Cognitive Behavioral Therapy Skills Research Articles

인지행동치료 기반 인성교육 프로그램 개발 및 효과

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

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

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

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

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

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

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

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

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

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

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

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

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

Plenary Session 2: Late onset psychosis / schizophrenia

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

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

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

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

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

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

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

Future of Mental Health in Sport: CBT and Athletes

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

The Appa Health App for Youth Mental Health: Development and Usability Study.

Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program.

Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study.

Homebound older adults are a high-risk group for depression. However, many of them face barriers to accessing evidence-supported mental health treatments. Digital mental health interventions can potentially improve treatment access, but few web-based interventions are explicitly tailored for depression in older adults. This paper describes the development process of Empower@Home, a web-delivered intervention for depression in homebound older adults that is based on cognitive behavioral therapy, and reports on the outcomes of usability studies. Empower@Home was developed in collaboration with community agencies, stakeholders, and older adults, guided by user-centered design principles. User needs were assessed through secondary data analysis, demographic and health profiles from administrative data, and interviews and surveys of community partners. A comparative usability evaluation was conducted with 10 older adults to assess the usability of Empower@Home compared to 2 similar programs. Field testing was conducted with 4 end users to detect additional usability issues. Feedback and recommendations from community partners heavily influenced the content and design of Empower@Home. The intervention consists of 9 sessions, including psychoeducation and an introduction to cognitive behavioral therapy skills and tools through short video clips, in-session exercises, an animated storyline, and weekly out-of-session home practice. A printed workbook accompanies the web-based lessons. In comparative usability testing (N=10), Empower@Home received a System Usability Scale score of 78 (SD 7.4), which was significantly higher than the 2 comparator programs (t9=3.28; P=.005 and t9=2.78; P=.011). Most participants, 80% (n=8), preferred Empower@Home over the comparators. In the longitudinal field test (n=4), all participants reported liking the program procedures and feeling confident in performing program-related tasks. The single-subject line graph showed an overall downward trend in their depression scores over time, offering an encouraging indication of the intervention's potential effects. Collaboration with community stakeholders and careful consideration of potential implementation issues during the design process can result in more usable, engaging, and effective digital mental health interventions.

Workshop (Knowledge Generation) ID 2001810

Background Guided internet-delivered CBT (ICBT) offers an alternative approach for mental health service delivery in the community for those with spinal cord injury (SCI). However, there is a lack of evidence to support its use through large, controlled trials. Study Objectives The primary aim of the current study is to explore the efficacy of ICBT in reducing symptoms of depression and anxiety among persons with SCI compared to an online SCI Rehabilitation Education program. Learning Objectives Upon completing this workshop, attendees will: 1) understand the state of mental health among those post SCI; 2) explain the evidence behind guided ICBT among those post SCI; 3) apply cognitive behaviour therapy skills. Overview The presenters of this workshop will engage in lecture to provide current state of evidence for ICBT among those post SCI, conduct small-group discussions to apply CBT skills and examine barriers and facilitators of implementing the program. Methods Participants (n=122) endorsing symptoms of depression and/or anxiety related to SCI were randomized to an 8-week transdiagnostic ICBT program for those with SCI or an online SCI Rehabilitation Education program. Participants completed measures on depression, anxiety, self-efficacy, quality of life, and pain at pre-, post-, 3-months, and 6-months post-intervention. Results Significantly greater improvements in depression, anxiety, self-efficacy, quality of life, and pain interference were seen in the ICBT group compared to the Education group at post treatment and follow-up. Completion rates (∼90%) and satisfaction (&amp;gt;90%) were high in both groups. Conclusions The findings provide evidence for the superiority of ICBT over education in improving well-being among those with SCI.

Interventions promoting mental health dimensions in infertile women: a systematic review

BackgroundScientific developments have brought hope to infertile couples; however, the results are not always favorable. This makes women suffer psychological pressure. Therefore, previous studies have investigated the effectiveness of many psychological interventions but no research identified the most common psychological interventions. In this regard, the present review aimed to investigate different psychological interventions that promote mental health in infertile to identify the most frequent (common) ones.MethodsIn the present study, the search was carried out using appropriate keywords Infertility, psychological interventions, mental health, stress, anxiety, depression and women in the Google Scholar، Magiran، SID، Pubmed، Scopus، Science Direct، ProQuest، Web of Science databases and One of the leading websites in health- WHO with Persian and English languages and two operators of “AND” and “OR” between 2000 and 2021.ResultsFirst, 7319 articles were searched, 6948 articles of which were removed due to irrelevant subjects, and 31 articles were removed due to duplication. 340 abstracts were examined and the results of 60 articles were extracted. Two approaches (examining the type and content of intervention) were used to extract findings. The first approach indicated high diversity in psychological interventions, leading to the categorization of the interventions into 4 categories of cognitive behavioral therapy (CBT), mind-body interventions (MBI), stress management skills, and others. CBT and MBI and stress management skills were found as the most frequent promoting interventions for mental health in infertile women. The second approach indicated the differences in protocols (number of sessions and time of interventions).ConclusionDespite differences in protocol of interventions under study, the results of all articles revealed the effectiveness of interventions in improving infertile women’s mental health; therefore, it is suggested to apply the most common psychological interventions based on scientific evidence (CBT, MBI, and stress management skills) along with infertility treatment methods. The results will help the specialists, policy-makers, and planners to select and implement the most appropriate psychological interventions for infertile women.

Evaluation of the impact of a self-stigma reduction programme on psychosocial outcomes among people with schizophrenia spectrum disorder

Purpose The purpose of this study is to evaluate the effectiveness of a self-stigma reduction programme on self-stigma. Design/methodology/approach A randomized controlled trial was conducted from November 2017 to December 2018 with 278 people diagnosed with schizophrenia (PDwS). Participants were randomly assigned to receive a self-stigma reduction programme (psychoeducation, cognitive behavioural therapy and social skills training) or treatment as usual. Findings PDwS in the intervention group experienced a greater reduction in the level of self-stigma (20.19 vs −0.62; p &lt; 0.001) at post-intervention and (37.35 vs −0.66; p &lt; 0.001) at six-month follow-up. Originality/value The first RCT examines the problem and implements intervention in middle east country. Also, the authors have conducted high-quality RCT.

Sokoon

The World Health Organization (WHO) estimates that depression, anxiety, and stress disorders (DASDs) are prevalent worldwide, resulting in the loss of 13 million years of life and trillions of dollars of economic loss annually. Mobile-based health (M-health) interventions can employ mental health interventions such as cognitive behavioral therapy (CBT) for adolescents worldwide. Arab youth who struggle with DASDs do not tend to engage in mental therapies, but gamification and modularization have the potential to boost their appeal. The authors have selected effective CBT interventions for DASDs, adapted them to digital interactive formats, and integrated gamification concepts. An Arabic mobile application, Sokoon, which means relaxation and relief, may encourage Arab users to practice the required CBT skills for mild-to-moderate DASDs. A pilot study was conducted to evaluate the effectiveness of Sokoon App in a small group of adults who had signs of aDASDs. Sokoon was practicable, well-received by users, and had a positive impact on participants' feelings of anxiety and sadness.

The impact of a children's literature-based cognitive behavioural therapy skills curriculum on middle-school youth who self-report clinically relevant and non-clinical mental health symptomatology

To evaluate potential differences in the impact of a children's literature-based mental health literacy and cognitive behavioural therapy (CBT) skills curriculum on middle-schoolers with and without mental health symptoms that may be clinically relevant. Youth (aged 11-14; grades 7-8) who received a 3-month teacher-delivered intervention embedded in the language arts curriculum (N=196) were compared to a wait-list control group (N=233) from a large, diverse, urban school board in Canada. The Revised Child Anxiety and Depression Scale (RCADS) and Life Problems Inventory (LPI) were administered. Youth were divided according to scores of possible clinical relevance into "clinical" and "non-clinical" groups. A mixed ANOVA (Intervention and Clinical status at baseline are between subject scores and Time is the only repeated measure) was used clustered by classroom. Thirty-three-point six percent of all participants endorsed symptoms of potential clinical relevance on the RCADS and/or one of its subscales. The primary analyses were non-significant but also underpowered to detect outcomes (RCADS β = 0 .14; LPI β = 0.28). LPI scores improved numerically for intervention vs. control youth (clinical: -8% vs. +24%; non-clinical -9% vs. 0%, effect size = .002). This study was underpowered; however, it did identify a potentially clinically meaningful trend in a measure of maladaptive coping (LPI) favouring the intervention. A future, well-powered study is needed to characterize the impact of this intervention.

Skill Improvement Through Learning in Therapy (SKILT): A Study Protocol for a Randomized Trial Testing the Direct Effects of Cognitive Behavioral Therapy Skill Acquisition and Role of Learning Capacity in Depression.

To improve psychological treatments for major depressive disorder (MDD), a better understanding on how symptoms ameliorate during treatment is essential. In cognitive behavioral therapy (CBT), it is unclear whether procedures focused on the acquisition of CBT skills play a causal role in the improvement of CBT skills. In this randomized trial, we isolate a single CBT Skill Acquisition Procedure (CBTSAP) and test its direct effects on CBT skills and related therapy processes (i.e., change in (idiosyncratic) dysfunctional thinking and reward processing). We hypothesize that the CBTSAP causes improvements in CBT skills and related therapy processes compared to an active control condition. In addition, we hypothesize that individual differences in attentional bias and memory functioning (defined as learning capacity) moderate the effects of CBTSAP on outcomes and that using mental imagery as a cognitive support strategy to strengthen the effects of the CBTSAP will be most beneficial for patients with low learning capacity. 150 patients with MDD will be randomized to one of three conditions: 1. an active control condition, 2. CBTSAP, 2. CBTSAP plus mental imagery, all consisting of three sessions. Primary outcomes will be change in CBT skills, changes in (idiosyncratic) dysfunctional thoughts and behaviors, reward processing. Depressive symptoms are a secondary outcome. Measures of learning capacity will be conducted at baseline and tested as a potential moderator. Knowing whether and for whom the acquisition of CBT skills leads to change in therapy processes and a subsequent reduction of depressive symptoms will inform on how to personalize and optimize psychotherapy outcomes for depression. The trial is registered at the German Clinical Trial Register (DKTR; registration number: DRKS00024116).