Cognitive Behavioral Therapy Program Research Articles

Development of an Internet-delivered Cognitive Behavioral Program for Inflammatory Bowel Disease: A Pilot Study

This pilot study examined a new internet-delivered cognitive behavior therapy program (iCBT) for anxiety, depression and/or stress in adults with inflammatory bowel disease (IBD). Eighteen of 21 participants completed the 9-module program. Measures of anxiety, depression, and stress were administered at baseline, and at 6-, 12-, and 24-weeks post-baseline. The iCBT program resulted in significant decreases in anxiety and stress 12 weeks post enrollment, with no significant changes in depression.

Impact of an automated Internet-based cognitive behavioral therapy program on suicide thinking and risk among United States rural adults

Cognitive behavior therapy (CBT) is an evidence-based psychotherapy for mental disorders, including depression. Internet-based CBT (iCBT) programs increasingly are showing similar impact to clinician-delivered CBT. We assessed the impact of Thrive, a fully-automated iCBT depression treatment program on suicidal thinking. Participants were randomly assigned to the intervention (INT) group (n = 218) or a waitlist control group (WLC, n = 230). Intent-to-treat analyses tested for group differences at 8-weeks in suicidal thinking (CHRT-SR3 subscale, primary outcome), and secondary outcomes including depression symptoms (PHQ-9), anxiety symptoms (GADS-7), work and social adjustment (WSAS), and resilience (CD-RISC-10). Using self-reports, participants were evaluated at baseline, 4 and 8 weeks for each outcome. Thrive program adherence (n = 218) was assessed by number of lessons completed. Although not statistically significant, the INT group was 38.7% less likely than the control group to present with suicidal thinking at 8 weeks (odds ratio 0.61, p = 0.10). Comparison of 8-week depression symptom slopes showed statistically significant effects favoring the INT group (WLC = − 3.04 vs Thrive = − 4.32, p = 0.007) (d = 0.08); no other significant group differences were observed. Lessons completed were significantly related to lower PHQ-9 (p = 0.026) and GAD-7 scores (p < 0.01). Study results are consistent with a previous study showing nonsignificant effect of an automated iCBT program for reducing suicidal thinking, but a significant positive impact on depression symptoms among rural US adults. Future studies should test whether strategies for boosting lesson completion are successful in enhancing the efficacy of Thrive to reduce suicide risk.Trial Registration: National Institutes of Health Trial ID: NCT03595254.

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial.

BackgroundPosttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice.ObjectiveThis study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use.MethodsWe conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46).ResultsPre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=−0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice.ConclusionsWeb-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study.Trial RegistrationClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473

Online 8-week cognitive therapy for problem gamblers: The moderating effects of depression symptoms and perceived financial control.

Background and aimsOnline interventions for problem gambling are increasingly popular, but not everyone benefits from them. We describe 12 years of real-world data from an online intervention for gambling problems and aim to find out the extent to which depression, alcohol use, and sense of financial control influence the effectiveness of the program.MethodsWe analyzed treatment effectiveness and moderators in the Finnish “Peli Poikki” program (2007–2018)—an 8-week cognitive behavioral therapy and follow-up program for problem gambling. Participants were Finnish-speaking adults over 18 years of age (N = 2011, 66.9% males). We measured the self-reported level of problem gambling, depression, alcohol use, and sense of financial control across four treatment phases (baseline, post-treatment, 6-month follow-up, and 12-month follow-up), as well as the presence of gambling debt, psychological and physiological health, years suffered from gambling problems, and demographic variables.ResultsParticipation grew across years with retention rates of 55%, 30%, and 19% for post-treatment and the two follow-ups, respectively. The average problem gambling scores declined significantly following treatment and remained low throughout the follow-ups. However, this decline (the beneficial treatment effect) was reversed after the follow-ups for those with high depression scores and those who felt they had no control over their finances.Discussion and ConclusionsThe Peli Poikki program is a well-functioning online intervention but less effective in the long term for participants with persisting symptoms of depression or without a sense of financial control. More attention is needed to screen and direct people with comorbidities to the appropriate services.

High Plasma Oxytocin Levels in Men With Hypersexual Disorder.

ContextHypersexual disorder (HD) involves excessive, persistent sexual behaviors related to various mood states and the diagnosis compulsive sexual behavior disorder is included as an impulse control disorder in the 11th revision of the International Classification of Diseases. Although the neurobiology behind the disorder is not clear, some studies suggest dysregulated hypothalamic-pituitary-adrenal axis. Oxytocin acts as counterregulatory neuroendocrine hormone to cortisol and is also involved in sexual behavior.ObjectiveWe hypothesized that oxytocin may play a role in the pathophysiology of HD with compensatory actions to cortisol.DesignLongitudinal.SettingANOVA clinic (Karolinska University Hospital).Patients or other participants64 males with HD and 38 age-matched healthy volunteers.Main Outcome MeasuresPlasma oxytocin levels, measured with radioimmunoassay; Hypersexual Disorder Screening Inventory; and Hypersexual Disorder: Current Assessment Scale for assessing hypersexual symptoms.InterventionsA patient subgroup (n = 30) completed the manual-based group-administered cognitive-behavioral therapy (CBT) program for HD, and posttreatment oxytocin levels were measured.ResultsHypersexual men (n = 64) exhibited significantly higher oxytocin plasma levels (mean ± SD: 31.0 ± 9.9 pM) compared with healthy volunteers (16.9 ± 3.9 pM; P < 0.001). There were significant positive correlations between oxytocin levels and the rating scales measuring hypersexual behavior. Patients who completed CBT treatment (n = 30) had a significant reduction of oxytocin plasma levels from pretreatment (30.5 ± 10.1 pM) to posttreatment (20.2 ± 8.0 pM; P < 0.001).ConclusionsThe results suggest that the hyperactive oxytocinergic system in hypersexual men may be a compensatory mechanism to attenuate hyperactive stress.

An Internet-Based Cognitive Behavioral Therapy Program for Anxiety and Depression (Tranquility): Adaptation Co-design and Fidelity Evaluation Study.

BackgroundInternet-based cognitive behavioral therapy (iCBT) is a necessary step toward increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to the therapeutic principles of cognitive behavioral therapy (CBT) or usability standards. In addition, many existing iCBT programs do not include treatments targeting both anxiety and depression, which are commonly co-occurring conditions.ObjectiveThis study aims to evaluate the usability of Tranquility—a novel iCBT program for anxiety—and its fidelity to CBT principles. This study also aims to engage in a co-design process to adapt Tranquility to include treatment elements for depression.MethodsCBT experts (n=6) and mental health–informed peers (n=6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression by using 2 simulated client case examples. Mental health–informed peers engaged in 2 co-design focus groups to discuss adaptations to the existing anxiety program and the integration of interventions for depression. Both groups completed web-based surveys assessing the usability of Tranquility and the likelihood that they would recommend the program.ResultsThe CBT experts’ mean rating of Tranquility’s fidelity to CBT principles was 91%, indicating a high fidelity to CBT. Further, 5 out of 6 CBT experts and all mental health–informed peers (all participants: 11/12, 88%) rated Tranquility as satisfactory, indicating that they may recommend Tranquility to others, and they rated its usability highly (mean 76.56, SD 14.07). Mental health–informed peers provided suggestions on how to leverage engagement with Tranquility (eg, adding incentives and notification control).ConclusionsThis preliminary study demonstrated the strong fidelity of Tranquility to CBT and usability standards. The results highlight the importance of involving stakeholders in the co-design process and future opportunities to increase engagement.

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Parent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study.

This article reports on a pilot study of a parent-only cognitive behavioural therapy (CBT) programme for parents of children with autism spectrum disorders (ASD) and anxiety difficulties. Twenty-one parents of anxious children with ASD (5–11 of age) completed the From Timid to Tiger intervention. Parent outcome measures were assessed at post-intervention and at 3-month follow-up. Analysis indicated significant reductions in both parent and clinician reports of child anxiety symptoms. Specifically, 38% of children were free of their primary diagnosis at treatment end and this increased to 57% when measured at 3-month follow-up. Positive gains were evidenced regarding parents’ ability to manage their child's anxiety without accommodating to it. The results provide preliminary evidence of parent-only CBT programs for children with ASD

Brief Cognitive Behavioral Therapy for Patients with Comorbid Depression and Type 2 Diabetes in an Urban Primary Care Facility: Randomized Controlled Trial

Background: The relation between depression and diabetes is bidirectional and both can lead to morbidity and mortality. Despite the success of Cognitive Behavioral Therapy (CBT) in managing psychiatric comorbidities, research on its use in the treatment of comorbid diabetes and depression is limited and with varying results. The aim of the study is to assess the efficacy of CBT on depressed patients with type 2 diabetes.&#x0D; Methods: This randomized controlled trial was conducted at an urban primary healthcare center in Egypt from February 2019 to March 2020 and included 80 participants. Key inclusion criteria were uncontrolled type 2 diabetes (T2D) (HbA1c &gt;7.5%) and depression symptoms diagnosed by Beck’s Depression Index. Participants were assessed for all battery of instruments. Subsequently, participants were randomized to control and treatment groups. The treatment group received four CBT sessions. Both groups received a thirty-minute structured diabetes education and their usual diabetes treatment. Three months later, all participants were reassessed for depression and diabetes compliance and all labs were performed post intervention. Both the primary (the difference in HbA1c pre-post intervention) and secondary outcomes (the change in depressive symptoms assessed) were analyzed using ANCOVA.&#x0D; Results: Both groups were matching at baseline. Post intervention, the CBT group revealed a significant reduction in depressive symptoms while adjusting for Beck Depression Index (BDI) pre-intervention [F (1, 74) = 7.074, p = 0.010]. Moreover, HBA1c was improved significantly when controlling for pre-intervention BDI scores and BMI [F (1,73) = 4.27, p = 0.042] compared to the control group.&#x0D; Conclusions: The CBT program was both inexpensive and easily accessible. It could fit very well in primary care settings. The results indicated CBT intervention was effective in improving diabetes control and depression. However, a larger-scale study to test its effect on a larger scale population and its long-term impact is recommended.

Feasibility and acceptability of cognitive behavioural therapy in older Japanese people with cognitive decline: a single-arm intervention

Abstract Studies have shown that cognitive behavioural therapy (CBT) for older people with cognitive decline and depression/anxiety improves negative moods. However, CBT research focusing on this population in Japan is limited. This study aimed to evaluate the feasibility of a cognitive behavioural program for people with cognitive decline. Sixteen Japanese patients with mild dementia (n = 3) and mild cognitive impairment (MCI, n = 13) participated in the study. A single-arm, pre–post study was implemented in two hospitals in Japan. The CBT program included eight bi-weekly sessions. The feasibility outcomes (satisfaction, understanding and usefulness) were measured immediately after completing the sessions, and depression, anxiety, quality of life (QOL), neuropsychiatric symptoms, and caregiver burden were measured at three time points (i.e. before, immediately after, and 3-month follow-up). Ten MCI participants attended all sessions and the mean patient satisfaction scores using the Client Satisfaction Questionnaire were 31.0±10.05 out of 32. Linear mixed model analyses demonstrated that the time effect was significant for depression (d = 1.62), anxiety (d = 1.39), and QOL (d = 1.00) for the patients, and significant for anxiety (d = 1.08) for their caregivers. The study found that this CBT program is feasible and acceptable for older Japanese people with cognitive decline. The program also improved patients’ QOL, anxiety and depressive symptoms, and decreased caregivers’ anxiety. Key learning aims (1) Recently, studies have shown that CBT for older people living with dementia has been effective in treating their depression and anxiety. However, evidence for the efficacy of CBT and other curative or care options for people living with dementia is limited in Japan. (2) We studied a short-period CBT program and found that it was likely to be feasible and acceptable for use among older Japanese people with mild cognitive impairment, that it may improve negative mood among this group, and that it may lessen the care burden for caregivers. (3) Furthermore, we found that caregiver involvement in the implementation of CBT for older people may be effective in improving the mood of family members.

A group-based cognitive behavioral therapy program for family caregivers of people with dementia

A group-based cognitive behavioral therapy program for family caregivers of people with dementia

Modified School-Based Facing Your Fears for Students with Autism Spectrum Disorder and Anxiety: A Preliminary Quasi-Experimental and Qualitative Analysis

With a high prevalence of anxiety among children with Autism Spectrum Disorder, researchers have identified implementing effective treatments in real-world settings as a priority. In the present study, multiple methods were employed to evaluate the effectiveness of educators delivering a modified school-based Facing Your Fears Cognitive Behavior Therapy program to treat anxiety among students with Autism Spectrum Disorder. Participants included 5 students, 6 educators and 7 parents. Settings were a public elementary school and private school. Multiple methods included a quasi-experimental group design, time series design, semi-structured interviews and focus groups. Quantitative results indicated that with training and on-going feedback educators obtained a modest level of fidelity in implementing the intervention. Non-significant decreases in student anxiety symptoms across all informant ratings (students, parents and teachers) were observed. Social validity ratings across participants were high. Qualitative findings revealed the following themes: (a) outcomes; (b) program structure; (c) inclusion; and (d) factors critical for success. These preliminary results offer a model for researchers to collaborate with key stakeholders in adapting interventions for use in schools, bridging the gap between research and practice. They highlight educator’s ability to deliver empirically-supported treatments to address anxiety among students with Autism Spectrum Disorder.

The effectiveness of a group cognitive behavioral therapy program in

the purpose of this study is to investigate the effectiveness of a group therapy program to reduce depression among tramadol addicts in Jeddah, Saudi Arabia. The study population consisted of a sample of tramadol addicts who visited a private clinic in Jeddah. The total number of the sample was 24 addicts who voluntarily agreed to participate in the study

Using evaluative frameworks to examine the implementation outcomes of a cognitive behavioral therapy program for autistic students with anxiety within public school settings.

Cognitive behavioral therapy helps to treat anxiety symptoms in autistic youth, but it is difficult for families to access cognitive behavioral therapy in the community. Training school providers to deliver cognitive behavioral therapy may help autistic youth and their families to access these programs. Unfortunately, we do not know how cognitive behavioral therapy programs can be delivered by school providers and how these programs help the autistic students who access them. This study addressed this gap and was part of a larger study that looked at the effectiveness of Facing Your Fears-School-Based in 25 public schools. The study goals were to understand whether Facing Your Fears-School-Based helped students and the factors that made it easy or difficult to deliver Facing Your Fears-School-Based in schools. Thirty providers participated in interviews guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Participants shared information that fell into several major categories that included (1) delivering Facing Your Fears-School-Based to many different students; (2) the positive impact of Facing Your Fears-School-Based on students' school participation; and (3) plans to continue using Facing Your Fears-School-Based. School providers also shared that Facing Your Fears-School-Based was easy to use for non-mental health providers and reported adapting Facing Your Fears-School-Based to meet student needs. The results of this study suggest that Facing Your Fears-School-Based may help autistic students and highlight the importance of using mental health programs in schools that are flexible, able to be adapted, and that are able to be used by many different types of school providers.

Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study.

BackgroundDepression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care.ObjectiveThe aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression.MethodsThis retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures.ResultsOn average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (P<.001), with a continued, though slower, decline over subsequent weeks (P<.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model.ConclusionsUsing a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care.

The effects of a group cognitive behavioral therapy program using video communication for pregnant women with depressed mood in Korea: a pilot study.

PurposeThis study presents the development of a group video communication-based cognitive behavioral therapy (CBT) program for depressed pregnant women. It also provides the results of a preliminary test of its effects on their depression, automatic thoughts, and dysfunctional attitudes. MethodsIn this quasi-experimental single-group pre- and posttest design study, 13 pregnant women participated in a 4-week, eight-session group CBT program, based on Beck’s cognitive theory and using video communications from November 2020 to January. Pregnant women between 14 and 32 weeks who were members of an online maternity and parenting community and residing in the cities of Changwon and Gimhae, Korea, were invited to voluntarily participate. Trained nurses led CBT sessions of 3–4 participants per group via video communication. Participants were assessed pre- and postintervention with self-report questionnaires for measurement of depression, automatic thought, and dysfunctional attitude after normality test according to the Shapiro-Wilk test of the variables. The data were analyzed using paired t-test and Pearson correlation coefficients.ResultsDepression (t=7.90, p<.001), automatic thoughts (t=4.89, p<.001), and dysfunctional attitudes (t=2.42, p=.032) significantly decreased after the 4-week online program. There were statistically significant correlations among the three variables.ConclusionThis program was found to be effective in reducing depression, automatic thoughts, and dysfunctional attitudes. Above findings suggest that a group CBT program using video communication can be an effective therapeutic modality that helps pregnant women at risk for depression alleviate their negative emotions related to depression.

My Health Too: Investigating the Feasibility and the Acceptability of an Internet-Based Cognitive-Behavioral Therapy Program Developed for Healthcare Workers.

Background: The COVID-19 crisis has had a considerable mental health impact on healthcare workers. High levels of psychological distress are expected to have a significant impact on healthcare systems, warranting the need for evidence-based psychological interventions targeting stress and fostering resilience in this population. Online cognitive behavioral therapy (CBT) has proved to be effective in targeting stress and promoting resilience. However, online CBT programs targeting stress in healthcare workers are lacking.Objective: The aim of our study is to evaluate the feasibility and acceptability of an internet-based CBT intervention, the My Health Too program we developed during the first COVID-19 epidemic peak in France.Methods: We recruited 10 participants among Alsace region hospital staff during the first peak of the pandemic in France. They were given 1 week to test the website and were then asked to answer an internet survey and a semi-structured phone interview.Results: We conducted a thematic analysis of the content from the phone interviews. Major themes were identified, discussed and coded: the technical aspects, the content of the website and its impact on participants’ emotions and everyday life. Overall, the participants reported finding the website easy to use and interactive. They described the resources as easy to understand, readily usable, and useful in inducing calm and in helping them practice self-compassion.Conclusion: Our results suggest that the My Health Too online CBT program is highly feasible and acceptable to healthcare workers during the highly stressful times of the pandemic peak. The feedback provided helped to improve the program whose efficacy is to be tested.

Evaluation of the Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET) in the Philippines: a study protocol for a randomized controlled trial

BackgroundThe Philippines has been severely affected by the methamphetamine crisis. The government has launched a policy war against drug use, although the severe sanctions imposed on drug users have been criticized internationally. To help implement a more effective and humane approach to drug use, this study aimed to introduce a comprehensive treatment program for methamphetamine users based on cognitive-behavioral therapy (CBT) whose effectiveness will be evaluated through a randomized controlled trial.MethodsMethamphetamine users admitted into government-run rehabilitation facilities are recruited and randomly assigned to either a CBT-based treatment program or existing therapeutic community (TC)-based treatment. The CBT treatment program was developed based on the Matrix Model that considers cultural and social factors in the Philippines. After 6 months of treatment, there will be a three-month follow-up, when the participants’ drug use (tested through urine testing) and other psychological variables, including craving, coping skills, and well-being, will be compared. Potential participants are given a summary of the study and a consent form. The consent form is signed and dated by participants prior to their study participation. Ethical approval was obtained prior to the commencement of the study.DiscussionThis is the first randomized controlled trial to compare the residential CBT program and the TC model for methamphetamine users in the Philippines. The study aims to fill the current knowledge and capacity gaps by introducing a CBT-based treatment program to improve the psychosocial well-being of drug users in the Philippines. Moreover, if the effectiveness of the treatment program is demonstrated, anti-drug campaigns and severe sanctions against drug users may be reconsidered.Trial registrationUMIN Clinical Trials Registry JPRN-UMIN000038597. Registered on 15 November 2019. Protocol version October 17, 2021 ver.2

Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial.

BackgroundAlcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear.ObjectiveThis trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers.MethodsA three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment.ResultsDuring the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%).ConclusionsIn this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions.Trial RegistrationClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726

Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial.

BackgroundCognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated.ObjectiveThis study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing.MethodsThis study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility.ResultsIn the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained.ConclusionsThe findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size.Trial RegistrationUniversity Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb