Cognitive Behavioral Therapy Skills Training Research Articles

Comparative effectiveness of remote digital gamified and group CBT skills training interventions for anxiety and depression among college students: Results of a three-arm randomised controlled trial

Digital interventions can enhance access to healthcare in under-resourced settings. However, guided digital interventions may be costly for low- and middle-income countries, despite their effectiveness. In this randomised control trial, we evaluated the effectiveness of two digital interventions designed to address this issue: (1) a Cognitive Behavioral Therapy Skills Training (CST) intervention that increased scalability by using remote online group administration; and (2) the SuperBetter gamified self-guided CBT skills training app, which uses other participants rather than paid staff as guides. The study was implemented among anxious and/or depressed South African undergraduates (n = 371) randomised with equal allocation to Remote Group CST, SuperBetter, or a MoodFlow mood monitoring control. Symptoms were assessed with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Intention-to-treat analysis found effect sizes at the high end of prior digital intervention trials, including significantly higher adjusted risk differences (ARD; primary outcome) in joint anxiety/depression remission at 3-months and 6-months for Remote Group CST (ARD = 23.3–18.9%, p = 0.001–0.035) and SuperBetter (ARD = 12.7–22.2%, p = 0.047–0.006) than MoodFlow and mean combined PHQ-9/GAD-7 scores (secondary outcome) significantly lower for Remote Group CST and SuperBetter than MoodFlow. These results illustrate how innovative delivery methods can increase the scalability of standard one-on-one guided digital interventions. Preregistration international standard randomised controlled trial number (isrtcn) submission #47,089,643.

A randomized comparison trial of culturally adapted HIV prevention approaches for Native Americans reducing trauma symptoms versus substance misuse: The Healing Seasons protocol

Native Americans (NA) experience interrelated risks of trauma exposure, substance use, and HIV risk behaviors that put them at increased risk for HIV infection. Despite these known risk factors, there are very few published randomized trials testing interventions to reduce trauma-related symptoms and substance misuse among NA. MethodsThe Healing Seasons study is a randomized comparsion trial of two counseling strategies, Narrative Exposure Therapy (NET) addressing PTSD or Motivational interviewing with cognitive behavioral therapy skills training (MIST) addressing substance misuse as a means to prevent HIV among NA. Using a community-based participatory research approach, we adapted both evidence-based interventions to be specific to the risk contexts and realities of NA and to include psychoeducational and skill-building components that include cultural-specific stories, virtues, and traditional treatment strategies. Participants, 16 years and older, were recruited from a Pacific Northwest tribal community, screened over the phone, enrolled in person, and randomized in equal numbers to NET or MIST. We stratified by age (16–29 years and 30 or older) and gender (male or female identified) to ensure balance between treatment arms. The primary outcomes were number of sex partners and frequency of sexual acts (with and without condoms), sex under the influence of substances, frequency of substance use, and PTSD severity. DiscussionBehavioral interventions for NA are needed to prevent HIV risk behaviors when faced with trauma symptoms and substance misuse. This study will provide evidence to determine feasibility and efficacy of addressing related risk factors as part of counseling-based HIV prevention intervention to reduce sexual risk among this population.Trial registration: ClinicalTrials.gov number, NCT03112369, registered April 12, 2017.

Assessing treatment fidelity and contamination in a cluster randomised controlled trial of motivational interviewing and cognitive behavioural therapy skills in type 2 diabetes

BackgroundCompetencies in psychological techniques delivered by primary care nurses to support diabetes self-management were compared between the intervention and control arms of a cluster randomised controlled trial as part of a process evaluation. The trial was pragmatic and designed to assess effectiveness. This article addresses the question of whether the care that was delivered in the intervention and control trial arms represented high fidelity treatment and attention control, respectively.MethodsTwenty-three primary care nurses were either trained in motivational interviewing (MI) and cognitive behavioural therapy (CBT) skills or delivered attention control. Nurses’ skills in these treatments were evaluated soon after training (treatment arm) and treatment fidelity was assessed after treatment delivery for sessions midway through regimen (both arms) using the Motivational Interviewing Treatment Integrity (MITI) domains and Behaviour Change Counselling Index (BECCI) based on consultations with 151 participants (45% of those who entered the study). The MITI Global Spirit subscale measured demonstration of MI principles: evocation, collaboration, autonomy/support.ResultsAfter training, median MITI MI-Adherence was 86.2% (IQR 76.9–100%) and mean MITI Empathy was 4.09 (SD 1.04). During delivery of treatment, in the intervention arm mean MITI Spirit was 4.03 (SD 1.05), mean Empathy was 4.23 (SD 0.89), and median Percentage Complex Reflections was 53.8% (IQR 40.0–71.4%). In the attention control arm mean Empathy was 3.40 (SD 0.98) and median Percentage Complex Reflections was 55.6% (IQR 41.9–71.4%).ConclusionsAfter MI and CBT skills training, detailed assessment showed that nurses had basic competencies in some psychological techniques. There appeared to be some delivery of elements of psychological treatment by nurses in the control arm. This model of training and delivery of MI and CBT skills integrated into routine nursing care to support diabetes self-management in primary care was not associated with high competency levels in all skills.Trial registrationISRCTN75776892; date registered: 19/05/2010.

Investigating the effectiveness of the cognitive remediation and cognitive behavior therapy skills training program (CRCST).

10087 Background: Improvements in cancer treatments over the past forty years have led to a significant increase in the number of pediatric oncology survivors. With this feat, also emerges the ongo...

Creating a cognitive–behavioural therapy (CBT) skills cascade for palliative care practitioners

IntroductionEmotional distress is common in palliative care and access to expert psychological help is limited. We have developed, evaluated and cascaded a brief training in CBT skills for palliative care...

Development and Validation of the Cognitive-Behavioral Therapy Skills Questionnaire

Although several theories exist to describe why patients improve in cognitive-behavioral therapy (CBT), in only a limited number of studies has CBT skill acquisition been examined, particularly among patients with complex clinical profiles. Thus, the overarching aim of this research was to develop a tool to measure patients' use of CBT skills, such that it would have clinical utility for patients and therapists during treatment. In Study 1, the authors developed an initial set of items for the Cognitive-Behavioral Therapy Skills Questionnaire (CBTSQ). They submitted these items to an exploratory factor analysis in an initial administration (n = 350) and to a confirmatory factor analysis in a second administration (n = 378). Results indicated that there were two factors (Behavioral Activation and Cognitive Restructuring) with good factor structure and internal consistency, and both the factors evidenced expected relationships with other constructs. In Study 2, the criterion validity of the CBTSQ was investigated on a patient sample in a CBT-oriented treatment setting. Results showed that CBTSQ scores increased following treatment, and Cognitive Restructuring and Behavioral Activation scores predicted reduction of overall psychiatric symptoms and depression. Thus, the CBTSQ appears to be a promising measure of CBT skill acquisition and treatment outcome as well as an instrument that can help patients and therapists monitor progress specifically related to a CBT skills training treatment approach.

Cognitive-behavioural skills training for medical students: development and evaluation

Aims and methodThe effective management of patients with anxiety, depression or somatisation, who commonly present across all medical disciplines, requires an understanding of both pharmacological and psychological approaches such as cognitive-behavioural therapy (CBT). However, there is little research addressing effective ways of delivering CBT training that is relevant for doctors. We provided CBT skills training that included supervised casework to medical students at Oxford University and assessed participants' experiences.ResultsThe training was feasible, sustainable and highly valued. Students reported marked improvements in knowledge and skills related to CBT and felt more convinced of its effectiveness for patients and its relevance for doctors. They also gained generic medical skills and an increased understanding of mental health problems.Clinical implicationsSupervised casework appears to be an effective format for learning. It allowed students enhanced responsibility for patient care and an opportunity to practise using cognitive-behavioural strategies, some of which would be transferable to medical consultations.