Cognitive Behavioral Therapy For Patients Research Articles

PS09 (P50): A randomized controlled trial of integrative cognitive behavioural therapy for patients with alopecia areata: a pilot study

PS09 (P50): A randomized controlled trial of integrative cognitive behavioural therapy for patients with alopecia areata: a pilot study

Performance Validity and Outcome of Cognitive Behavior Therapy in Patients with Chronic Fatigue Syndrome

There is limited research examining the impact of the validity of cognitive test performance on treatment outcome. All known studies to date have operationalized performance validity dichotomously, leading to the loss of predictive information. Using the range of scores on a performance validity test (PVT), we hypothesized that lower performance at baseline was related to a worse treatment outcome following cognitive behavioral therapy (CBT) in patients with Chronic Fatigue Syndrome (CFS) and to lower adherence to treatment. Archival data of 1081 outpatients treated with CBT for CFS were used in this study. At baseline, all patients were assessed with a PVT, the Amsterdam Short-Term Memory test (ASTM). Questionnaires assessing fatigue, physical disabilities, psychological distress, and level of functional impairment were administered before and after CBT. Our main hypothesis was not confirmed: the total ASTM score was not significantly associated with outcomes at follow-up. However, patients with a missing follow-up assessment had a lower ASTM performance at baseline, reported higher levels of physical limitations, and completed fewer therapy sessions. CFS patients who scored low on the ASTM during baseline assessment are more likely to complete fewer therapy sessions and not to complete follow-up assessment, indicative of limited adherence to treatment. However, if these patients were retained in the intervention, their response to CBT for CFS was comparable with subjects who score high on the ASTM. This finding calls for more research to better understand the impact of performance validity on engagement with treatment and outcomes.

Internet-Based Cognitive Behavioral Therapy for Patients Reporting Symptoms of Anxiety and Depression After Myocardial Infarction: U-CARE Heart Randomized Controlled Trial Twelve-Month Follow-up.

BackgroundThe U-CARE Heart trial was one of the first randomized controlled trials to evaluate the effect of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety or depression for patients with a recent myocardial infarction. While the effects of internet-based cognitive behavioral therapy on Hospital Anxiety and Depression Scale (HADS) scores at 14 weeks postbaseline were not significant, in this study, we investigated possible long-term effects of treatment.ObjectiveThe aim of this study was to evaluate the long-term effectiveness of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety and depression in patients 12 months after a myocardial infarction and to explore subsequent occurrences of cardiovascular disease events.MethodsShortly after acute myocardial infarction, 239 patients (33% female, mean age 59.6 years) reporting mild-to-moderate symptoms of anxiety or depression were randomized to 14 weeks of therapist-guided internet-based cognitive behavioral therapy (n=117) or treatment as usual (n=122). Data from national registries were used to explore group differences in clinical outcomes such as cardiovascular disease and cardiovascular-related mortality for a follow-up period of up to 5 years: group differences in HADS total score 1 year post–myocardial infarction, the primary outcome, was analyzed using multiple linear regression. Secondary outcomes, such as HADS anxiety and depression subscales and the Cardiac Anxiety Questionnaire total score (CAQ), which measures heart-focused anxiety, were analyzed in the same way. Multiple imputation was used to account for missing data, and a pooled treatment effect was estimated. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) for data pertaining to registry outcomes.ResultsBoth groups reported lower HADS total scores 1 year after myocardial infarction than those at baseline. HADS total scores were not significantly different between the treatment and control groups 1 year after myocardial infarction (β=–1.14, 95% CI –2.73 to 0.45, P=.16). CAQ was the only measure improved significantly by internet-based cognitive behavioral therapy when compared with treatment as usual (β=–2.58, 95% CI –4.75 to –0.42, P=.02) before adjusting for multiple comparisons. The composite outcome of nonfatal cardiovascular events and cardiovascular-related mortality did not differ between groups but was numerically higher in the internet-based cognitive behavioral therapy group, who were at slightly greater risk (HR 1.8, 95% CI 0.96 to 3.4, P=.07). Adjusting for previous myocardial infarction and diabetes attenuated this estimate (HR 1.5, 95% CI 0.8 to 2.8, P=.25).ConclusionsInternet-based cognitive behavioral therapy was not superior in reducing self-reported symptoms of depression or anxiety compared to treatment as usual at the 1-year follow-up after myocardial infarction. A reduction in cardiac-related anxiety was observed but was not significant after adjusting for multiple comparisons. There was no difference in risk of cardiovascular events between the treatment groups. Low treatment adherence, which might have affected treatment engagement and outcomes, should be considered when interpreting these results.Trial RegistrationClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191International Registered Report Identifier (IRRID)RR2-10.1186/s13063-015-0689-y

Cognitive behavioral therapy for patients with mild to moderate depression: Treatment effects and neural mechanisms

In this study, we combined clinical assessment and magnetic resonance imaging (MRI) techniques to investigate the brain mechanisms in mild to moderate depression (MMD) patients following cognitive behavioral therapy (CBT). Data were collected from 30 MMD patients and 18 healthy controls, and we divided patients into two treatment periods (4 weeks, 8 weeks). Clinical assessment indicated that depression characteristics, as quantified by Hamilton Depression Rating Scale (HAMD), were significantly higher in MMD patients than in healthy controls. At the baseline, MRI data revealed abnormalities in the hippocampus and nucleus accumbens (NAc) of patients with MMD, e.g., smaller gray matter volumes of the hippocampus and nucleus accumbens (NAc), as well as weaker functional connectivity between NAc and the posterior cingulate cortex/precuneus. Moreover, the hippocampus and NAc volumes were negatively correlated with the HAMD scores in MMD patients. After CBT intervention, the HAMD scores decreased, and the structural and functional characteristics of NAc in MMD patients obtained at 8-week were improved; e.g., no significant differences in NAc volume or NAc-based functional connectivity between the two groups. Taken together, our results provided evidence suggesting that CBT is an effective treatment for MMD patients. Alterations of gray matter volume and resting-state functional connectivity after 8 weeks of CBT indicated a potential modulation mechanism in brain structural modifications and functional connectivity plasticity within the NAc in MMD patients.

Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications.

BackgroundDepression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care.ObjectiveThe objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints.MethodsA systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified.ResultsThe studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life.ConclusionsNo clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies.

Getting down to business: an examination of occupational outcomes in cognitive behavioral therapy for depression

ABSTRACT Depression is associated with unemployment and poor occupational functioning. Although cognitive behavioral therapy (CBT) has been shown to reduce depressive symptoms, the degree to which it improves occupational outcomes has received little attention. We investigated change in job status and presenteeism (i.e., the inability to focus on and accomplish work) over the course of CBT. We assessed employment status, presenteeism, depressive symptoms, cognitive style, and CBT skills at intake and posttreatment in a sample of 126 participants enrolled in a 16-week course of CBT for depression. Employment status significantly improved from pre to posttreatment, with 11 of the 27 patients (41%) seeking to improve their employment status achieving this goal. Among the 59 consistently employed patients, presenteeism decreased significantly over the course of treatment (dz = 1.13). We also found, even after controlling for changes in symptoms, reductions in negative cognitive style (but not changes in CBT skills) were associated with reductions in presenteeism. Our findings suggest CBT patients experience positive changes in occupational outcomes, both in finding work and being more focused and productive at work. Changes in negative cognitive styles appeared to partly explain this latter change. We encourage future work examining CBT’s impact on occupational outcomes.

Cognitive Behavioral Therapy for Patients with Trigeminal Neuralgia: A Feasibility Study.

To test the feasibility and acceptability of a customized six-session cognitive behavioral therapy (CBT) group intervention for adults with recurrent trigeminal neuralgia (TN). Fifteen participants with TN were recruited from a specialist facial pain unit in London, United Kingdom. The effects of the group intervention were evaluated using validated self-report measures, which the participants completed before and after the intervention and at 1-month and 9-month follow-ups. A semi-structured interview was also used at the 1-year follow-up to gather qualitative feedback of the group intervention. Participants reported an increase in confidence in managing everyday tasks in the presence of TN symptoms, a reduction in negative beliefs about pain, and an increase in engagement in meaningful activity. All patients completed the group intervention (100% retention rate). Qualitative feedback highlighted that the group CBT intervention was helpful, and no participants reported a worsening of mood or experience as a result of the intervention. The trends for improvement in several domains, plus the positive experiences of the participants, suggest that a CBT management program is acceptable and feasible for this population and should be further developed and implemented on a larger scale to determine its clinical efficacy.

Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis.

Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. This study is registered as PROSPERO CRD42017078690. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

Mechanisms of change and heterogeneous treatment effects in psychodynamic and cognitive behavioural therapy for patients with depressive disorder: a randomized controlled trial

BackgroundMajor depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD.MethodsOne hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included.DiscussionThe clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning.Trial registrationClinicalTrials.gov Identifier: NCT03022071.

Effects of cognitive behavioral therapy in patients with fibromyalgia: a single blind, randomized controlled study

INTRODUCTION: Fibromyalgia (FM) is a long-lasting musculoskeletal pain, which remains a problematic clinical entity globally and the management of this condition is a challenge for the health providers. Numerous individual treatment options are available to improve the symptoms of fibromyalgia, but a specificity tailored to particular patient is still missing. Thus, in this study we tested both the individual effects of physiotherapy techniques and the combination of cognitive behavioral therapy along with physiotherapy techniques would bring any changes on the fibromyalgia symptoms. OBJECTIVE: To determine the combined effect of cognitive behavioral therapy along with physiotherapy techniques in the management of fibromyalgia symptoms. METHODS: This experimental study recruited 60 FM participants aged 18-50 years from Dehradun, India and were randomized into one of 2 groups: Integrated Physiotherapy only, integrated physiotherapy and cognitive behavioral therapy for 12 weeks. Visual analogue scale, revised fibromyalgia impact questionnaire, beck depression index, shortform-36 health surveys, Pain pressure algometer, General Anxiety Disorder - 7 were recorded at baseline, four weeks, eight weeks and twelve weeks. RESULTS: After three months significant improvement (p&lt;0.05) were noted on all the above outcome measures of integrated physical therapy and cognitive behavioral therapy group. CONCLUSION: Cognitive behavioral therapy combined with Physiotherapy treatment had an effect to reduce the depression and disability, improvement on the quality of life on fibromyalgia.

Autonomous Motivation Moderates the Relation of Self-Criticism to Depressive Symptoms Over One Year: A Longitudinal Study of Cognitive-Behavioral Therapy Patients in a Naturalistic Setting

Introduction: This study examined whether motivation moderated the relation between self-criticism and depression over one year in a sample of adults receiving cognitive-behavior therapy (CBT). Methods: Participants (N = 38) completed measures of pre-treatment self-criticism (Time 1), autonomous/controlled motivation for engaging in CBT at the beginning of treatment (Time 2), and interviewer-rated depression at Time 1, and one year after baseline (Time 3). Results: Multiple regression analyses of moderator effects showed that patients higher in self-criticism with lower autonomous motivation for CBT had higher levels of depressive symptoms one year later. The effect of controlled motivation was nonsignificant. Discussion: Our findings support the buffering hypothesis that engaging in CBT because it is personally meaningful may protect patients high in self-criticism from experiencing the poorer treatment outcomes associated with their specific vulnerability. However, given the small sample size, the results will need to be replicated within larger samples to ensure generalizability.

Individualised cognitive behaviour therapy in patients of substance use disorders: three case studies.

The current study aims to investigate the effectiveness of Cognitive Behaviour Therapy (CBT) in the treatment of patients with substance use disorders. Three diagnosed patients with substance use disorders were recruited -i.e. 305.20 (F12.10) cannabis used disorder, 291.81 (FI0.239) alcohol withdrawal disorder and 292.0 (F11.23) opioid withdrawal disorder, respectively. The patients were detoxified and individual treatment plan was formulated on the basis of CBT. The CBT therapeutic outcomes were evaluated on the basis of pre- and post-assessment scores. Results indicate that CBT worked effectively in one-on-one session. CBT effectively worked to manage patients' anger, craving, stress, sleep hygiene and assertive behaviour. It is concluded that CBT is an effective approach to deal with patients' anger, stress, craving, sleep and assertive behaviour.

Individualised cognitive behaviour therapy in patients of substance use disorders: three case studies

Abstract&#x0D; The current study aims to investigate the effectiveness of Cognitive Behaviour Therapy (CBT) in the treatment of patients with substance use disorders. Three diagnosed patients with substance use disorders were recruited —i.e. 305.20 (F12.10) cannabis used disorder, 291.81 (FI0.239) alcohol withdrawal disorder and 292.0 (F11.23) opioid withdrawal disorder, respectively. The patients were detoxified and individual treatment plan was formulated on the basis of CBT. The CBT therapeutic outcomes were evaluated on the basis of pre- and post-assessment scores. Results indicate that CBT worked effectively in one-on-one session. CBT effectively worked to manage patients’ anger, craving, stress, sleep hygiene and assertive behaviour. It is concluded that CBT is an effective approach to deal with patients’ anger, stress, craving, sleep and assertive behaviour.&#x0D; Keywords: Cognitive Behavioural Therapy; Canabis Used Disorder; Alcohol Withdrwal Disorder; Opioid Withdrawal Disorder. Continuous....

CBT MobileWork©: User-Centered Development and Testing of a Mobile Mental Health Application for Depression

“Homework assignments,” a critical element of Cognitive Behavioral Therapy (CBT) for depression, are a means of CBT skill generalization and maintenance. Yet, homework adherence is often low. We developed CBT MobileWork,© a smartphone application (app) to promote CBT skills practice “as-needed.” We applied a user-centered design in a laboratory setting with 8 depressed patients and 5 therapists for the initial development and testing. We then completed a real-world evaluation of CBT MobileWork© with 15 depressed patients in CBT and their therapists. This report details the prototype development, presents data evaluating feasibility and usability in the lab and real-world, and presents preliminary findings of associated measures. Our data indicates that both patients and therapists reported high levels of satisfaction and rated the application highly usable during testing in both controlled laboratory and under real-world conditions. A moderate association between app use and reductions in depression was found. CBT MobileWork© has preliminary feasibility for CBT skills practice and may benefit patients with CBT homework completion.

PENGARUH TERAPI PERILAKU KOQNITIF TERHADAP GAMBARAN DIRI: SISTEMATIKA REVIEW

Body image is a crucial factor in the formation of individual identity. Increasing body image on an individual requires an intervention which can change thoughts, feelings and attitudes affecting the behavior related to the whole body and its function. This systematic review evaluates the existed evidence to identify the effect of Cognitive Behavioral Therapy (CBT) on body image. The literature review is conducted by selecting the corresponding articles which are published between 2011 and 2017. Various databases used are CINAHL, EBSCO, Proquest, Pubmed, Science Direct, and Semantic Scholar. The inclusion criteria are the articles publishing original data, being fully written in English, researching human as an object and exploring the cognitive behavioral therapy and body image. There are eight articles that showed the effect of cognitive behavioral therapy on body image including reducing body image concern, reducing bad stigma towards body image and irrational beliefs on body changing, increasing body area satisfaction, improving appearance evaluation and improving a positive body image. The application of cognitive behavioral therapy is essential and effective in improving body image. This study recommends health professionals, especially nurses, to apply cognitive behavioral therapy in patients with various diseases involving body image disturbance.

Utilizing placebos to leverage effects of cognitive-behavioral therapy in patients with depression

BackgroundPatients with depression often experience difficulties with completing homework assignments during cognitive-behavioral therapy (CBT). In the present study, we investigated the effects of a specific placebo which aimed at improving the practice of a daily relaxation exercise during a four-week outpatient program. MethodsA total of 126 patients diagnosed with major depressive disorder were randomly assigned to one of three groups: ‘Coping with Depression’ course, ‘Coping with Depression’ course with additional daily placebo treatment, and waiting-list group. The placebo (sunflower oil) was introduced as a natural medicine to help the patients focus on their inner strengths and to mobilize their bodies’ natural healing powers. The placebo was taken orally before the daily relaxation exercise. ResultsThe placebo improved homework quantity and quality (both p < .001). The placebo group practiced more often and experienced greater relaxation effects than the no-placebo group. Additionally, the placebo group showed a greater reduction of depression symptoms (p < .001). LimitationsThe primary limitation of the study is the lack of a psychophysiological measure of relaxation. ConclusionsPlacebos can be used to leverage CBT effects in patients with depression.

Trajectories and associations between depression and physical activity in patients with cardiovascular disease during participation in an internet-based cognitive behavioural therapy programme.

There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity. To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy. A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale - self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor. After 2 weeks the internet-based cognitive behavioural therapy group had a temporary worsening in depressive symptoms. At 9-week follow-up, depressive symptoms (P<0.001) and physical activity (P=0.02) had improved more in the internet-based cognitive behavioural therapy group. Only in the internet-based cognitive behavioural therapy group, was a significant correlation (r=-0.39, P=0.002) between changes in depressive symptoms and changes in physical activity found. Structural equation analyses revealed that internet-based cognitive behavioural therapy decreased depressive symptoms, and that a decrease in depression, in turn, resulted in an increase in physical activity. Internet-based cognitive behavioural therapy was more effective than an online discussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.

Targeting fear of positive evaluation in patients with social anxiety disorder via a brief cognitive behavioural therapy protocol: a proof-of-principle study.

Our aim was to develop a brief cognitive behavioural therapy (CBT) protocol to augment treatment for social anxiety disorder (SAD). This protocol focused specifically upon fear of positive evaluation (FPE). To our knowledge, this is the first protocol that has been designed to systematically target FPE. To test the feasibility of a brief (two-session) CBT protocol for FPE and report proof-of-principle data in the form of effect sizes. Seven patients with a principal diagnosis of SAD were recruited to participate. Following a pre-treatment assessment, patients were randomized to either (a) an immediate CBT condition (n = 3), or (b) a comparable wait-list (WL) period (2 weeks; n = 4). Two WL patients also completed the CBT protocol following the WL period (delayed CBT condition). Patients completed follow-up assessments 1 week after completing the protocol. A total of five patients completed the brief, FPE-specific CBT protocol (two of the seven patients were wait-listed only and did not complete delayed CBT). All five patients completed the protocol and provided 1-week follow-up data. CBT patients demonstrated large reductions in FPE-related concerns as well as overall social anxiety symptoms, whereas WL patients demonstrated an increase in FPE-related concerns. Our brief FPE-specific CBT protocol is feasible to use and was associated with large FPE-specific and social anxiety symptom reductions. To our knowledge, this is the first treatment report that has focused on systematic treatment of FPE in patients with SAD. Our protocol warrants further controlled evaluation.

Describing a critical life event and its psychological consequences: The type of language used by patients suffering from depression and its relationship with personality development

Information on personality development (and its linguistic predictors) in the aftermath of a critical life event among depressive patients is relatively limited. The study’s aim was to verify two hypotheses: (1) Participants with depression will use concrete rather than abstract language to describe their most recent critical life event and its psychological consequences and (2) The more abstract the language used, the higher the level of personality development. 16 Cognitive Behavioral Therapy patients suffering from depression participated in the study (M = 34 years old; SD = 4.02). Their level of personality development was assessed qualitatively by two independent coders. The coding system was based on the Positive Disintegration Theory (Dąbrowski 1964). We used typology from the Linguistic Category Model (Semin and Fiedler 1991) to analyse the level of abstractness vs. concreteness. Depressed patients were classified as either abstract language speakers or concrete language speakers. There were equal numbers of both types of speakers. Moreover participants consistently used one type of language, regardless of whether they were describing the critical life event itself or its psychological consequences. As expected, using higher levels of language abstractness when speaking correlated with possessing higher levels of personality development. Our findings provide practitioners with useful knowledge on the benefits of using abstract language to improve supportive strategies when dealing with people in crisis and modify the psychotherapeutic protocols used to treat depression.

Guided Internet-Based Cognitive Behavioral Therapy in Japanese Patients With Obsessive-Compulsive Disorder: Protocol for a Randomized Controlled Trial.

BackgroundCognitive behavioral therapy for obsessive-compulsive disorder has been established, but access to this therapy in Japan is limited. Internet-based cognitive behavioral therapy may improve treatment accessibility and sufficiently improve obsessive-compulsive symptoms. There are few randomized controlled trials examining the effectiveness of internet-based cognitive behavioral therapy in patients with obsessive-compulsive disorder. We designed a randomized controlled trial protocol to assess the effectiveness of guided internet-based cognitive behavioral therapy in Japanese patients with obsessive-compulsive disorder.ObjectiveWe aimed to develop a protocol for a randomized controlled trial of internet-based cognitive behavioral therapy in Japanese patients with obsessive-compulsive disorder.MethodsThe randomized controlled trial will compare internet-based cognitive behavioral therapy treatment and usual care groups, each consisting of 15 participants (n=30) diagnosed with obsessive-compulsive disorder. We will evaluate the effectiveness of a 12-week intervention. The primary outcome of symptom severity will be measured using the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes will be assessed with the Obsessive-Compulsive Inventory, Beck Anxiety Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Working Alliance Inventory-Short Form, and the Euro Qol – 5 Dimension. All measures will be assessed at weeks 0 (baseline) and 12 (follow-up). In the statistical analysis comparing treatment effects, the least-squares means and their 95% CIs will be estimated by analysis of covariance with the change in total outcomes scores at week 12. All comparisons are planned, and all P values will be two-sided, with values <.05 considered statistically significant.ResultsThe study will be performed from January 2020 to March 2021, and results are expected to be available in mid-2021.ConclusionsThe trial will demonstrate whether internet-based cognitive behavioral therapy improves access and is more effective than more usual care for patients with obsessive-compulsive disorder in Japan.Trial RegistrationUniversity Hospital Medical Information Network (UMIN) 000039375; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000044422International Registered Report Identifier (IRRID)DERR1-10.2196/18216