Cognitive Behavioral Therapy Skills Research Articles

The Friends and Family for Mental Health Program: a pilot study of a cognitive behavioral therapy skills intervention for rural adults.

Limited access to psychological treatment is a pressing problem in the US, especially in more rural areas. One potentially underutilized resource is informal care from friends and family members. Although those in rural areas rely on informal care more than those in urban areas, there is little to guide interested caregivers in how they can be most effective. In this study, we conducted a pilot test of the Friends and Family for Mental Health Program, a mental health skills program we developed to enhance informal care and reduce psychological symptoms among informal caregivers. To provide an initial test of the potential benefits of this program, we evaluated the impact of the program on informal care skills, hope, psychological symptoms, and mental health skills. Informal care skills and hope improved. Participants also reported reduced anxiety. We considered intervention feedback to inform intervention development. Overall, findings provided preliminary support for the program and provide directions for future refinements. Though further research is needed, initial evidence suggests mental health skills programs directed at informal caregivers are both desired and beneficial in rural areas.

A Pilot CBT-Based Group Mental Health Intervention for SGM Asylum Seekers

This study investigated the feasibility and acceptability of a culturally adapted group therapy intervention for SGM asylum seekers. From an initial pool of 16 eligible individuals contacted, five completed a majority of the intervention group sessions as well as exit interviews. Thematic analysis of these interview transcripts, as well as a case study of one participant, suggested that participants had a positive perception of the intervention and developed new cognitive behavioral therapy skills, including distress tolerance, cognitive flexibility, assertiveness, and self-compassion skills. Themes identified included a reduction in social isolation, enhanced solidarity, and heightened motivation for therapy engagement. Participants expressed preferences for culturally relevant discussion topics and identified the importance of privacy and personalized attention in the individual sessions that supplemented the group program. Despite logistical hurdles and variable engagement levels, the studied intervention has the potential to alleviate mental health morbidity in this underserved and vulnerable population, as well as spark interest in further engagement in therapy.

Chronic pain after traumatic brain injury: a collaborative care approach.

Chronic pain is common after traumatic brain injury (TBI), frequently limits daily activities, and is associated with negative outcomes such as decreased community participation. Despite the negative impact of chronic pain, few people with TBI receive effective treatment. This paper describes a collaborative care (CC) intervention, TBI Care, adapted specifically to treat chronic pain in people living with TBI, emphasizing expert clinician input, cognitive behavioral therapy (CBT) techniques, and other non-pharmacological approaches for decreasing pain interference. 79 participants engaged in the CC intervention from two academic medical rehabilitation clinics with weekly assessments of pain intensity, interference, and medication use. Participant feedback on the intervention was gathered by interview with the care manager (CM) at the last treatment session and/or booster session. Provider feedback was gathered by a confidential survey post intervention. Ninety percent of participants received at least 11 of the target 12 sessions with a care manager (CM), the majority occurring over the phone. Participants endorsed an average of 7 pain locations. All participants received pain education, skills in self-monitoring, goal setting/behavioral activation and relaxation training. Pain interference scores (impact on activity and enjoyment), tracked weekly by the CM, significantly decreased across sessions. 89% of participants received recommendations for CBT skills, 65% received referrals for additional treatments targeting pain interference, and 43% received care coordination. 75% of participants reported 6 or more medications/supplements at both the first and last session, with changes recommended primarily for headache treatment. Feedback from participants and providers was positive. TBI Care, a novel patient-centered CC approach, was flexibly delivered, tailored to the needs of those living with TBI and chronic pain, with a high level of participant engagement, and satisfaction among participants and providers. This approach, prioritizing pain self-management strategies and other non-pharmacological approaches, along with optimizing pharmacological treatment, led to significant reductions in self-reported pain interference and intensity during the intervention. Using a CC model in TBI is feasible and successfully improved access to evidence-based treatments for chronic pain as well as outcomes for pain interference and intensity. ClinicalTrials.gov, identifier NCT03523923.

Efficacy of a Mobile App-Based Intervention for Young Adults With Anxiety Disorders: A Randomized Clinical Trial.

Anxiety disorders are prevalent and undertreated among young adults. Digital mental health interventions for anxiety are promising but limited by a narrow range of therapeutic components and low user engagement. To investigate the efficacy of and engagement with Maya, a scalable, self-guided, comprehensive mobile cognitive behavioral therapy (CBT) intervention with embedded engagement features, comparing the effects of 3 incentive conditions. This randomized clinical trial recruited young adults aged 18 to 25 years with anxiety disorders through online advertisements and outpatient psychiatry clinics at Weill Cornell Medicine. Enrollment was between June 16, 2021, and November 11, 2022. Data analysis was performed from December 21, 2022, to June 14, 2024. Participants received a 6-week program of the intervention and were randomized to 1 of 3 different text message-based incentive conditions (gain-framed, loss-framed, or gain-social support). The primary outcome was change in anxious symptoms from baseline to end of treatment, as measured by the Hamilton Anxiety Rating Scale (HAM-A). The Anxiety Sensitivity Index and the Leibowitz Social Anxiety Scale scores were secondary measures. The sample consisted of 59 participants (mean [SD] age, 23.1 [1.9] years; 46 [78%] female; 22 [37%] Asian, 3 [5%] Black, 5 [8%] Hispanic or Latino, 1 [2%] American Indian or Alaska Native, 25 [42%] White, and 6 [10%] >1 race; 32 [54%] college-educated and 12 [20%] graduate or professional school-educated; mean [SD] baseline HAM-A score, 15.0 [6.5]). Anxiety, measured by HAM-A, decreased across conditions from baseline to end of the intervention (mean difference, -5.64; 95% CI, -7.23 to -4.05), and symptomatic improvement was maintained at the week 12 follow-up (baseline to follow-up mean difference, -5.67; 95% CI, -7.29 to -4.04). However, there was no evidence that change in anxiety differed by incentive condition (loss-framed vs gain-social support mean difference, -1.40; 95% CI, -4.72 to 1.93; gain-framed vs gain-social support mean difference, 1.38; 95% CI, -1.19 to 3.96). Secondary anxiety measures (Anxiety Sensitivity Index and Liebowitz Social Anxiety Scale scores) showed a similar pattern of improvement, with no evidence of differences between incentive conditions. Participants completed most of the 12 sessions (mean [SD], 10.8 [2.1]; 95% CI, 10.3-11.4), and User Mobile Application Rating Scale app quality ratings exceeded the published threshold for acceptability at all study visits. There was no evidence that either session completion or app quality ratings differed by incentive condition. In this randomized clinical trial of an app-based intervention for anxiety, the primary hypothesis that improvement in anxiety would be greatest in the condition using gain of points plus social incentives was not supported; however, the results suggest that a CBT application incorporating a full suite of CBT skills and embedded user engagement features was efficacious in improving symptoms in young adults with anxiety disorders. Given these findings, digital interventions represent a promising step toward wider dissemination of high-quality, evidence-based interventions. ClinicalTrials.gov Identifier: NCT05130281.

What to Do When Worries Ring True: How CBT Clinicians Can Address Realistic Worries When Treating Youth With Anxiety

ABSTRACT Cognitive-behavioral therapy (CBT) is effective for many youth who are struggling with anxiety. Yet, the straightforward applications of CBT skills for youth anxiety that are presented in CBT manuals tend to assume that clients’ worries are very unlikely to occur and/or that clients are “catastrophizing” about potential outcomes. The examples provided in manuals often suggest that, by implementing CBT skills, clients will discover that they have been overestimating risk, which will decrease their anxiety. In practice, clinicians frequently treat youth who present with worries that are more realistic – that is, they align with youths’ prior experiences and/or reflect true possibilities of negative outcomes. Clinicians who are treating these youth may question the appropriateness of CBT and wonder how to proceed with treatment. In this practical paper, we discuss the scope and applications of CBT skills when treating youth who are experiencing realistic worries. In line with flexibility within fidelity, we provide recommendations on how to assess and conceptualize youth anxiety and how to tailor core CBT strategies for this population of anxious youth. We illustrate our recommendations with a range of case examples. We intend for this resource to help enhance the applicability and effectiveness of CBT so that the greatest possible number of youth are able to benefit from treatment.

인지행동치료 기반 인성교육 프로그램 개발 및 효과

Objectives This study aimed to develop and implement a character education program based on cognitive behav-ioral therapy(CBT) for university students and to verify its effectiveness. Methods This program, grounded in CBT, included psychoeducation, self-monitoring, cognitive restructuring, problem-solving training, and communication skills training. The study subjects were 35 university students ma-joring in child development and education, enrolled in the ‘Childcare Teacher Character Theory’ course offered during the second semester of 2022 at M University. The program was conducted over a total of 29 sessions, each lasting 75 minutes, held twice weekly. The effectiveness of the program was validated through pre- and post-as-sessments, using questionnaires to measure self-esteem, self-efficacy, depression, problem-solving ability, and psychological well-being. Additionally, content analysis was utilized to examine alterations in communication skills, along with specific cognitive, emotional, and behavioral changes among the study subjects. Results The primary findings of this study are as follows. Firstly, significant differences were observed in self-es-teem, self-efficacy, problem-solving ability, and psychological well-being in the pre- and post-program assessments. Specifically, regarding depression, a significant difference was observed in the sub-factor of de-pressive affect. Secondly, the content analysis revealed that post-program implementation, there were seven positive changes observed across cognitive, emotional, and behavioral domains, including improvements in com-munication skills. Conclusions The character education program based on CBT for university students is expected to enhance self-esteem, self-efficacy, communication skills, problem-solving abilities, and psychological well-being, while reducing depressive affect, thus contributing to the cultivation of character. This study is significant in that it has developed and verified the effectiveness of a systematic, evidence-based character education program tailored for university students.

An mHealth Intervention for Gay and Bisexual Men's Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunică): Protocol for a Randomized Controlled Trial.

The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men's co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. To test Comunică's efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men's identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries. ClinicalTrials.gov NCT03912753; https://clinicaltrials.gov/study/NCT03912753. DERR1-10.2196/52853.

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.

Addressing negative symptoms of schizophrenia in a Psychosis Day Hospital: a case report

IntroductionNegative symptoms are present in more than two thirds of schizophrenic patients throughout the evolution of the disorder. These include symptoms related to reduced motivation or pleasure, such as avolition, anhedonia and asociality, and reduced expressivity, including alogia and blunted affect.We present the case of a 24-year-old man who was admitted to our Psychosis Day Hospital after several psychotic episodes, presenting with prominent negative symptomatology that was imbued with mystical delusional beliefs.Objectives1)To describe the clinical particularities of this case, focusing on the improvement of negative symptoms during the course of treatment at our Day Hospital.2)To review the available evidence regarding the pharmacological and psychotherapeutic management of negative symptoms of schizophrenia. MethodsA review of the patient’s clinical history and complementary tests were carried out. Likewise, we reviewed the available literature in relation to the management of negative symptoms of schizophrenia in an ambulatory setting.ResultsThe patient was admitted to our Day Hospital after four psychiatric hospitalizations due to mystical delusions, ideas of grandiosity and hyper-spirituality, along with prominent negative symptoms at the moment of inclusion at our centre, including social withdrawal, diminished affective response, lack of interest in the academic sphere and poor social drive. Although previous positive symptoms were present in a lesser degree, the patient interpreted the presence of the negative symptoms described above as a “punishment” or “test” from spiritual creatures.Management of negative symptoms represents a major unmet need in schizophrenia. Modest effect size evidence for pharmacological approaches favours the use of antipsychotic in monotherapy and augmentation of antipsychotic treatment with other agents, such as antidepressants. Scarce evidence regarding psychotherapeutic approaches to these symptoms points to the use of cognitive behaviour therapy and social skills training.Conclusions-Clinical identification and characterization of negative symptoms is crucial when treating patients with schizophrenia, as these are associated with important disability and poorer functional outcomes.-Differentiation of primary and secondary negative symptoms is a key aspect in the evaluation and management of schizophrenic patients.-This case outlines the coexistence of positive and negative symptoms, and illustrates the challenges in the pharmacological and psychotherapeutic management of these symptoms at a Psychosis Day Hospital.Disclosure of InterestNone Declared

The acceptability and feasibility of a cognitive behavioural therapy managing emotions group on a male psychiatric intensive care unit: a mixed methods evaluation

Research suggests that the provision of psychological interventions within acute inpatient settings is effective and important for improving clinical outcomes. There remains limited research on the application of such interventions for individuals admitted to psychiatric intensive care units (PICU), and notably none for male-only PICU environments specifically. Two published protocols have been evaluated in female and mixed gender PICU settings, one a cognitive behavioural therapy (CBT) anger management group and one dialectical behaviour therapy (DBT) skills group. No studies have reported on a general CBT-based group in a male PICU. This study aimed to assess the acceptability and feasibility of a CBT-based managing emotions skills group, delivered in brief 30-minute sessions, within a 7-bed male PICU. All individuals admitted to the PICU during the study period were invited to attend a five-session group. A mixed methods design was used incorporating measuring attendance and retention, a pre–post quasi-experimental design and a qualitative component. Pre- and post-group self-report outcome measures of calmness, anxiety, recovery, and qualitative feedback were gathered and analysed. Pre- and post-outcome measures demonstrate significant improvements in calmness and reduction in anxiety following attendance. Attendance, retention and qualitative feedback data suggests that the group was acceptable and feasible for the participants. Initial findings suggest that adapted CBT skills group-based interventions tailored to the male PICU population are acceptable, feasible, and beneficial to participants. The clinical and research implications are discussed.

Feasibility and acceptability of a brief web‐based training on cognitive behavioral tools for educators

AbstractA youth mental health crisis has been exacerbated significantly by the COVID‐19 pandemic. Teachers are often front‐line support for students in need. Yet teachers themselves are struggling, making it difficult to help their students. Cognitive behavioral interventions (CBIs) have been shown to reduce mental health symptoms in school settings. Learning and implementing a psychological intervention, however, places undue burden on teachers who are already struggling. This project aimed to develop and assess the acceptability and feasibility of a brief, web‐based training for educators on cognitive behavioral tools that can be implemented in classrooms without additional psychological or practical burden. Attendees (n = 193) attended one of two 1‐h trainings on applying cognitive behavioural therapy (CBT) in classrooms. Attendees completed pre‐ and posttraining surveys on their knowledge and comfort using CBT. Following the course, attendees reported increases in knowledge and comfort using CBT skills, with large effect sizes. Attendees reported being highly satisfied with the course and likely to recommend the course to colleagues. Limitations of this work include a relatively small, homogenous sample and a low rate of completing both pre‐ and posttraining measures. Suggestions for future research include measuring change in practice as a result of the training. Implications of our findings are discussed.

Integrating "Super Skills for Exams" Programme in the School Curriculum to Support Adolescents Preparing for Their National Examinations in Turkey.

Examination stress is the most common stressor reported by adolescents across the globe. Exam stress involves mental distress related to anticipated academic challenges or fear of failure in the examinations, test anxiety, or fear of being unable to meet certain expectations of themselves or others. The aim of this study was to determine the effectiveness of a transdiagnostic resilience program (Super Skills for Exams; SSE), when integrated in the school curriculum and delivered by the school counsellors, in reducing exam stress among adolescents who are preparing for their national examinations. SSE is based on the principles of Cognitive Behaviour Therapy (CBT), behavioural activation, and social skills training, and includes sessions in promoting healthy lifestyles. Participants were 7129 (3661 female and 3468 male) adolescents in grades 7 and 8, from all the 245 secondary schools from Ugur College in seven regions and 31 cities across Turkey. All the participants completed a set of questionnaires to measure self-efficacy for learning and test anxiety, academic stress, emotion regulation, and lifestyles. Results revealed significant reduction in academic stress (i.e., test anxiety, work pressure, self-expectation, and despondency) and maladaptive emotion regulation strategies, and significant increase in self-efficacy and adaptive regulation strategies following the intervention. Adolescents who participated in SSE reported an increase in the consumption of healthy food. This study provides preliminary empirical support for the integration of SSE within the school curriculum for helping adolescents cope with exam stress as they prepare for their national exams.

A gamified cognitive behavioral therapy for Arabs to reduce symptoms of depression and anxiety: A case study research.

Depression and anxiety are prevalent mental health issues addressed by online cognitive behavioral therapy (CBT) via mobile applications. This study introduces Sokoon, a gamified CBT app tailored for Arabic individuals, focusing on alleviating depression and anxiety symptoms (DASDs). The objectives of this study were to: Evaluate the effectiveness of Sokoon in reducing symptoms of depression and anxiety. Assess the usability of the intervention through user engagement and adherence to CBT skills. A single-group pre-post design evaluated Sokoon's impact on adults with DASDs. In consultation with psychiatrists, Sokoon integrates evidence-based skills such as relaxation, gratitude, behavioral activation, and cognitive restructuring, represented by planets. Its design incorporates Hexad theory and gamification, supported by a dynamic difficulty adjustment algorithm. The study involves 30 participants aged 18-35 (86.7% female), specifically those with mild to moderate depression and anxiety. Based on a sample of 30 participants, Sokoon, a smartphone-based intervention, significantly reduced symptoms of depression and anxiety (d = 2.7, d = 3.6, p < 0.001). Over a two-week trial, participants experienced a notable decrease in anxiety and depressive symptoms, indicating the effectiveness of the model. Sokoon shows potential as a valuable tool for addressing DASDs. Sokoon, the gamified CBT application, offers an innovative approach to increasing CBT skills adherence and engagement. By leveraging Hexad theory and gamification, Sokoon provides an enjoyable and engaging user experience while maintaining the effectiveness of traditional CBT techniques. The study findings suggest that Sokoon has a positive impact on reducing symptoms of depression and anxiety.

Skill Use Mediates the Within-Person Effect of the Alliance on Session-to-Session Changes in Anxiety and Depression in the Unified Protocol

ObjectiveBoth the therapeutic alliance and the specific skills taught in treatment are thought to contribute to change in cognitive-behavior therapy (CBT), but it is unclear if or how these processes influence each other and outcomes in treatment. We tested the hypothesis that the degree to which patients used CBT skills would mediate the relation between the alliance and session-to-session changes in anxiety and depression. MethodAdult participants (N = 70; Mage = 33.74, 67% female, 70% White) with emotional disorders were randomized to receive 6 or 12 sessions of the Unified Protocol. Before each session, participants reported anxiety and depression severity and past-week skillfulness. After each session, participants rated the strength of the alliance. We tested whether greater within-person skillfulness mediated the relation between within-person alliance strength and session-to-session changes in anxiety and depression. ResultsSkillfulness significantly mediated the effect of the alliance on session-to-session changes in anxiety, ab = –.02, p =.04, and depression, ab = –.02, p =.02, such that a stronger alliance predicted greater next-session skillfulness, which predicted session-to-session decreases in anxiety and depression. When alliance subscales were examined separately, the strongest effect was observed for agreement on therapy tasks. ConclusionsImprovements in the alliance may facilitate skill use and indirectly predict reductions in anxiety and depression through skill use in CBT. We encourage research on how to enhance both the alliance and skillfulness in CBT.

An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing.

Headache disorders are common, debilitating health problems. Cognitive-behavioral therapy (CBT) is recommended but rarely easily available. With the use of the internet and communication technologies among youth and young adults, these individuals could be self-trained in CBT skills. There is an increasing number of internet-based interventions for headaches, but there has been little research into the usability of these interventions because evaluating usability across the intervention development life cycle is costly. We developed an internet-based CBT program, the Specialized Program for Headache Reduction (SPHERE). While developing it, we aimed to improve SPHERE through rapid usability testing cycles. This study aims to presents a rapid and affordable usability testing approach that can be performed throughout the intervention development life cycle. This paper also provides evidence of the usability of SPHERE. We used the "think aloud" usability testing method based on Krug's approach to test user interaction within a lab setting. This was followed by a short posttest interview. We planned to test SPHERE with 3-5 participants testing the same part of the program each cycle. Both the design and development team and the research team actively participated in the usability testing process. Observers independently identified the top 3 usability issues, rated their severity, and conducted debriefing sessions to come to consensus on major issues and generate potential solutions. The testing process allowed major usability issues to be identified and rectified rapidly before piloting SPHERE in a real-world context. A total of 2 cycles of testing were conducted. Of the usability issues encountered in cycles 1 and 2, a total of 68% (17/25) and 32% (12/38), respectively, were rated as major, discussed, and fixed. This study shows that rapid usability testing is an essential part of the design process that improves program functionality and can be easy and inexpensive to undertake.

Plenary Session 2: Late onset psychosis / schizophrenia

Overview: This presentation will focus on late-onset schizophrenia (LOS) as well as ageing of persons with early-onset schizophrenia (EOS). 20% of middle-aged and older patients with schizophrenia have onset of illness after age 40. LOS is characterized by female preponderance, better premorbid functioning, fewer positive symptoms, and less cognitive impairment than EOS. EOS presents a paradox of aging – i.e., there is accelerated physical aging with multimorbidity and elevated mortality, while the mental well-being tends to improve with age. Adverse social determinants of health such as childhood traumas, social isolation, discrimination, and food insecurity worsen health. On the other hand, family and social support and access to necessary healthcare enhance the likelihood of sustained remission and recovery. Antipsychotics tend to be effective at doses lower than those in young adults, though the risk of side effects is higher. Psychosocial interventions like cognitive behavior therapy and social skills training are useful. It is important to employ the principles of Positive Psychiatry including promotion of resilience, social connections, optimism, and healthy lifestyle in people with schizophrenia

Three types of university students with subthreshold depression characterized by distinctive cognitive behavioral skills

ABSTRACT Subthreshold depression impairs young people’s quality of life and places them at greater risk of developing major depression. Cognitive behavioral therapy (CBT) is an evidence-based approach for addressing such depressive states. This study identified subtypes of university students with subthreshold depression and revealed discrete profiles of five CBT skills: self-monitoring, cognitive restructuring, behavioral activation, assertive communication, and problem solving. Using data from the Healthy Campus Trial (registration number: UMINCTR-000031307), a hierarchical clustering analysis categorized 1,080 students into three clusters: Reflective Low-skilled, Non-reflective High-skilled, and Non-reflective Low-skilled students. Non-reflective Low-skilled students were significantly more depressed than other students (p < .001). The severity of depression seemed to be related to the combination of self-monitoring skills and other CBT skills. Considering the high prevalence of poor self-monitoring skills in persons with autism, the most severe depression was observed in the significant association between Non-reflective Low-skilled students and autistic traits (p = .008). These findings suggest that subthreshold depression can be categorized into three subtypes based on CBT skill profiles. The assessment of autistic traits is also suggested when we provide CBT interventions for Non-reflective Low-skilled students.

Usability and feasibility of E-nergEYEze: a blended vision-specific E-health based cognitive behavioral therapy and self-management intervention to reduce fatigue in adults with visual impairment

BackgroundOver 50% of adults with visual impairment experience severe fatigue. Therefore, we developed a guided E-health intervention based on cognitive behavioral therapy and self-management to reduce fatigue in this population. This pilot study evaluated the usability, feasibility, fidelity and potential effectiveness of E-nergEYEze.MethodsE-nergEYEze was developed by a design team and customized by conducting a pilot study using an iterative development strategy. The intervention was first tested in a usability study among adults with visual impairment (n = 5). Participants were asked to think-aloud while exploring the intervention features and a semi-structured interview was performed afterwards. Subsequently, the enhanced intervention was tested in a feasibility study. Adults with visual impairment and severe fatigue (n = 10) followed the intervention partially with guidance from a social worker and one-time computer trainer support. Fatigue severity (Checklist Individual Strength), fatigue impact (Modified Fatigue Impact Scale) and cognitive behavioral therapy skills (Competencies of Cognitive Therapy Scale-Self Report) were measured at baseline and at three months follow-up and analyzed with the Wilcoxon signed-rank test. The intervention was evaluated through evaluation forms.ResultsThe usability study resulted in adjustments to content and lay-out with regard to optically shortened text sentences, separate pages for information and assignments with one read-aloud audio and an additional descriptive explanation of page content. Digital challenges were overcome with mandatory computer training and e-platform modifications. The feasibility study showed a positive trend in reducing fatigue severity (Z -6.108; P < .001; SD 8.4), impact of fatigue (Z − 4.451; P < .001; SD 11.4) and cognitive behavioral therapy skills (Z -2.278; P = .023; SD 19.3). Participants gave useful feedback regarding accessibility, content and guidance, with an overall positive experience. The intervention was rated with a median score of 8 (range 7–10).ConclusionWe developed, evaluated and optimized E-nergEYEze by applying a user-centered and iterative approach. E-nergEYEze showed a promising trend to reduce fatigue severity and impact of fatigue and to increase cognitive behavioral therapy skills. The study methods were feasible and the fidelity of the intervention protocol was suitable. Performing a randomized controlled trial is warranted to give insight into whether E-nergEYEze is cost-effective in reducing severe fatigue in adults with visual impairment.Trial registrationInternational Clinical Trial Registry Platform: NL7764. Date registered: 28-05-2019.

Exploring user experiences of a text message-delivered intervention among individuals on opioid use disorder treatment in Kenya: A qualitative study.

Opioid use disorder causes significant burden of disease and treatment comprises pharmacotherapy and psychosocial treatment. Cognitive behavioral therapy is an effective psychosocial intervention used in substance use disorders treatment and can be delivered using digital approach. There is limited use of digital treatment among individuals with opioid use disorder in Kenya. This study aimed to describe the experiences and feedback from participants with opioid use disorder enrolled in a text-message intervention in Kenya. Qualitative data was collected from participants in the intervention arm of a feasibility trial testing a text-message intervention based on cognitive behavioral therapy. Data was collected using open-ended questions in a questionnaire and structured in-depth interviews amongst those who received the intervention. Framework method was applied for analysis. Twenty-four participants (83.3% males) were enrolled with a mean age of 32.5 years (SD9.5). Five themes were identified namely: (1) Gain of cognitive behavioral therapy skills which included: identification and change of substance use patterns; drug refusal skills; coping with craving and self-efficacy; (2) Therapeutic alliance which included: development of a bond and agreement on treatment goals; (3) Feedback on intervention components and delivery such as: frequency, and duration of the text message intervention; (4) Challenges experienced during the intervention such as: technical problems with phones; and barriers related to intervention delivery; (5) Recommendations for improvement of intervention in future implementations. The findings demonstrated participants' satisfaction with intervention, gain of skills to change substance use patterns, highlighted challenges experienced and suggestions on improving the intervention among individuals with opioid use disorder. The feedback and recommendations provided by the participants can guide implementation of such interventions to allow acceptability, effectiveness and sustainability. Trial registration: This study was part of a randomized feasibility trial. Clinical trial registration: Pan African Clinical Trial Registry: Registration number: PACTR202201736072847. Date of registration: 10th January 2022.

Future of Mental Health in Sport: CBT and Athletes

Collegiate and professional athletes are at higher risk of developing anxiety disorders, depressive disorders, and substance abuse disorders. These competitive athletes often struggle with unique stressors such as balancing social life with sport and mental health stigma due to expectation of mental toughness. Research suggests these vulnerabilities amongst competitive athletes may make them hesitant to seek mental health resources. Cognitive-Behavioral Therapy (CBT) is an evidence-based approach that promotes skill development that reduces symptoms of anxiety, depression, substance use and other mental health struggles. CBT strategies may also enhance athletic performance. Combined, CBT skills for athletes may have promise as a primary prevention strategy for mental health symptoms, a secondary prevention strategy by offering referral for more serious symptoms and may earn buy in from coaches and athletes due to the potential for enhancing athletic performance. This paper provides empirical and theoretical rationale and framework for such an approach.