Cognitive Behavioral Therapy Research Articles

Patterns of sub-optimal change following CBT for childhood anxiety.

Children and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub-optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diagnosis immediately following treatment or at any point during the 12 months following treatment. Data were collected from 10 clinical sites with assessments at pre-and post-treatment and at least once more at 3, 6 or 12-month follow-up. Participants were assigned to one of three groups based on diagnostic status for youths who: (a) retained an anxiety diagnosis from post to end point (minimal responders); (b) remitted anxiety diagnoses at post but relapsed by end point (relapsed responders); and (c) retained a diagnosis at post but remitted to be diagnosis free at end point (delayed responders). Growth curve models assessed patterns of change over time for the three groups and examined predictors associated with these patterns including demographic, clinical and parental factors, as well as treatment factors. Higher primary disorder severity, being older, having a greater number of anxiety disorders, having social anxiety disorder, as well as higher maternal psychopathology differentiated the minimal responders from the delayed and relapsed responders at the baseline. Results from the growth curve models showed that severity of the primary disorder and treatment modality differentiated patterns of linear change only. Higher severity was associated with significantly less improvement over time for the minimal and relapsed response groups, as was receiving group CBT, when compared to the delayed response group. Sub-optimal response patterns can be partially differentiated using variables assessed at pre-treatment. Increased understanding of different patterns of change following treatment may provide direction for clinical decision-making and for tailoring treatments to specific groups of clinically anxious youth. Future research may benefit from assessing progress during treatment to detect emerging response patterns earlier.

Cognitive behavior therapy intervention on adolescents to decrease anxiety problem study: the role of serotonin

The existence of demands that occur simultaneously causes some adolescents to be unable to adapt properly, especially the condition of adolescents who experience changeable emotions, are unstable, easily stressed, feel anxious, depressed, and feel helpless. Cognitive behavior therapy (CBT) is a form of psychotherapy that can be used for adolescent emotional problems. The purpose of this study is to prove that CBT interventions can increase serotonin levels and reduce adolescent anxiety levels. The research population is adolescents with anxiety problems in the city of Surabaya. The research sample is 32 respondents with techniques systematic sampling. Inclusion criteria include: i) adolescents aged 12–18 years, ii) experiencing mental emotional anxiety problems as measured by a score with self-reporting questionnaire (SRQ-29), and iii) being willing to participate in the research and get permission from parents. Data collection using an instrument in the form of a Taylor Manifest Anxiety Scale (TMAS). The data have been analyzed by the Wilcoxon test. The results show that there were significant differences in serotonin levels and anxiety levels before and after the intervention given CBT. The average value of serotonin levels in the posttest was higher than the pretest (p=0.001) and the average value of anxiety levels in the posttest was lower than the pretest (p=0.043) indicating that giving CBT interventions was able to significantly reduce anxiety levels. CBT interventions are proven to increase serotonin levels and reduce adolescent anxiety levels. By changing the form of thought and the resulting consequences, the intensity of the subject's anxiety decreases.

The therapeutic alliance in blended versus face-to-face cognitive behavioral therapy for adolescents and young adults with a depressive disorder

IntroductionA depressive disorder during adolescence is a serious and disabling disorder, which has a high impact on the development of adolescents. Blended treatment, combining online and face-to-face sessions, is effective and can reduce some of the barriers for adolescents to use mental health care. There is a lack of knowledge about whether therapeutic alliance is established in blended treatment for adolescents and young adults suffering from a depressive disorder. This study examines whether the quality of the therapeutic alliance differs when cognitive behavior therapy (CBT) is delivered in combination with online intervention (b-CBT) compared to solely face-to-face (FtF-CBT) and the extent to which a stronger therapeutic alliance is associated with better treatment outcome. MethodsA pragmatic quasi-experimental design was used. Data collected within two separate studies were combined. A total of 85 participants (80 % female), aged 13–22 (mean = 16.63, SD = 1.92) were recruited within mental health care institutions and diagnosed with a depressive disorder (using K-SADS). Assessments were done at pre-treatment (T0), after five weeks (T1), after ten weeks (T2), post-treatment (T3) and one to four weeks after treatment (T4) and included measures of depressive symptomatology (CDI-2). The therapeutic alliance was measured at T1, T2 and T3 by the TASC. t-tests for independent samples were used to test differences in therapeutic alliance rates between b-CBT and FtF-CBT at post-treatment. A linear growth model for depressive symptoms based on five time points with Latent Growth Curve Analysis (LGCA) was used to test whether the therapeutic alliance is associated with depressive symptoms. ResultsNo differences in therapeutic alliance between b-CBT and FtF-CBT were found on either client-rated or therapist-rated therapeutic alliance. For both intervention groups, no significant association between the therapeutic alliance and depressive outcome was found. DiscussionThis study shows that providing part of CBT using an online environment does not have a negative impact on the therapeutic alliance. In contrast to earlier research, no association was found between the therapeutic alliance and therapy outcome in neither the b-CBT nor the FtF-CBT intervention.

Comparison of effects of interventions to promote the mental health of parents of children with autism: A systematic review and network meta-analysis.

Individuals diagnosed with autism spectrum disorders often face persistent challenges in social interaction and engage in repetitive and stereotyped behaviors. Parenting a child with autism can profoundly affect parents both physically and psychologically, potentially leading to negative impacts on their mental health. This study employs a network meta-analysis methodology to evaluate the comparative effectiveness of mental health interventions specifically designed for parents of autistic children. A total of 69 empirical intervention studies involving 4213 parents of autistic children were included in the analysis. Employing the frequency framework model and utilizing Stata 16.0 software, we quantitatively analyzed the impact of various interventions on anxiety, depression, parenting stress, and parenting self-efficacy. Our findings indicate that mindfulness-based interventions demonstrate the highest efficacy in reducing parenting stress, while cognitive behavioral therapy is effective in alleviating anxiety and depression in parents of children with autism. Psychoeducational interventions have shown significant benefits in mitigating parental anxiety, depression, and parenting stress, and acceptance and commitment (ACT) displays promising outcomes in reducing depression. We also elaborate on the underlying mechanisms that contribute to the effectiveness of these interventions. This network meta-analysis presents valuable insights for the development of targeted interventions to provide support to parents of children with autism.

Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms

BackgroundPerinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies. The purpose of this paper is to provide a conceptual framework and a randomized controlled trial protocol (RCT) for use in future studies. Methods and analysisAn RCT was designed to evaluate the effectiveness of a group videoconference intervention (VCI) to reduce PDA symptoms across pregnancy and postpartum period. Participants are randomly assigned to study groups: VCI + standard of care, or attention control (AC) + standard of care. Both groups have weekly one-hour group videoconference sessions for 9 weeks. The VCI groups are facilitated by a mental health professional using a manualized program based on mindfulness-based practices and cognitive behavioral therapy (MBCT). The AC groups are facilitated by a registered nurse using a manualized program for childbirth and parenting education. The primary outcomes are depressive symptoms as measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7). ConclusionThis RCT study protocol can be used as a standard approach to improve the ability to compare findings across studies, applied in any setting (e.g., rural or urban), and adapted to diverse communities.Trial Registration:ClinicalTrials.govNCT03932760

Effectiveness and prediction of treatment to guided internet-based cognitive behavioural therapy for health anxiety: A cohort study in routine psychiatric care

ObjectiveHealth anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence. MethodA longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventory (SHAI-14) and a within-group design with repeated measures was utilized for the primary analysis. ResultsParticipants showed significant improvements from pre- to post-treatment (d = 1.61). At post-treatment, 60 % (95 % CI 58–62) demonstrated statistically reliable change (RCI), and 44 % (95 % CI 42–46) were in remission. On average, participants completed 7 (SD = 4) out of 12 treatment modules. For each additional completed module, the mean reduction was 0.31 (95 % CI 0.10 to 0.54) points on the SHAI-14. ConclusionsGuided ICBT for health anxiety can be effective when delivered within the context of routine psychiatric care. The study suggests that effect sizes are comparable with those in RCTs and higher treatment adherence is associated with better outcomes in health anxiety. ICBT could be used to increase availability to effective therapy for health anxiety.

Intervention programme to improve emotional regulation among adolescent with mental disorders: a systematic review

Adolescence is an important period for developing social and emotional habits that are important for mental well-being. This research aimed to know the effectiveness of intervention programs to improve emotional regulation in adolescents with mental disorders. Preparation using the PICO approach, determination of inclusion and exclusion criteria, and a literature review of scientific English articles published between 2016 and 2023 were conducted. Data were obtained from the SCOPUS, Science Direct, SpringerLink, ProQuest, and SAGE databases. Assessment of the title, abstract, and full text of the article with the keywords "Adolescent," "Child," "Teenager," "Emotion regulation," "Emotion exposure," "Intervention," "Mental Disorders," "Randomised Control Trial." The systematic review report was reviewed critically to ensure that all PRISMA steps and items were included. Nine articles met the inclusion criteria. The choice of programs and methods of intervention may vary depending on the specific mental disorders and individual needs of adolescents. Nursing interventions, including cognitive behavioral therapy, mindfulness-based interventions, group therapy, support groups, and school-based programs, are widely used to manage and treat mental health disorders with the aim of improving well-being and recovery. The effectiveness of intervention programs varies, and selection should consider adolescent needs, resources, and cultural contexts. Consulting mental health professionals or organizations is recommended.

The Sleep Course: An inclusive trial examining the feasibility, acceptability, and preliminary efficacy of a digital sleep intervention for adults with self-reported sleep difficulties

Cognitive Behavioural Therapy for Insomnia (CBTi) is a well-established first-line treatment for insomnia and sleep difficulties, yet numerous barriers hinder its widespread adoption. One potential criticism of the existing evidence base for CBTi is that many trials exclude participants that would commonly be seen in in primary care, such as those aged over 65, with comorbid health conditions, or prescribed sleep medication. The current pilot study therefore aimed to assess the acceptability and efficacy of a brief, digitally delivered sleep intervention, the Sleep Course using a broad range of participants. Participants (n = 74) completed the 6-week, 4-lesson intervention alongside measures of sleep disturbance, sleep-related impairment, depression, anxiety and sleep-wake patterns (via sleep diary). Generalized estimating equations analysis modelled change in participants' outcomes from pre- to post-treatment and 3-month follow-up, and subgroup analyses explored the role of possible moderators (e.g., age over 65, co-morbidities, and concurrent prescription medication use). The intervention was associated with good rates of satisfaction (79 %) and lesson completion (70 %). Results showed significant and large reductions in insomnia, sleep disturbance and associated symptoms (e.g., d = 1.06–1.37 change in insomnia symptoms). Evidence of high acceptability and clinical improvement was found irrespective of age, physical comorbidity, and sleep medication use. However, there was evidence of less improvement among those taking medications or having tried psychological treatment in the past. These results provide strong preliminary evidence for the intervention as an acceptable, efficacious and scalable treatment for a broad range of participants with sleep difficulties. Larger randomised controlled trials are needed.

The impact of sleep on neurodevelopmental disorders and the contribution of ICT in improving sleep quality in adolescents and adults

Sleep is an essential process for the human body, contributing to the optimal functioning of the brain and the immune system, aiding in stress management, and overall enhancing quality of life. The relationship between sleep and neurodevelopmental disorders is bidirectional; sleep is influenced by specific disorders, while symptoms of these disorders are exacerbated by sleep problems. This article aims to explore the significance of sleep in the context of neurodevelopmental disorders such as Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and Specific Learning Disorder through a literature review. Additionally, the research concludes that leveraging Information and Communication Technology (ICT), such as virtual reality, digital cognitive behavioural therapy for insomnia (DCBT-I), smartphone applications, and the Internet of Things (IoT), can contribute to improving sleep quality in adolescents and adults.

Progress of systematic psychological interventions in elderly patients with femoral fractures: A comprehensive review

This review aims to gain a deeper understanding of the psychological state of elderly patients with femoral fractures and provide more theoretical and practical support for clinical treatment and care. Through a literature analysis, we found that elderly patients with femoral fractures face various psychological issues such as anxiety, depression, sleep disorders, and social isolation. The application of systematic nursing interventions in clinical practice, including cognitive-behavioral therapy, mindfulness therapy, family therapy, art therapy, interpersonal therapy, emotion-focused therapy, and relaxation training, has yielded significant results. Systematic psychological interventions can improve the psychological state and quality of life of elderly patients with femoral fractures. Therefore, promoting the application and practice of systematic psychological interventions in the clinical care of elderly patients with fractures will provide more effective psychological services to a wider group of patients with fractures in the future.

Glucagon-like Peptide 1 Receptor Agonists and Obesity Associated with Eating Disorders

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective medications for managing obesity and related metabolic complications. However, their use presents specific challenges when obesity is coexisting with eating disorders. In such cases, the appetite-suppressing effects of GLP-1RAs could potentially exacerbate behaviors like dietary restriction and dietary restraint, two behavioral patterns that help sustain eating disorder psychopathology, thus complicating treatment for these disorders. Because of these concerns, it is essential for clinicians to screen for eating disorders before prescribing GLP-1RAs in individuals with overweight or obesity. Their use is currently contraindicated for patients with atypical anorexia nervosa, bulimia nervosa, or subthreshold bulimia nervosa, as GLP-1RAs could worsen the restrictive eating behaviors common in these conditions. Although some emerging research suggests that GLP-1RAs might reduce binge-eating episodes, there is not yet enough evidence to support their use specifically for treating binge-eating disorder (BED) and its associated psychopathology. According to new recommendations from cognitive behavior therapy for BED, GLP-1RAs may be cautiously considered in patients with clinical obesity who do not overvalue shape and weight, have no history of anorexia nervosa or bulimia nervosa, and who have already made progress in adopting regular eating patterns and reducing binge-eating episodes.

Participant acceptability and clinician satisfaction of cognitive behavioural therapy and medication management algorithm compared with enhanced standard care for treatment of depression among youth with HIV.

Background: Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that cognitive behavioural therapy (CBT) and medication management algorithm (MMA) (COMB-R) significantly improved depression in youth with HIV (YWH) compared with enhanced standard care (ESC). Acceptability and satisfaction were examined among study participants and clinicians.Method: Between March 2017 and March 2019, 13 U.S. sites enrolled YWH, aged 12-24, diagnosed with nonpsychotic depression. Sites were randomised to either COMB-R (CBT by a therapist and licensed prescriber) or ESC (standard psychotherapy and medication management). After the intervention (week 24), participants, prescribers, and therapists rated acceptability and satisfaction. We compared site-level means using Wilcoxon tests.Results: Both COMB-R (n = 69) and ESC (n = 71) participants had a mean age of 21.4 years, with 53% female, and 54% having acquired HIV perinatally. Baseline age, sex, depression levels, RNA viral load, and CD4 count were comparable between arms. The distribution of site-level mean participant acceptability was greater in COMB-R compared with ESC (p = 0.04). The distribution of site-level mean prescriber satisfaction was greater in COMB-R (p = 0.01). The was no evidence that the site-level mean therapist satisfaction did not differ between arms (p = 0.52).Discussion: Acceptability and satisfaction for participants and licensed prescribers were higher at COMB-R sites compared with standard of care, indicating that this tailored, manual-guided, collaborative, measured care intervention was less burdensome in terms of the number of visits. Patient and medication provider satisfaction rates were higher than standard of care.Conclusion: While these results support the use of CBT and MMA in treating depression among YWH, further research is required to determine generalisability.

Concepts of Implied Interventions for Treating Depression: A Comprehensive Review

Hence, answering the question how a person is able to secure and maintain lifelong good mood would facilitate in deceiphering depression; a common and etiologically complex multi factorial mental health disorder which affects over 264 m individuals worldwide with tremendous effect on morbidity and economic burden. Here, our study results from more than 100 experimental and observational studies with respect to effective treatments for depression across three main groups such as: Pharmacological interventions, Psychotherapeutic approaches, and Emerging digital health solutions have been effective as implied interventions to tret Depression. While antidepressants, particularly selective serotonergic reuptake inhibitors (SSRIs), continued as the bedrock of therapy; Novel therapies with Ketamine have shown potential for treatment failure cases. Large-scale studies of Psychotherapeutic methods, such as Cognitive Behavioural Therapy (CBT) and Interpersonal Therapy (IPT), show high effectiveness rates in most populations. Digital health interventions, such as e-therapy, were potential alternatives and particularly suitable for patients in rural areas. Integrating these modalities will allow clinicians to offer more individualised and tailored care. This review provided an overview of the mechanisms of each intervention for depression as a clinical aid to inform decisions by clinicians as well as policy makers seeking to improve treatment pathways for individuals with Mood disorders and Depression.

My grief app for prolonged grief in bereaved parents: a randomised waitlist-controlled trial

ABSTRACT A minority of bereaved adults experiences prolonged grief disorder, depression, and/or posttraumatic stress disorder, with heightened risks observed among bereaved parents. Cognitive-behavioural therapies, both face-to-face and online, have demonstrated efficacy in treating post-loss mental health problems. Mobile phone applications potentially offer an efficient and cost-effective way to deliver self-help to bereaved adults, yet controlled effectiveness studies are lacking. Therefore, we examined the short-term efficacy of the My Grief app, based on cognitive-behavioural therapy, in 248 bereaved parents, in a randomised controlled trial (Clinicaltrials.gov, identifier: NCT04552717). Participants were randomly allocated to access to the My Grief app (n = 126) or a waitlist (n = 122). At baseline and post-assessment, symptoms of prolonged grief, posttraumatic stress, and depression, negative grief cognitions, rumination, and avoidance were assessed. Reductions in prolonged grief and posttraumatic stress symptoms and negative cognitions in the intervention group were larger than in the control group, albeit with small effect sizes. Fifteen app users reported negative experiences with the app; for example, some mentioned that it elicited painful memories and emotions related to their loss. My Grief appears to achieve modest improvements in mental health in bereaved parents. Given that it is accessible and low-cost, it is an important addition to the suite of prolonged grief interventions.

Alcohol Use Disorder: Current and Emerging Therapies

Alcohol use disorder (AUD) is a medical condition characterized by problematic and unhealthy patterns of alcohol use ranging from frequent to heavy alcohol consumption. It is a well-recognized psychiatric syndrome that includes a broad spectrum of symptoms and behaviors associated with alcohol misuse. People with AUD don’t stop drinking alcohol despite emotional distress, social, occupational, or health problems. Pharmacological management of AUD depends on the patient’s condition to reduce the symptoms and improve the patient’s health. The US FDA approved three medications, namely naltrexone, acamprosate, and disulfiram for the treatment of AUD. Apart from these medications, psychological therapy, cognitive behavioral therapy, and encouraging patient participation in support groups have been showing promising results. The present review briefly discusses the epidemiology, symptoms, stages, diagnosis, screening, and emerging psychosocial therapies and pharmacotherapy of AUD including approved and off-label uses of drugs and newer agents. Keywords: Alcohol use disorder, Acamprosate, Baclofen, Disulfiram, Gabapentin, Naltrexone, Nalmefene

Brief CBT for suicide prevention, delivered remotely, can reduce suicide attempts

Brief cognitive behavioral therapy (BCBT) delivered remotely to patients — historically, considered high‐risk and inappropriate candidates for virtual therapy — reveals that therapists can see these patients safely and effectively via video telehealth, say researchers of the first‐ever randomized clinical trial using telehealth for suicide prevention.

Behavioral Addiction Treatment Centers in the Hospitals of Türkiye: A Web-Based Research.

This study investigates the current landscape of behavioral addiction treatment in Türkiye hospitals, considering both inpatient and outpatient approaches. The analysis involved examining the websites of 1393 hospitals across Türkiye based on various criteria. The review of the websites was conducted between June and September 2023. The findings reveal that out of these hospitals, comprising 822 public and 571 private institutions, only 51 provide treatment for behavioral addictions. Behavioral addiction treatments are available in 23 of the 81 provinces in Türkiye, and 24 out of the 51 hospitals offering treatment for behavioral addictions are located in İstanbul (47.1%), while three (5.9%) are located in Ankara. Among these 51 hospitals, 22 are public, and 29 are private. The primary focus of treatment revolves around internet and gambling addiction. Upon analyzing the patient groups served, it was observed that 49% (n = 25) of the hospitals specialize in treating adult patients, while 29.4% (n = 15) cater to pediatric patients. While the websites of 11 hospitals contain information about the behavioral addiction treatments offered, they lack any information on the patient groups to which they cater. The predominant treatment modalities include psychotherapy (25.49%), followed by psychopharmacotherapy (19.61%) and cognitive-behavioral therapy (17.65%). In conclusion, the treatment of behavioral addictions, such as those related to the internet, gaming, and shopping, are offered in hospitals across various regions and age groups. Considering that only 3.7% of hospitals in Türkiye treat behavioral addictions, this type of treatment is not widespread.

Feasibility study of the e-learning version of the "Journey of the Brave:" a universal anxiety-prevention program based on cognitive behavioral therapy.

School-based cognitive behavioral therapy (CBT) programs could contribute toward preventing anxiety disorders in children. However, setting aside class time for such programs is difficult. Internet-based CBT (I-CBT) is an efficient way to provide CBT. However, studies on I-CBT for anxiety prevention remain scarce, including I-CBT for school-based universal prevention programs. Therefore, we developed an e-learning version of a school-based anxiety-prevention CBT program, "Journey of the Brave," which was effective in Japan, to make it more flexible and accessible. This study evaluated its feasibility. We conducted a single-arm study based on 44 parents and children. Children aged 10-12years took the e-learning program at home. Parents and children responded to a questionnaire three times: before the learning (Pre), after the learning (Post), and three months later (FU: Follow-up). Feasibility was comprehensively evaluated through dropout rates, satisfaction and learning records, and changes in scores on psychological scales assessing anxiety symptoms, emotion-regulation skills, and children's emotional and behavioral problems. Of the 44 children, 42 started the e-learning, and 32 continued it (dropout rate of 23.8%). Furthermore, 83.9% of the children and 96.8% of the parents responded "agree" or "somewhat agree" regarding overall satisfaction. The parent-rated Spence Children's Anxiety Scale(SCAS) (SCAS-P) showed a significant decrease between Pre and FU (p = 0.014, 95% CI = (-9.22, -0.84)); however, the child-rated SCAS (SCAS-C) reduction was not significant (p = 0.08). The Emotion‑Regulation Skills Questionnaire (ERSQ) also increased significantly between Pre and FU (p = 0.045, 95% CI = (0.18, 18.31)). The Total Difficulties Score of the Strengths and Difficulties Questionnaire(SDQ) decreased significantly from Pre to Post (p = 0.025, 95% CI = (-3.62, -0.19)); however, it was not significantly different between Pre and FU (p = 0.67). The e-learning version showed low dropout rates and high satisfaction ratings from parents and children. Moreover, this study did not rule out the possibility that the program reduced children's anxiety and improved their emotional-regulation skills. Therefore, its potential and feasibility were indicated. UMIN, UMIN000049182, Registered 11 October 2022.

The Canvas of Grief and Loss: Painting A Way for Mental Vitality

The purpose of this systematic review was to explore the relationship between grief and loss counseling and the beneficial effects it has on mental health. By analyzing a variety of different studies and peer-reviewed journal articles that targeted bereavement topics, it revealed how grief and loss counseling is beneficial depending on the person and type of grief that has developed. Key findings include how grief impacts an individual emotionally, physically, and spiritually which reflects how the overall well-being of a person is. It is also noted how psychological wellness may impact physiological wellness. Another key finding was how complicated grief therapy is one of the most successful grief and loss counseling practices to help bereaved individuals, but other interventions were also found successful. Those other interventions consisted of emotionally focused therapy, compassion-focused therapy, family-focused therapy, interpersonal therapy, standard psychotherapy, cognitive behavioral therapy, bibliotherapy, and snow globe therapy. There are more interventions to help people than listed, but the paper specifically addressed those. However, future research needs to be completed to gain further understanding of grief and loss and how to help bereaved individuals obtain care that fits their desired needs. It is essential to take note of how everyone processes grief at their own pace which also explains why certain interventions may not be successful for every grieving individual. It is also significant to acknowledge when people can find benefit through the loss, it helps the individual move through the process of grieving which highlights the meaningful influence of finding a purpose for the pain.

Cost-Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression Among Adults in Primary Care.

Approximately 1 in 5 adults are diagnosed with depression in their lifetime. However, less than half receive help from a health professional, with the treatment gap being worse for individuals with socioeconomic disadvantage. Computer-assisted cognitive behavioral therapy (CCBT) is an effective and convenient strategy to treat depression; however, its cost-effectiveness in a sociodemographically diverse population remains unknown. To evaluate the cost-effectiveness of clinician-supported CCBT compared with treatment as usual (TAU) in a primary care population with a substantial number of patients with low income, limited computer or internet access, and lack of college education. This economic evaluation was a randomized clinical trial-based cost-effectiveness analysis. The trial was conducted at the Departments of Family and Geriatric Medicine and Internal Medicine at the University of Louisville. Enrollment occurred from June 24, 2016, to May 13, 2019. Participants had mild to moderate depression and were followed up for 6 months after treatment completion. The last follow-up assessment was conducted on January 30, 2020. Statistical analysis was performed from August 2023 to August 2024. CCBT intervention was provided for 12 weeks and included 9 modules ranging from behavioral activation and cognitive restructuring to relapse prevention strategies, supported by telephonic sessions with a clinician, in addition to TAU, which included standard clinical management in primary care. The primary health outcome was quality-adjusted life years (QALYs), estimated using the Short-Form 12 questionnaire (SF-12). The secondary outcome was treatment response, defined as at least 50% improvement in the Patient Health Questionnaire. The intervention cost included sessions with mental health clinicians and the cost of the CCBT software, plus the cost of loaner computer and internet data plan for low-resource households. An incremental cost-effectiveness ratio (ICER) was computed, while adjusting for baseline scores, age, and sex. The cost-effectiveness acceptability curve presented the probability of CCBT being cost-effective for a range of willingness-to-pay values. Among the 175 primary care patients included in this study, 148 (84.5%) were female; 48 (27.4%) were African American, 2 (1.2%) were American Indian or Alaska Native, 4 (2.5%) were Hispanic, 106 (60.5%) were White, and 15 (8.6%) were multiracial; and the mean (SD) age was 47.03 (13.15) years. CCBT was associated with better quality of life and higher chance of treatment response at the posttreatment and 6-month time points, compared with the TAU group. The ICER for CCBT was $37 295 (95% CI, $22 724-$66 546) per QALY, with a probability of 89.4% of being cost-effective at a willingness-to-pay threshold of $50 000/QALY. The ICER per case of treatment response was $3623 (95% CI, $2617-$5377). In this trial-based economic evaluation, CCBT was found to be cost-effective, compared with TAU, in primary care patients with depression. As this study included individuals with low income and with limited internet access who are underrepresented in cost-effectiveness studies, it has important policy implications for addressing unmet needs in sociodemographically diverse populations.