PVC-specific CBT protocol targeting symptom preoccupation in patients with symptomatic idiopathic PVCs. Nineteen patients diagnosed with symptomatic idiopathic PVCs and symptom preoccupation underwent PVC-specific CBT over 10 weeks. The treatment was delivered by a licensed psychologist via videoconference in conjunction with online text-based information and homework assignments. The main components of the treatment were exposure to cardiac-related symptoms and reducing cardiac-related avoidance and control behavior. Self-rated measures were collected at baseline, post treatment, and at 3- and 6-month follow-ups. The primary outcome was PVC-specific QoL at posttreatment assessment measured with a PVC-adapted version of the Atrial Fibrillation Effects on Quality of Life questionnaire. Secondary measures included symptom preoccupation measured with the Cardiac Anxiety Questionnaire. PVC burden was evaluated with 5-day continuous electrocardiogram recordings at baseline, post treatment, and 6-month follow-up. We observed large improvements in PVC-specific QoL (Cohen d=1.62, P<.001) and symptom preoccupation (Cohen d=1.73, P<.001) post treatment. These results were sustained at the 3- and 6-month follow-ups. PVC burden, as measured with 5-day continuous electrocardiogram, remained unchanged throughout follow-up. However, self-reported PVC symptoms were significantly lower at posttreatment assessment and at both the 3- and 6-month follow-ups. Reduction in symptom preoccupation had a statistically significant mediating effect of the intervention on PVC-specific QoL in an explorative mediation analysis. This uncontrolled pilot study shows preliminary promising results for PVC-specific CBT as a potentially effective treatment approach for patients with symptomatic idiopathic PVCs and symptom preoccupation. The substantial improvements in PVC-specific QoL and symptom preoccupation, along with the decreased self-reported PVC-related symptoms warrant further investigation in a larger randomized controlled trial. ClinicalTrials.gov NCT05087238; https://clinicaltrials.gov/study/NCT05087238.

The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology.

Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.

Using implementation methods to study a combined dance/movement therapy (DMT) and cognitive behavioral therapy (CBT) protocol at an inpatient substance use setting

There is evidence that dance/movement therapy (DMT) has positive outcomes for patients with various conditions when used either as a standalone therapy or when coupled with a gold standard modality such as cognitive behavioral therapy (CBT). This combined DMT/CBT has yet to be studied for patients struggling with alcohol and substance use disorders from a structured, manualized, implementation perspective. The current study outlines patient engagement and satisfaction with a 4-session DMT/CBT program at an inpatient addiction treatment facility. The 4-session manualized DMT/CBT protocol comprised “impulse inventory,” “studying impulses,” “subconscious movement,” and “body language.” Participants reported the most engagement in “studying impulses” and attended an average of 2.38 sessions during their time in treatment. Most patients reported receiving some (55%) or substantial (23%) benefit from the protocol. These findings lay the foundation to better optimize a DMT/CBT protocol for patients struggling with alcohol and substance use disorders. However, about a quarter of patients received no benefit from the group (23%), highlighting known barriers to DMT in general. Findings can help small inpatient facilities utilize information toward next steps of optimizing a DMT/CBT protocol.

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.

Cognitive behavioral therapy for anxiety and opioid use disorder: Development and pilot testing

IntroductionAnxiety disorders are highly prevalent among people with opioid use disorder (OUD), and they have a negative impact on disorder course and treatment outcomes. The objective of this Stage 1 A/1B behavioral treatment development trial was to develop a novel cognitive-behavioral therapy (CBT) protocol for co-occurring anxiety disorders and OUD. MethodsFollowing a period of iterative manual development involving patient interviews and feedback from content experts, we tested a 12-session individual CBT protocol in a small, open pilot trial (N = 5). This was followed by a small, randomized controlled trial (N = 32), comparing the new protocol to 12 sessions of manualized Individual Drug Counseling. All participants also received medication for OUD. ResultsOverall, support for feasibility and acceptability was strong, based on recruitment and retention rates and patient satisfaction ratings. Within-subjects results identified 11-point reductions in anxiety symptom severity (on a 0–56 point scale); these gains were sustained through 3 months of follow-up. However, these changes did not differ between randomized conditions. With respect to opioid outcomes, 85 % of participants were abstinent in the prior month at the end of treatment. Opioid use outcomes also did not differ by treatment condition. ConclusionsThese results support the feasibility and acceptability of a CBT protocol for co-occurring anxiety and OUD. However, in this small pilot trial results do not show an initial benefit over an evidence-based psychosocial treatment targeted to OUD alone, in combination with medication for OUD.

Comparing the Effectiveness of Schema Therapy and Pre-Marriage Cognitive-Behavioral Therapy on the Desire to Marry and Fear of Marriage Among Single Women

Objective: The present study aimed to compare the effectiveness of schema therapy and cognitive-behavioral therapy before marriage on the desire to marry and fear of marriage among single women. Methods and Materials: The present study was quasi-experimental, employing a pre-test and post-test design with a non-equivalent control group. The study population consisted of single women in district one of Tehran in 2022. The sample included 60 individuals selected via convenience sampling based on a call from the study population and randomly assigned to two experimental groups and one control group. Participants responded to the Heidari, Mazaheri, and Pooretemad (2004) marriage desire questionnaire and the Samiei, Yousefi, and Nashatdoust (2014) fear of marriage questionnaire before and after the intervention. The first experimental group underwent schema therapy and the second experimental group underwent cognitive-behavioral therapy in eight 90-minute sessions, based on the schema therapy protocol (Leahy, Robert, 2011) and the cognitive-behavioral therapy protocol (Beck, 1964), respectively. Data were analyzed using one-way ANOVA and follow-up tests with SPSS software. Findings: The results showed that schema therapy and cognitive-behavioral therapy significantly increased the desire to marry and decreased the fear of marriage among single women (p &lt; 0.05). Conclusion: Given the findings, it can be concluded that pre-marriage schema therapy and cognitive-behavioral therapy can be proposed as effective therapeutic methods for improving the desire to marry and reducing the fear of marriage among single women, and can be employed as significant and key interventions in the pre-marriage domain.

Comparing the Effect of Transcranial Direct Current Stimulation (TDCS) and Cognitive-Behavioral Therapy on Substance Craving Control and Rumination in Methamphetamine-Dependent Patients

Objective: The aim of the current study was to compare the effect of Transcranial Direct Current Stimulation (TDCS) and Cognitive-Behavioral Therapy on substance craving control and rumination in methamphetamine-dependent patients. Methods and Materials: The present study, in terms of its objective, was applied research, utilizing a pre-test post-test design within a quasi-experimental research framework. The statistical population included all male patients dependent on methamphetamine who visited the Gam Addiction Treatment Clinic in Ghaemshahr city in the year 2020, from whom 45 individuals were selected through convenience sampling and randomly divided into three groups of 15 (two experimental and one control group). Participants in all three groups responded to the Drug Desire Questionnaire (DDQ) (2002) and the Hocksmann-Nolen Marw Rumination Questionnaire (1991) in three stages: pre-test, post-test, and follow-up. For the first experimental group, Transcranial Direct Current Stimulation (TDCS) was applied with a maximum current intensity of 2 milliamperes, and for the second experimental group, twelve sessions of Cognitive-Behavioral Therapy were conducted based on the Cognitive-Behavioral Therapy protocol (Bayling, McCabe, Antony, 2011), while the control group received no treatment. Data were analyzed using SPSS statistical software. Findings: The results showed that both treatments were effective. However, the effectiveness of Transcranial Direct Current Stimulation (TDCS) on craving control and the effectiveness of Cognitive-Behavioral Therapy on rumination were greater. Conclusion: Both treatments can be used to reduce psychological problems in methamphetamine-dependent patients.

Cognitive Behavioral Therapy for Tinnitus: Outpatient-Based Treatment

Background and Objectives Cognitive behavioral therapy (CBT) is a treatment option for subjective tinnitus. There are many reports on its clinical efficacy, but the protocol has not been well established. The purpose of this study was to set an outpatient-based CBT protocol and evaluate its clinical efficacy for tinnitus.Subjects and Method A total of 85 chronic tinnitus patients was assessed in this prospective study. After evaluating for eligibility, 30 patients completed CBT based on a protocol of 5 weekly sessions in an outpatient setting. Therapeutic efficacy was assessed by Tinnitus Handicap Inventory (THI) questionnaires and visual analogue scale (VAS) for tinnitus. The initial scores were compared with the final scores, which were assessed a month after the fifth CBT session.Results The results showed that CBT reduced THI and VAS scores significantly (&lt;i&gt;p&lt;/i&gt;&lt;0.05).Conclusion The results of the study suggest that an outpatient-based CBT protocol can be clinically beneficial for patients with tinnitus.

Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial.

Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa. This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group. In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples. Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant. Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants. German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245.

Intensive cognitive behavioral group therapy for the treatment of panic disorder

Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety. Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients. Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted. Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy. Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.

Cognitive-behavioral group therapy for obesity to reduce cardiovascular risks in patients with type 2 diabetes

Obesity is one of the risk factors for the development and progression of type 2 diabetes (T2D). Decrease in body weight (BW) by 10% from the initial level in patients with T2D and obesity significantly reduces the risk of cardiovascular events. Low effectiveness of measures to reduce body weight in patients with T2D is due to hidden eating disorders against the background of mental imbalance, high levels of anxiety and depression, and frustration with glycemic levels. Solving the problem of the low frequency of achieving target values for reducing weight in type 2 diabetes through the development and evaluation of the clinical effectiveness of cognitive-behavioral therapy protocols is of high scientific and practical significance.

Дистанционная когнитивно-поведенческая терапия, основанная на принятии и ответственности для лечения повторяющегося травмирующего поведения.

The article describes clinical manifestations of repetitive traumatic behavior directed (focused) on the body or skin picking disorder. The spectrum of forms of repetitive traumatic behavior directed at the body is detailed. A diagnostic algorithm and a psychological approach to the assessment and initial treatment of psychosocial stressors in this group of patients are proposed. The general tactics of treatment are presented, and emphasis is placed on the specifics of cognitive behavioral therapy (CBT) for repetitive traumatic behavior directed at one's own body, as well as its effectiveness and limitations. It is shown that the «classical» CBT protocol (for example, habit change training, habituation, attention management, stimulus control) is an insufficient tactic of psychotherapeutic treatment, because it is unable to help the patient cope with internal experiences and emotional dysregulation. In this regard, it is recommended to use a multimodal protocol with an emphasis on metacognitive features of perception of the situation, regulation of impulsivity, maladaptive perfectionism and minimization of empirical avoidance of one's own experiences.

Comparison of the efficacy of cognitive-behavioral therapy and mindfulness therapy on fear the negative of evaluation in individuals with social anxiety disorder

Introduction: Social anxiety disorder is characterized by the fear of negative evaluation. This psychological construct results in individual’s poor functioning. Aim: The present research aimed to compare the effects of cognitive-behavioral therapy (CBT) and mindfulness therapy on the fear of negative evaluation in individuals with social anxiety disorder. Method: This quasi-experimental study, with a pretest-posttest control group design, was conducted on a population of individuals with social anxiety symptoms, who were referred to the psychological clinics of Shiraz, Iran, in 2019. Sampling was performed using the convenience sampling method. After initial evaluations, 45 people were randomly divided into three equal groups (two intervention groups and one control group). The CBT protocol proposed by Hoffman and Otto (2008) and the Acceptance and Mindfulness protocol by Fleming and Kukowski (2007) were used to implement the interventions (12 two-hour sessions). The participants also completed the Social Phobia Inventory (SPIN) by Connor et al. (2000) and the Fear of Negative Evaluation Scale by Leary (1983) before and after the intervention. Data analysis was performed in SPSS-24, using multivariate analysis of covariance (MANCOVA). Results: The results of MANCOVA test showed a significant difference between the scores of the control and experimental groups (P&lt;0.001). Compared to the control group, the fear of negative evaluation reduced in the experimental groups. Although there was no significant difference between the two treatment approaches (P&gt;0.05), the effect of mindfulness treatment was slightly higher than CBT. Conclusion: In this study, comparison of the two mindfulness and CBT approaches indicated no significant difference between these two methods in reducing the fear of negative evaluation among individuals with social anxiety. Therefore; it is suggested to use acombination of these two methods to reduce the fear of negative evaluation.

Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder

Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.

A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness.

Cognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. Friends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. First, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. The mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Relatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support.

Effectiveness of Cognitive-behavioral Therapy on the Positive and Negative Psychotic Symptoms and Emotion Regulation of Patients With Schizophrenia Spectrum Disorders

Objective Schizophrenia is the most debilitating psychiatric disorder with the highest psychiatric ward admission rate. Drug therapy is the first line of treatment. However, it does not result in appropriate therapeutic responses in many patients, and they experience emotional regulation difficulties and psychosis symptoms after initial symptom resolution. Cognitive-behavioral therapy (CBT) is currently an adjuvant treatment besides drug therapy to target the persistent symptoms of psychosis. The present study aims to determine the effectiveness of CBT on the positive and negative symptoms and emotional regulation of those suffering from schizophrenia spectrum disorders. Materials &amp; Methods The research design was single-subject and of the AB type (baseline and intervention) with a follow-up phase. Besides the routine therapy sessions, CBT sessions were held for the study participants. They were patients admitted to Razi Educational and Therapeutic and Research Psychiatric Center in Tehran City, Iran, who were selected based on the inclusion criteria. Thirty patients were selected with convenience sampling, and 5 were randomly placed in the CBT group. They were evaluated with the scales of positive and negative symptoms of Kay, Fiszbein, and Opler (1986) and difficulties in emotional regulation by Gratz and Roemer (2004) in the baseline, intervention, and follow-up phases. The treatment sessions were planned based on the CBT protocol developed by Laura Smith, Paula Nathan, Uta juniper, Patrick Kingsep, and Louella Lim (2003). Non-overlap of all pairs (NAP), percentage of non-overlapping data (PND), percentage of all non-overlapping data (PAND), percentage of data points exceeding the median (PEM), Cohen’s d effect size, and improvement percentages were used to analyze the data, and visual graphs were used for data presentation. Results The outcomes showed that in the intervention phase, compared to the baseline phase, the effect sizes of the positive and negative symptoms in the first to fifth participants were 1.6, 3.1, 3.2, 1.9, and 2.4, respectively. Only the effect sizes of the second and third participants were large. The effect sizes of the emotional regulation factor in the first to fifth participants were 2.8, 1.2, 1.1, 2.2, and 1.9, respectively. The effect size of the second participant was large, and the rest were average. The findings of this study showed that during the post-therapy and follow-up stages, while patients who had received CBT still experienced positive and negative symptoms of psychosis and difficulties in emotional regulation; these symptoms decreased in comparison with the baseline phase. Furthermore, their improvement percentages were not significant. Conclusion Data analysis showed that although CBT is effective in reducing positive and negative psychotic symptoms and improving the emotional regulation of patients, the data obtained from Cohen’s d effect size and recovery indices showed that the results are not clinically significant. In other words, although the patients who received CBT showed a slight improvement in psychotic symptoms and difficulty in emotional regulation, they could not maintain the therapeutic gains in the follow-up phase.

Telemedicine for unhealthy alcohol use in adults living with HIV in Alabama using common elements treatment approach: A hybrid clinical efficacy-implementation trial protocol

BackgroundUnhealthy alcohol use is an unaddressed barrier to achieving and maintaining control of the human immunodeficiency virus (HIV) epidemic. Integrated screening, treatment of common behavioral and mental health comorbidities, and telemedicine can improve alcohol treatment and HIV clinical and quality of life outcomes for rural and underserved populations. ObjectiveIn a randomized controlled clinical trial, we will evaluate the effectiveness and implementation of telephone-delivered Common Elements Treatment Approach (T-CETA), a transdiagnostic cognitive behavioral therapy protocol, on unhealthy alcohol use, HIV, other substance use and mental health outcomes among predominantly rural adults with HIV receiving care at community clinics in Alabama. MethodsAdults with HIV receiving care at four selected community clinics in Alabama will receive a telephone-delivered alcohol brief intervention (BI), and then be assigned at random (stratified by clinic and sex) to no further intervention or T-CETA. Participants will be recruited after screening positively for unhealthy alcohol use or when referred by a provider. The target sample size is 308. The primary outcome will be change in the Alcohol Use Disorder Identification Test (AUDIT) at six- and 12-months post-enrollment. Additional outcomes include HIV (retention in care and viral suppression), patient-reported mental health (anxiety, depression, posttraumatic stress), and quality of life. A range of implementation measures be evaluated including T-CETA provider and client acceptability, feasibility, cost and cost-effectiveness. ConclusionsThis trial will inform alcohol treatment within HIV care programs, including the need to consider comorbidities, and the potential impact of alcohol interventions on HIV and quality of life outcomes.

Effectiveness of an innovative treatment protocol for misophonia in children and adolescents: Design of a randomized controlled trial

BackgroundMisophonia is a recently identified disorder in which individuals experience intense, uncontrollable and disproportional irritation, anger or disgust when confronted with specific sounds or stimuli associated with these sounds. Prevalence rates in children and adolescents are currently still to be investigated. The reported average age of onset is around 13 years, in clinical practice children from 8 years old are referred.Misophonia is associated with avoidance and anticipation anxiety, possibly leading to serious educational and social consequences for children and families. Worldwide, no evidence-based treatment exists specifically for children and adolescents with misophonia.This article presents the design of a randomized controlled trial testing the effectiveness of cognitive behavioral therapy (CBT) combined with psychomotor therapy (PMT) for misophonia in children and adolescents (aged 8–18). MethodsIn total, 82 patients will be randomly assigned to a treatment condition or waiting list condition of 3 months (WCG). Treatment consists of 7 weekly group therapy sessions (1.5 h CBT plus 1.5 h PMT) and a follow-up after 3 weeks. Pre and post treatment assessments will be conducted during a baseline assessment, after 3 and 6 months. The primary outcome will be assessed by the Amsterdam Misophonia Scale – Youth (AMISOS-Y) and secondary outcomes (e.g. quality of life) and putative predictors (e.g. parenting burden) will be studied. ConclusionThis trial is the first study worldwide testing the effectiveness of a combined CBT plus PMT protocol for misophonia in children and adolescents. If proven effective, this protocol provides an innovation to improve care for youth with misophonia.

Integration of Common Elements Treatment Approach (CETA) into public sector HIV clinics for unhealthy alcohol use in urban Zambia: Qualitative evaluation on acceptability and feasibility

BackgroundIn Sub-Saharan Africa, unhealthy alcohol use (UAU) is a growing threat to achieving ‘the last mile’ towards ending AIDS by 2030. Common Elements Treatment Approach (CETA) is a multisession transdiagnostic cognitive behavioral therapy protocol that can treat a range of common co-morbid mental and behavioral mental health problems, including UAU. In a randomized controlled trial (RCT), we previously reported that CETA was clinically effective in reducing UAU and mental health comorbidities among PWH in Zambia. In this qualitative evaluation we sought to explore health worker, key policymaker and patient perspectives on the acceptability and feasibility of integrating CETA within existing HIV services. MethodologyWe conducted focus group discussions (FGDs) with PWH who reported alcohol use, lay and profession HIV clinic staff, and key informant interviews with policy-makers. Following trial completion, we conducted in-depth interviews (IDIs) among people with HIV and UAU who received CETA, and HIV peer counsellors that provided CETA. Data were transcribed verbatim and analyzed in NVivo 12 using thematic analysis. Emerging themes were organized according to acceptability and feasibility. ResultsAll participant types reported CETA to be acceptable due to the perceived need and relevance to HIV-related behavioral health issues. HIV peer counselors, successfully provided CETA with a rigorous supervision structure using an apprenticeship model. Participants receiving CETA also remained motivated throughout the sessions as they learned new problem-solving skills, which they continued to use following the close of the study. Implementation factors related to limited behavioral health infrastructure, workloads, and human resources were seen as challenges to the scale-up and sustainability of CETA within HIV care. ConclusionCETA was feasible and acceptable at 2 urban sites in Zambia. Future studies integrating of CETA into HIV care should consider implementation factors such as infrastructure, workloads, and human resources to support integration into HIV care.

Brazilian research consortium on obsessive-compulsive spectrum disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: Cognitive-Behavior Therapy treatment.

To summarize the evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). A systematic review of the literature on CBT interventions for the treatment of adult OCD, comprising behavior therapy and exposure and response prevention (ERP) was done. The objective of this study is to present updated clinical guidelines to clinicians, providing comprehensive details regarding the necessary procedures to be incorporated into the CBT protocol. We searched the literature published from 2013-2020 in five databases (PubMed, Cochrane, Embase, Psycinfo and Lilacs), considering: study design, primary outcome measures, type of publication and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). We examined 44 new studies used to update the APA guidelines from 2013. High-quality evidence supports CBT including ERP techniques as the first-line CBT treatment for OCD. In addition, protocols for internet-delivered CBT have also demonstrated their efficacy for the treatment of adults with OCD. CBT based on ERP is a widely used treatment according to high-quality scientific evidence to treat adults with OCD.