Cognitive Behavioral Therapy Techniques Research Articles

Pathophysiology and treatment of hoarding disorder.

Hoarding disorder (HD) is a newly listed disease in the new category of Obsessive-Compulsive and Related Disorders in the DSM-5. Patients with HD find it difficult to discard possessions regardless of their actual value and to organize those things. As a result, the possessions overflow the living space and hinder living functions. Though the hoarding symptom had been regarded as a subtype of obsessive-compulsive disorder (OCD) to date, recent studies have revealed many differences in clinical characteristics, including onset, course, degree of insight, and treatment responses, between hoarding and other subtypes. Moreover, several neuroimaging studies have found specific changes of brain structure and function in OCD patients with hoarding symptoms compared to patients with non-hoarding OCD. Meanwhile, strategies for treatment of HD have not been standardized. At present, psychological treatment using cognitive behavioral therapy techniques has a certain effect. In this review, we outline the pathophysiology and treatment of HD.

Cognitive Behavioral Therapy for Social Anxiety

Social anxiety disorder (also known as social phobia) is a cross-culturally real illness, which leads to dysphoric and anxious mood and high level of distress for those people. Cognitive behavioral therapy (CBT) has proved to be one of the most effective and common treatments to social anxiety. This paper is intended to explain how CBT conceptualizes the reasons for social anxiety, and describe the most relevant CBT techniques, cognitive restructuring and exposure therapy, to treat the problem. To better treat the social anxiety, the importance of the patients’ past and their sociocultural environment are worthy of attention. Chinese traditional culture emphasizes on interpersonal relationships, interpersonal harmony and the hierarchy within the relationships results in the higher level of anxiety in Chinese. Cognitive behavioral group therapy (CBGT) seems to be one of the most common and effective treatment for social anxiety for Chinese.

Evaluation of acceptance and commitment therapy for domestic violence offenders.

OBJECTIVE: There are currently few empirically supported batterer intervention programs (BIPs) for perpetrators of domestic violence. In practice, a combination of psychoeducation on power and control dynamics (i.e., Duluth Model) and cognitive-behavioral therapy (CBT) techniques are widely used in BIPs but produce limited effects on violent recidivism. Thus, the purpose of this study was to examine the impact of an Acceptance and Commitment Therapy (ACT)-based program (Achieving Change Through Values-Based Behavior [ACTV]; Lawrence, Langer Zarling, & Orengo-Aguayo, 2014) on reducing new criminal charges 1 year postintervention compared with the traditional treatment (a combination of the Duluth Model and CBT). METHOD: Administrative data were collected from a sample of 3,474 men who were arrested for domestic assault and court-mandated to a BIP (nonrandomized either ACTV or Duluth/CBT) from 2011 to 2013. Incidence and frequency of new criminal charges were examined during the intervention time period as well as 12 months postintervention time period, and analyses were completed for the entire intent-to-treat sample as well as treatment completers only. RESULTS: Compared with Duluth/CBT participants, significantly fewer ACTV participants acquired any new charges, domestic assault charges, or violent charges. ACTV participants also acquired significantly fewer charges on average in the 1 year after treatment than Duluth/CBT participants. This pattern of results emerged for both treatment completers and noncompleters. ACTV had a significantly higher dropout rate. CONCLUSIONS: This investigation provides preliminary evidence for the feasibility and effectiveness of an ACT-based group for men who have been arrested for domestic assault. (PsycINFO Database Record (c) 2017 APA, all rights reserved) Language: en

Improvement in anxiety and depression symptoms following cognitive behavior therapy for pediatric obsessive compulsive disorder

Pediatric obsessive-compulsive disorder (OCD) co-occurs frequently with other mental health conditions, adding to the burden of disease and complexity of treatment. Cognitive behavioral therapy (CBT) is efficacious for both OCD and two of its most common comorbid conditions, anxiety and depression. Therefore, treating OCD may yield secondary benefits for anxiety and depressive symptomatology. This study examined whether anxiety and/or depression symptoms declined over the course of OCD treatment and, if so, whether improvements were secondary to reductions in OCD severity, impairment, and/or global treatment response. The sample consisted of 137 youths who received 12 sessions of manualized CBT and were assessed by independent evaluators. Mixed models analysis indicated that youth-reported anxiety and depression symptoms decreased in a linear fashion over the course of CBT, however these changes were not linked to specific improvements in OCD severity or impairment but to global ratings of treatment response. Results indicate that for youth with OCD, CBT may offer benefit for secondary anxiety and depression symptoms distinct from changes in primary symptoms. Understanding the mechanisms underlying carryover in CBT techniques is important for furthering transdiagnostic and/or treatment-sequencing strategies to address co-occurring anxiety and depression symptoms in pediatric OCD.

Journal Digest

Journal Digest

A Comparative Study of the Impact of Cognitive-Behavioral Education and Conventional Training on Self-Care in Depressed Patients with Heart Failure: A Clinical Trial

Background: Promoting adherence to self-care behaviors is crucial in people with heart failure (HF) who also suffer from psychological problems like depression. The purpose of this study was to disclose the effect of cognitive-behavioral education, compared to conventional training, on self-care behaviors in depressed HF patients. Methods: This randomized clinical trial was performed on 80 individuals (40 in the behavioral - cognitive education group and 40 in the conventional education group) with heart failure and depression who had been admitted to the Cardiology Ward of Ali-ibn-Abitaleb and Khatam-al-Anbiya hospitals of Zahedan in 2018. Data were collected using the Beck depression inventory (BDI) and the self-care heart failure index version 6.2 (SCHFI V. 6.2) before and eight weeks after the end of educational interventions. Patients in the control group received the routine educational materials in four sessions, whereas those in the treatment group received the related educational content through cognitive-behavioral therapy technique in five sessions. Data were analyzed in SPSS V. 21 using independent and paired t-tests, chi-square, and covariance analysis. Results: Although the mean score of self-care behaviors in the cognitive-behavioral group and the conventional education group was not significantly different before the intervention, it was significantly higher in the treatment group (65.14 ± 7.01) than in the control group (36.59 ± 8.25) after the intervention. Conclusions: Given the dramatic impact of cognitive-behavioral education on the improvement of self-care behaviors, it is suggested that the principles of this therapy be integrated into common educational programs for depressed patients with heart failure.

Using cognitive behavioural therapy techniques in COPD

Symptoms of COPD can be managed with cognitive behavioural therapy, says Karen Heslop-Marshall

Self-management interventions in the treatment of depressive disorders: ready for clinical practice?

Only about half of those suffering from a depressive disorder seek treatment. Self-management interventions are one way to reduce this treatment gap. These interventions are mostly based on evidence-based techniques of cognitive behavioural therapy, which are taught by a computer program instead of a therapist. Numerous studies have shown the effectiveness of these interventions. However, these studies also raise a number of questions. These concern the efficacy both in the external rating and in the long-term course and the efficacy in severe depressive symptoms or in combination with antidepressant medication. Finally, the question arises as to the use of these interventions in patients in clinical practice and in people who are not particularly Internet-savvy. We addressed these questions in a large randomized study (EVIDENT study). This study investigated the efficacy of Intervention deprexis®. The results of this study are summarised in this overview and placed in the context of other interventions available in Germany.

NIHILISTIC DELUSION IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER WITH CATATONIC FEATURES IN A GERIATRIC PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

NIHILISTIC DELUSION IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER WITH CATATONIC FEATURES IN A GERIATRIC PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

EFFECT OF PSYCHOTHERAPY ON DEPRESSED PATIENTS WITH CORONARY ARTERY DISEASE (CAD)

Objectives: To see the effects of psychotherapy in depressed patients withcoronary artery disease (CAD) Methodology: This was a randomized clinical trial conducted in Preventivesection, Cardiology department, Lady Reading Hospital, Peshawar from March2018 to October 2018. Verbal informed consent was taken from patients.Patients from both genders and all ages were included. Patients were randomlyallocated to therapy group and non-therapy group. In therapy group, treatmentplan based on cognitive behavioral therapy techniques, were administered tosubjects. There were six session in total, two every week. The subjects in nontherapygroup received routine care. After completing the sessions, the subjectswere reassessed by PHQ-9 to see improvement in the level of depression. Datais presented as frequency, mean and standard deviation calculated for eachvariable. Paired T test was used to compare continuous data and Chi-square forcategorical variables. Results: A total of 1100 patients with CAD presenting to cardiology departmentwere enrolled. Out of these 1100 patients, 272 post MI patients diagnosed with ofdepression on PHQ- 9 were selected for the study.. A sample of 260 subjects whomet the inclusion criteria was analyzed Therapy group had 125 subjects andnon-therapy group had 135 subjects. Mean age was 57.07±13.07. Males were43% and females 57%. Of total literate were 33%, hypertension was documentedin 52.3 %, diabetes in 31.2%, and Current smokers were 21.2 %. At baseline thePHQ scores were 10.08±1.68 in therapy group and 10.10±1.49 in non-therapygroup respectively (p =0.783). After six sessions of treatment, therapy groupshowed reduction in level of depression PHQ-9 scores to 6.04±0.347 PHQscores were 10.08±1.68 in therapy group and 10.10±1.49 in non-therapygroup (p 0.783) at the baseline (p≤0.001), In non therapy group the level ofdepression did not reduce significantly. Conclusion: Psychotherapy was found to be effective treatment in reducingsymptoms of depression. Key Words: CAD, Depression, PHQ-9, Psychotherapy

A Randomised Controlled Feasibility Trial of Immersive Virtual Reality Treatment with Cognitive Behaviour Therapy for Specific Phobias in Young People with Autism Spectrum Disorder

We examined the feasibility and acceptability of using an immersive virtual reality environment (VRE) alongside cognitive behaviour therapy (CBT) for young people with autism experiencing specific phobia. Thirty-two participants were randomised to treatment or control. Treatment involved one session introducing CBT techniques and four VRE sessions, delivered by local clinical therapists. Change in target behaviour was independently rated. Two weeks after treatment, four treatment participants (25%) and no control participants were responders; at 6 months after treatment, six (38%) treatment and no control participants were responders. At 6 months post-treatment, symptoms had worsened for one treatment and five control (untreated) participants. Brief VRE exposure with CBT is feasible and acceptable to deliver through child clinical services and is effective for some participants.

Cognitive-behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT.

Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome. The Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU). Secondary care mental health services in five cities in the UK. People with CRS aged ≥ 16 years, with an International Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms. Individual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services. The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs. Participants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) -3.32 to 1.55 points; p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (-2.40 points, 95% CI -4.79 to -0.02 points; p = 0.049). CBT was associated with a net cost of £5378 (95% CI -£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46; p = 0.58). Cognitive-behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained. Current Controlled Trials ISRCTN99672552. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.

Alliance, technique, both, or more? Clinicians' views on what works in cognitive-behavioral therapy for eating disorders.

This study examined clinicians' views of the roles of two elements of cognitive behavioral therapy (CBT) in explaining treatment outcomes-CBT techniques and the therapeutic alliance. Ninety-eight clinicians who reported delivering CBT for eating disorders completed measures addressing their beliefs about what is effective in CBT, their use of specific techniques, and their own anxiety levels. Clinicians substantially overestimated the role of both therapeutic techniques and the alliance in explaining treatment outcomes in CBT. Weak but significant correlations were found between therapist anxiety levels and their beliefs about the value of therapeutic techniques or the alliance. However, these associations were in different directions, with higher levels of clinician anxiety associated with more belief in the effects of the alliance but with less belief in the role of CBT techniques. Belief in the role of the therapeutic alliance was associated with a lower likelihood of encouraging the patient to change their eating pattern, while belief in the role of techniques was linked to greater use of case formulation, cognitive restructuring, behavioral experiments and body image work. Clinicians overestimate the value of both the alliance and therapy techniques in explaining treatment outcomes in CBT for eating disorders. Their beliefs about the strength of these factors are related to their own anxiety, and to their choice of techniques. Clinicians and supervisors should attend to the evidence regarding the impact of a range of elements of therapy, and work with all of those factors to enhance outcomes.

Psychogenic movement disorders in children and adolescents: an update.

This short communication provides an update on childhood psychogenic movement disorders (PMD), focusing on descriptive studies and case reports from 2008 to 2018. Known also as functional movement/motor disorders, PMD diagnoses are relatively common in adults but less so in children. In group studies over the past decade, sample prevalence of childhood PMD ranged from 2.8 to 23.1%, with a higher percentage of girls in most studies (consistent with adult PMD literature). Common types of PMD included tremor (32.4%), dystonia (29.5%), and myoclonus (24.3%). Precipitating events for PMD onset included H1N1 influenza vaccinations, family/child stressors, anxiety/depression in the child or parent, panic attacks, behavior disorders, injury or accident, sexual abuse of the child or family member, death of a close relative, parental discord, domestic violence, school-related problems, medical illness/surgery, sleep disturbance, and participation in competitive sport or dance. The most frequently mentioned treatments were cognitive behavioral therapy, psychotherapy, relaxation techniques, and physiotherapy.Conclusion: Although additional cases of childhood PMD have been published over the past decade, little new information has appeared. There is still no "diagnostic gold standard," making an accurate estimate of prevalence virtually impossible and contributing to confusion among pediatricians when trying to identify children with PMD. What is Known: • Psychogenic movement disorders (PMD) occur in children as well as adults. • The most common types of childhood PMD are tremor, dystonia, and myoclonus. What is New: • The most common childhood PMD treatments were cognitive behavioral therapy, psychotherapy, physiotherapy, and relaxation techniques (2008-2018). • Due to lack of a standardized definition for PMD, confusion exists as to which movement disorders to include. With the inability to reliably diagnose PMD and the ambiguity as to which movement disorders it comprises, it is difficult to determine the most effective treatments.

Qualitative Analysis of Emotional Distress in Cardiac Patients From the Perspectives of Cognitive Behavioral and Metacognitive Theories: Why Might Cognitive Behavioral Therapy Have Limited Benefit, and Might Metacognitive Therapy Be More Effective?

Introduction: Cognitive behavioral therapy (CBT) alleviates emotional distress in mental health settings, but has only modest effects in cardiac patients. Metacognitive therapy (MCT) also alleviates depression and anxiety in mental health settings and is in its initial stages of evaluation for cardiac patients.Aim: Our objective is to compare how CBT and MCT models conceptualize cardiac patients' distress, and to explore why CBT has had limited benefit for cardiac patients and whether MCT has the potential to be more efficacious.Method: Forty-nine cardiac rehabilitation patients, who screened positively for anxiety and/or depression, provided semi-structured interviews. We analyzed transcripts qualitatively to explore the “fit” of patients' accounts of their distress with the main elements of cognitive behavioral and metacognitive theories. Four illustrative cases, representative of the diverse presentations in the broader sample, were analyzed in detail and are presented here.Results: Conceptualizing patients' distress from the perspective of CBT involved applying many distinct categories to describe specific details of patients' talk, particularly the diversity of their concerns and the multiple types of cognitive distortion. It also required distinction between realistic and unrealistic thoughts, which was difficult when thoughts were associated with the risk or consequences of cardiac events. From the perspective of MCT a single category—perseverative negative thinking—was sufficient to understand all this talk, regardless of whether it indicated realistic or unrealistic thoughts, and could also be applied to some talk that did not seem relevant from a CBT perspective.Discussion: Conceptualizing distress from the perspective of CBT presents multiple, diverse therapeutic targets, not all of which a time-limited therapy would be able to address. Given the difficulty of identifying them as unrealistic or not, thoughts about disease, death or disability may not be amenable to classic CBT techniques such as reality testing. MCT proved more parsimonious and, because it did not distinguish between realistic and unrealistic thoughts, might prove a better fit to emotional distress in cardiac patients.

Psychological Treatment for Major Depressive Disorder: Effectiveness of Cognitive Behavioural Therapy

Major depression, as a recurring and disabling disorder, can have a negative effect on the psychological and physical well-being of patients. Various psychological and medical interventions are generally used for patients with major depressive disorders. Patients suffering from major depressive disorders (MDD) may be subjected to medication only or medication may be used concurrently with psychological interventions. Psychological interventions like cognitive behavioural therapy (CBT) uses behavioural and cognitive principles to treat patients suffering from MDD, by helping them to identify, understand and analyse how the interaction of their thoughts, moods and behaviours triggers and aggravates depression. CBT has been beneficial in treating patients suffering from comorbidity of MDD with other disorders. While there is empirical and theoretical evidence supporting the use of CBT under various treatment settings and patient characteristics, research findings indicate varying rates of adequacy of the treatment. Further investigation of potential prescriptive risk factors associated with MDD in different contexts can help to predict more unbiased and consistent responses to different CBT techniques. This will make a valuable contribution to improving the use of CBT techniques for patients with different depressive characteristics and across different treatment settings and modes of delivery.

Mindfulness-based stress reduction: An introductory workshop

Event Abstract Back to Event Mindfulness-based stress reduction: An introductory workshop Fadwa Al Mughairbi1* 1 United Arab Emirates University, United Arab Emirates When was the last time you looked around you and wondered, curiously: “how”? When was the last time you looked inside yourself, and wondered curiously: “what”? How and what does the life taste like? Have you ever wondered how did we lose the sense of time? The child’s curiosity that brought plenty of joy and excitement into our lives? Well, maybe being Mindful can shed some light. What is Mindfulness? It is an ancient, straightforward practice that brings the ‘present moment’ into focus; being present with our emotions, physical sensations and our surroundings. It is about living in the moment, experiencing all its elements, ‘bad’ and ‘good’, accepting it as it comes, and developing a full awareness of our experiences, whatever they are. With mindfulness we are paying attention, deliberately to the present moment, and cultivating the non-judgmental essence of “here and now”. This helps us to live less ‘reactively’ and more ‘responsively’ with the reduction of physical and emotional stress that this enables. What is not It is not a ‘concentration’ meditation focused on deep breathing or rigorous exercise, nor it is a relaxation technique (although it will eventually lead to that). Mindfulness will not make you happy and positive all the time, nor will it solve all your problems. It is not about developing a forced control over our minds or detachment from emotions or your surroundings. Mindfulness is not about eliminating your weaknesses and achieving perfection. But, in the long run the awareness that Mindfulness practice builds supports greater peace and calm and creativity in all areas of our lives Beginning of the Story In 1979, Dr. Jon Kabat-Zinn developed an eight week “Stress Reduction and Relaxation Program,” aims to reduce stress, at the University of Massachusetts Medical Center. This program eventually was called “Mindfulness Based Stress Reduction (MBSR)”. Inspired by this, John Teasdale, Mark Williams and Zindel Segal developed “Mindfulness Based Cognitive Therapy (MBCT)” combining cognitive behavior therapy techniques and mindfulness practice, aiming to reduce the risk of relapse in depressed patients. The workshop In this introductory workshop, we are going to explore mindfulness, what is it? How it works, our expectations, and how to reduce stress with simple mindfulness techniques. References Kabat-Zinn, J. 1994. Whenever You Go: Mindfulness Meditation in Everyday Life. New York: Hyperion Kabat-Zinn, J. 1990. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delacourt. Teasdale, J., Williams, M., and Segal, Z. 2014. The Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress. New York: Guilford Williams, M. and Penman, D. 2011. Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World. New York: Rodale Keywords: mindfulness, wellbeing, stress reduction, MBSR, Meditation Conference: 4th International Conference on Educational Neuroscience, Abu Dhabi, United Arab Emirates, 10 Mar - 11 Mar, 2019. Presentation Type: Oral Presentation (invited speakers only) Topic: Educational Neuroscience Citation: Al Mughairbi F (2019). Mindfulness-based stress reduction: An introductory workshop. Conference Abstract: 4th International Conference on Educational Neuroscience. doi: 10.3389/conf.fnhum.2019.229.00019 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 09 Feb 2019; Published Online: 27 Sep 2019. * Correspondence: Dr. Fadwa Al Mughairbi, United Arab Emirates University, Al-Ain, United Arab Emirates, f.almughairbi@uaeu.ac.ae Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Fadwa Al Mughairbi Google Fadwa Al Mughairbi Google Scholar Fadwa Al Mughairbi PubMed Fadwa Al Mughairbi Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Treating Illness Distress in Chronic Illness

Abstract. Cognitive-behavioral therapy (CBT) is an evidence-based treatment for depression and anxiety recommended for those with and without physical long-term conditions (LTCs). However, the cognitive-behavioral mechanisms targeted in CBT protocols are based on empirical cognitive-behavioral models of depression and anxiety. In these models, emotions are conceptualized as primary mental health disorders rather than a reaction to the challenges of living with a LTC commonly referred to as illness distress. This raises important clinical questions with theoretical implications. These include: Is the experience of illness distress conceptually distinct from primary mental health diagnoses of anxiety and mood disorder? Are there unique cognitive-behavioral mechanisms related to illness self-management, which should be incorporated into CBT for illness distress? How can illness self-management interventions be embedded within existing CBT protocols for depression and anxiety? To address these questions, we distinguish between primary mental health disorders and illness distress conceptually and explore the impact of this on tailored treatment planning and engagement. Second, we review how health psychology theoretical models can help to inform modifications of existing cognitive-behavioral treatments for anxiety and depression to better support the needs of individuals experiencing illness distress. Third, we provide examples of how to embed processes important for illness self-management including, illness cognitions and adherence, alongside existing CBT techniques. The mechanisms and intervention techniques discussed may help to inform the development of integrated CBT treatments for illness distress for future hypothesis testing in comparative effectiveness trials.

Using cognitive behavioural therapy techniques in COPD

It is estimated that by 2020 chronic obstructive pulmonary disease is likely to become the fourth leading cause of death. People living with this condition may experience symptoms that can be managed with cognitive behavioural therapy, says Karen Heslop-Marshall Chronic obstructive pulmonary disease (COPD) is a term oftened used to describe two lung conditions in particular: chronic bronchitis and/or emphysema. Patients with COPD often experience symptoms of breathlessness, anxiety, panic and depression, and practice nurses are ideally placed to address these symptoms. This article looks at the use of cognitive behavioural therapy (CBT) techniques in symptom management, describes methods to assess the psychological impact of breathlessness, and outlines common techniques evaluated in a COPD CBT study by Heslop-Marshall et al (2018) . Research found that respiratory nurses were able to learn and deliver CBT techniques to patients with COPD and improved their symptoms of anxiety, depression, quality of life and reduced their use of healthcare resources. Self-management in primary care can be improved with CBT skills and practice nurses could improve self-management by incorporating CBT techniques.

Cognitive Behavioral Therapy for Sleep in Cancer Patients: Research, Techniques, and Individual Considerations

This article reviews cognitive behavioral therapy techniques for sleep in the cancer realm. There are unique factors associated with cancer that can exacerbate sleep issues. Stimulus control, sleep restriction, relaxation, paradoxical intention, and cognitive therapy are discussed as specific components of cognitive behavioral therapy for sleep, and practical techniques for implementation are provided. Individual considerations in implementing these techniques are also discussed, including factors such as age, ethnicity, gender, relationship status, educational level, work status, cancer history, pharmacologic treatments, and health beliefs.