Cognitive Behavioral Therapy Protocol Research Articles

Delivering a Cognitive Behaviour Therapy for psychosis (CBTp) informed crisis intervention in acute mental health inpatient settings: a therapy protocol

ABSTRACT Background People experiencing psychosis in acute crisis should be offered Cognitive Behavioural Therapy for psychosis (CBTp) however there are no protocols developed to inform delivery specifically for people in acute crisis receiving inpatient mental health care. This paper narratively describes a CBTp-informed crisis-focused therapy protocol to inform the delivery of therapy in inpatient settings. Method This study draws on relevant systematic reviews, qualitative interview studies with stakeholders, Delphi studies, and coproduction to develop the protocol. It draws upon crisis theories and CBTp theories to underpin it. Results This paper outlines a modularised approach to working with people with psychosis and in crisis. It outlines the key values underpinning the protocol, and the key modules of: engagement, assessment and identifying priorities; formulation of the crisis, stabilisation, safety, and problem solving, crisis plans and crisis cards, change strategy work focusing on crisis appraisals, and discharge and relapse planning. Discussion A crisis-focused cognitive behavioural therapy protocol is presented which can be used to inform therapy for people experiencing psychosis and in crisis. More research is required to explore the efficacy of such therapies.

Efficacy of cognitive behavioral therapy for menopausal symptoms and quality of life in Korean perimenopausal women: A pilot randomized controlled trial

ObjectivesTherapeutic interventions are crucial for perimenopausal women, given the challenging physical and psychological symptoms they face. This study focused on the development and verification of the efficacy of a cognitive behavioral therapy (CBT) protocol designed specifically for Korean perimenopausal women. Study designA CBT protocol for perimenopausal women was newly developed based on theory and evidence. Forty menopausal women were randomly assigned to either the CBT group (n = 19) or treatment-as-usual (TAU) group (n = 21). Participants in the CBT group underwent 60-min weekly sessions for eight weeks. The TAU group received standard care from gynecologists. Main outcome measuresAt baseline and follow-up, participants completed the Menopausal Rating Scale (MRS), World Health Organization Quality of Life Brief Version (WHOQOL-BREF), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-15 (PHQ-15), Menopause Emotional Symptom Questionnaire (MESQ), and Subjective Memory Complaints Questionnaire. ResultsThe CBT group showed significant changes in their MRS (F = 4.18, p = .048), WHOQOL-BREF (7.60, 0.009), GAD-7 (4.61, 0.038), PHQ-15 (5.49, 0.025), and MESQ scores (7.19, 0.011) compared to the TAU group. In the CBT group, changes in GAD-7 scores were correlated with PHQ-15 (ρ = 0.57, p < .05), MESQ (0.57, < 0.05), and WHOQOL-BREF scores (−0.53, < 0.05). ConclusionCBT prevents the worsening of menopausal and emotional symptoms, anxiety, and quality of life. CBT may have had a therapeutic effect through the following mechanisms: managing anxiety by changing perceptions of menopause through education and training for coping with various menopausal symptoms and improving self-efficacy in symptom management. Clinical trial registration numberKCT0007517.

Dynamics of clinical manifestations of social phobia, bulimia nervosa, and anorexia nervosa in medical university students during cognitive behavioral therapy and sertraline pharmacotherapy

In recent years, there has been a significant incidence of psychopathology, leading to a decrease in social adaptation and more serious consequences. In particular, one of these nosologies is social phobia. Social phobia in young people, in particular, in medical students, often leads to the development of eating disorders. A significant part of young people during their studies at the higher educational institution are under constant strain of adaptive resources, sometimes even in a state of decompensation. The purpose of the study was to investigate the dynamics of clinical manifestations of social phobia, bulimia nervosa, and anorexia nervosa in medical students against the background of cognitive behavioral psychotherapy and sertraline pharmacotherapy. The study was conducted in 2020–2021 among students of the Voronezh State Medical University named after N. N. Burdenko. 106 participants were divided into 4 groups. Group I was treated with individual cognitive behavioral therapy (CBT), group II received a combination of psychotherapy and pharmacotherapy with sertraline at a dosage of 100 mg/day, group III — psychopharmacotherapy with sertraline without cognitive psychotherapy, and group IV had cognitive behavioral group psychotherapy. During the two-month study positive dynamics in the frequency of symptoms of social anxiety, anorexia nervosa, and bulimia nervosa were noted among the patients of all groups. The best dynamics of symptoms of social phobia and eating disorders was noted among the participants of the first and second groups. The results in both groups are comparable. The next most effective method of therapy of the combined social phobia and eating disorders according to the two-month study was group cognitive psychotherapy. Sertraline pharmacotherapy without cognitive psychotherapy in the third group of the participants showed the least effectiveness. The results of the study allow recommending the use of individual and group CBT protocols and a combination of individual CBT and sertraline pharmacotherapy in the treatment of comorbid social phobia, anorexia ner vosa, and bulimia ner vosa in students of higher medical institutions.

An Online Single-Session Cognitive Behavioral Therapy for Depression and Anxiety Associated with Multiple Sclerosis-Pilot Study.

Background: Multiple sclerosis (MS) is one of the most debilitating neurodegenerative diseases in youth, significantly affecting all life domains. Therefore, a strong association between MS, depression and anxiety symptoms has been established. The objective of the present interventional one-group pretest-posttest study is to assess the feasibility of an online single-session intervention (SSI) based on a cognitive behavioral therapy protocol targeting depressive and anxiety symptoms, psychological mechanisms, fatigue and overall health status. Methods: In this pilot study, 31 patients with MS (Mage = 42 years, SD = 12.2) received the online CBT SSI. The impact of the intervention was assessed using validated instruments two weeks after the intervention and after a two-month follow-up period. Results: Statistically significant effects were observed for the reduction of depression, with B = -7.58, 95% CI (-12.84, -2.31) and p < 0.01, and anxiety, with B = -15.17, 95% CI (-18.31, -12.02) and p < 0.001, at post-test and follow-up screening. Additionally, positive outcomes were seen for irrational beliefs at post-test, with B = -25.86, 95% CI (-46.10, -5.61), along with negative automatic thoughts, with B = -4.47, 95% CI (-10.65, 1.71), which were preserved at follow-up. Despite the health status also improving, no significant changes were observed for dysfunctional attitudes and fatigue. Conclusions: This research proves that the online CBT SSI was efficient for decreasing mild to moderate symptoms of depression and anxiety and reducing the intensity of dysfunctional psychological mechanisms in our sample.

Cognitive Behavioral Therapy for Symptom Preoccupation Among Patients With Premature Ventricular Contractions: Nonrandomized Pretest-Posttest Study.

Premature ventricular contractions (PVCs) are a common cardiac condition often associated with disabling symptoms and impaired quality of life (QoL). Current treatment strategies have limited effectiveness in reducing symptoms and restoring QoL for patients with PVCs. Symptom preoccupation, involving cardiac-related fear, hypervigilance, and avoidance behavior, is associated with disability in other cardiac conditions and can be effectively targeted by cognitive behavioral therapy (CBT). The aim of this study was to evaluate the effect of a PVC-specific CBT protocol targeting symptom preoccupation in patients with symptomatic idiopathic PVCs. Nineteen patients diagnosed with symptomatic idiopathic PVCs and symptom preoccupation underwent PVC-specific CBT over 10 weeks. The treatment was delivered by a licensed psychologist via videoconference in conjunction with online text-based information and homework assignments. The main components of the treatment were exposure to cardiac-related symptoms and reducing cardiac-related avoidance and control behavior. Self-rated measures were collected at baseline, post treatment, and at 3- and 6-month follow-ups. The primary outcome was PVC-specific QoL at posttreatment assessment measured with a PVC-adapted version of the Atrial Fibrillation Effects on Quality of Life questionnaire. Secondary measures included symptom preoccupation measured with the Cardiac Anxiety Questionnaire. PVC burden was evaluated with 5-day continuous electrocardiogram recordings at baseline, post treatment, and 6-month follow-up. We observed large improvements in PVC-specific QoL (Cohen d=1.62, P<.001) and symptom preoccupation (Cohen d=1.73, P<.001) post treatment. These results were sustained at the 3- and 6-month follow-ups. PVC burden, as measured with 5-day continuous electrocardiogram, remained unchanged throughout follow-up. However, self-reported PVC symptoms were significantly lower at posttreatment assessment and at both the 3- and 6-month follow-ups. Reduction in symptom preoccupation had a statistically significant mediating effect of the intervention on PVC-specific QoL in an explorative mediation analysis. This uncontrolled pilot study shows preliminary promising results for PVC-specific CBT as a potentially effective treatment approach for patients with symptomatic idiopathic PVCs and symptom preoccupation. The substantial improvements in PVC-specific QoL and symptom preoccupation, along with the decreased self-reported PVC-related symptoms warrant further investigation in a larger randomized controlled trial. ClinicalTrials.gov NCT05087238; https://clinicaltrials.gov/study/NCT05087238.

The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology

Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043–1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303–311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138–144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616–629, 2013; Kendall et al. Cogn Behav Pract 12:136–148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34–43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.

Using implementation methods to study a combined dance/movement therapy (DMT) and cognitive behavioral therapy (CBT) protocol at an inpatient substance use setting

There is evidence that dance/movement therapy (DMT) has positive outcomes for patients with various conditions when used either as a standalone therapy or when coupled with a gold standard modality such as cognitive behavioral therapy (CBT). This combined DMT/CBT has yet to be studied for patients struggling with alcohol and substance use disorders from a structured, manualized, implementation perspective. The current study outlines patient engagement and satisfaction with a 4-session DMT/CBT program at an inpatient addiction treatment facility. The 4-session manualized DMT/CBT protocol comprised “impulse inventory,” “studying impulses,” “subconscious movement,” and “body language.” Participants reported the most engagement in “studying impulses” and attended an average of 2.38 sessions during their time in treatment. Most patients reported receiving some (55%) or substantial (23%) benefit from the protocol. These findings lay the foundation to better optimize a DMT/CBT protocol for patients struggling with alcohol and substance use disorders. However, about a quarter of patients received no benefit from the group (23%), highlighting known barriers to DMT in general. Findings can help small inpatient facilities utilize information toward next steps of optimizing a DMT/CBT protocol.

The effectiveness of cognitive behavioural therapy for depression in women with breast cancer: a systematic review and meta-analysis.

Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions. To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer. Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck's protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures. Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = -0.93 [95% CI -1.47, -0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer. CBT aligned to Beck's protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck's CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly.

Cognitive behavioral therapy for anxiety and opioid use disorder: Development and pilot testing

IntroductionAnxiety disorders are highly prevalent among people with opioid use disorder (OUD), and they have a negative impact on disorder course and treatment outcomes. The objective of this Stage 1 A/1B behavioral treatment development trial was to develop a novel cognitive-behavioral therapy (CBT) protocol for co-occurring anxiety disorders and OUD. MethodsFollowing a period of iterative manual development involving patient interviews and feedback from content experts, we tested a 12-session individual CBT protocol in a small, open pilot trial (N = 5). This was followed by a small, randomized controlled trial (N = 32), comparing the new protocol to 12 sessions of manualized Individual Drug Counseling. All participants also received medication for OUD. ResultsOverall, support for feasibility and acceptability was strong, based on recruitment and retention rates and patient satisfaction ratings. Within-subjects results identified 11-point reductions in anxiety symptom severity (on a 0–56 point scale); these gains were sustained through 3 months of follow-up. However, these changes did not differ between randomized conditions. With respect to opioid outcomes, 85 % of participants were abstinent in the prior month at the end of treatment. Opioid use outcomes also did not differ by treatment condition. ConclusionsThese results support the feasibility and acceptability of a CBT protocol for co-occurring anxiety and OUD. However, in this small pilot trial results do not show an initial benefit over an evidence-based psychosocial treatment targeted to OUD alone, in combination with medication for OUD.

Comparing the Effectiveness of Schema Therapy and Pre-Marriage Cognitive-Behavioral Therapy on the Desire to Marry and Fear of Marriage Among Single Women

Objective: The present study aimed to compare the effectiveness of schema therapy and cognitive-behavioral therapy before marriage on the desire to marry and fear of marriage among single women. Methods and Materials: The present study was quasi-experimental, employing a pre-test and post-test design with a non-equivalent control group. The study population consisted of single women in district one of Tehran in 2022. The sample included 60 individuals selected via convenience sampling based on a call from the study population and randomly assigned to two experimental groups and one control group. Participants responded to the Heidari, Mazaheri, and Pooretemad (2004) marriage desire questionnaire and the Samiei, Yousefi, and Nashatdoust (2014) fear of marriage questionnaire before and after the intervention. The first experimental group underwent schema therapy and the second experimental group underwent cognitive-behavioral therapy in eight 90-minute sessions, based on the schema therapy protocol (Leahy, Robert, 2011) and the cognitive-behavioral therapy protocol (Beck, 1964), respectively. Data were analyzed using one-way ANOVA and follow-up tests with SPSS software. Findings: The results showed that schema therapy and cognitive-behavioral therapy significantly increased the desire to marry and decreased the fear of marriage among single women (p &lt; 0.05). Conclusion: Given the findings, it can be concluded that pre-marriage schema therapy and cognitive-behavioral therapy can be proposed as effective therapeutic methods for improving the desire to marry and reducing the fear of marriage among single women, and can be employed as significant and key interventions in the pre-marriage domain.

Comparing the Effect of Transcranial Direct Current Stimulation (TDCS) and Cognitive-Behavioral Therapy on Substance Craving Control and Rumination in Methamphetamine-Dependent Patients

Objective: The aim of the current study was to compare the effect of Transcranial Direct Current Stimulation (TDCS) and Cognitive-Behavioral Therapy on substance craving control and rumination in methamphetamine-dependent patients. Methods and Materials: The present study, in terms of its objective, was applied research, utilizing a pre-test post-test design within a quasi-experimental research framework. The statistical population included all male patients dependent on methamphetamine who visited the Gam Addiction Treatment Clinic in Ghaemshahr city in the year 2020, from whom 45 individuals were selected through convenience sampling and randomly divided into three groups of 15 (two experimental and one control group). Participants in all three groups responded to the Drug Desire Questionnaire (DDQ) (2002) and the Hocksmann-Nolen Marw Rumination Questionnaire (1991) in three stages: pre-test, post-test, and follow-up. For the first experimental group, Transcranial Direct Current Stimulation (TDCS) was applied with a maximum current intensity of 2 milliamperes, and for the second experimental group, twelve sessions of Cognitive-Behavioral Therapy were conducted based on the Cognitive-Behavioral Therapy protocol (Bayling, McCabe, Antony, 2011), while the control group received no treatment. Data were analyzed using SPSS statistical software. Findings: The results showed that both treatments were effective. However, the effectiveness of Transcranial Direct Current Stimulation (TDCS) on craving control and the effectiveness of Cognitive-Behavioral Therapy on rumination were greater. Conclusion: Both treatments can be used to reduce psychological problems in methamphetamine-dependent patients.

Cognitive Behavioral Therapy for Tinnitus: Outpatient-Based Treatment

Background and Objectives Cognitive behavioral therapy (CBT) is a treatment option for subjective tinnitus. There are many reports on its clinical efficacy, but the protocol has not been well established. The purpose of this study was to set an outpatient-based CBT protocol and evaluate its clinical efficacy for tinnitus.Subjects and Method A total of 85 chronic tinnitus patients was assessed in this prospective study. After evaluating for eligibility, 30 patients completed CBT based on a protocol of 5 weekly sessions in an outpatient setting. Therapeutic efficacy was assessed by Tinnitus Handicap Inventory (THI) questionnaires and visual analogue scale (VAS) for tinnitus. The initial scores were compared with the final scores, which were assessed a month after the fifth CBT session.Results The results showed that CBT reduced THI and VAS scores significantly (&lt;i&gt;p&lt;/i&gt;&lt;0.05).Conclusion The results of the study suggest that an outpatient-based CBT protocol can be clinically beneficial for patients with tinnitus.

Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial.

Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa. This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group. In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples. Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant. Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants. German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245.

Intensive cognitive behavioral group therapy for the treatment of panic disorder

Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety. Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients. Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted. Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy. Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.

Cognitive-behavioral group therapy for obesity to reduce cardiovascular risks in patients with type 2 diabetes

Obesity is one of the risk factors for the development and progression of type 2 diabetes (T2D). Decrease in body weight (BW) by 10% from the initial level in patients with T2D and obesity significantly reduces the risk of cardiovascular events. Low effectiveness of measures to reduce body weight in patients with T2D is due to hidden eating disorders against the background of mental imbalance, high levels of anxiety and depression, and frustration with glycemic levels. Solving the problem of the low frequency of achieving target values for reducing weight in type 2 diabetes through the development and evaluation of the clinical effectiveness of cognitive-behavioral therapy protocols is of high scientific and practical significance.

Дистанционная когнитивно-поведенческая терапия, основанная на принятии и ответственности для лечения повторяющегося травмирующего поведения.

The article describes clinical manifestations of repetitive traumatic behavior directed (focused) on the body or skin picking disorder. The spectrum of forms of repetitive traumatic behavior directed at the body is detailed. A diagnostic algorithm and a psychological approach to the assessment and initial treatment of psychosocial stressors in this group of patients are proposed. The general tactics of treatment are presented, and emphasis is placed on the specifics of cognitive behavioral therapy (CBT) for repetitive traumatic behavior directed at one's own body, as well as its effectiveness and limitations. It is shown that the «classical» CBT protocol (for example, habit change training, habituation, attention management, stimulus control) is an insufficient tactic of psychotherapeutic treatment, because it is unable to help the patient cope with internal experiences and emotional dysregulation. In this regard, it is recommended to use a multimodal protocol with an emphasis on metacognitive features of perception of the situation, regulation of impulsivity, maladaptive perfectionism and minimization of empirical avoidance of one's own experiences.

Comparison of the efficacy of cognitive-behavioral therapy and mindfulness therapy on fear the negative of evaluation in individuals with social anxiety disorder

Introduction: Social anxiety disorder is characterized by the fear of negative evaluation. This psychological construct results in individual’s poor functioning. Aim: The present research aimed to compare the effects of cognitive-behavioral therapy (CBT) and mindfulness therapy on the fear of negative evaluation in individuals with social anxiety disorder. Method: This quasi-experimental study, with a pretest-posttest control group design, was conducted on a population of individuals with social anxiety symptoms, who were referred to the psychological clinics of Shiraz, Iran, in 2019. Sampling was performed using the convenience sampling method. After initial evaluations, 45 people were randomly divided into three equal groups (two intervention groups and one control group). The CBT protocol proposed by Hoffman and Otto (2008) and the Acceptance and Mindfulness protocol by Fleming and Kukowski (2007) were used to implement the interventions (12 two-hour sessions). The participants also completed the Social Phobia Inventory (SPIN) by Connor et al. (2000) and the Fear of Negative Evaluation Scale by Leary (1983) before and after the intervention. Data analysis was performed in SPSS-24, using multivariate analysis of covariance (MANCOVA). Results: The results of MANCOVA test showed a significant difference between the scores of the control and experimental groups (P&lt;0.001). Compared to the control group, the fear of negative evaluation reduced in the experimental groups. Although there was no significant difference between the two treatment approaches (P&gt;0.05), the effect of mindfulness treatment was slightly higher than CBT. Conclusion: In this study, comparison of the two mindfulness and CBT approaches indicated no significant difference between these two methods in reducing the fear of negative evaluation among individuals with social anxiety. Therefore; it is suggested to use acombination of these two methods to reduce the fear of negative evaluation.

Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder

Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.

A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness.

Cognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. Friends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. First, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. The mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Relatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support.

Effectiveness of Cognitive-behavioral Therapy on the Positive and Negative Psychotic Symptoms and Emotion Regulation of Patients With Schizophrenia Spectrum Disorders

Objective Schizophrenia is the most debilitating psychiatric disorder with the highest psychiatric ward admission rate. Drug therapy is the first line of treatment. However, it does not result in appropriate therapeutic responses in many patients, and they experience emotional regulation difficulties and psychosis symptoms after initial symptom resolution. Cognitive-behavioral therapy (CBT) is currently an adjuvant treatment besides drug therapy to target the persistent symptoms of psychosis. The present study aims to determine the effectiveness of CBT on the positive and negative symptoms and emotional regulation of those suffering from schizophrenia spectrum disorders. Materials &amp; Methods The research design was single-subject and of the AB type (baseline and intervention) with a follow-up phase. Besides the routine therapy sessions, CBT sessions were held for the study participants. They were patients admitted to Razi Educational and Therapeutic and Research Psychiatric Center in Tehran City, Iran, who were selected based on the inclusion criteria. Thirty patients were selected with convenience sampling, and 5 were randomly placed in the CBT group. They were evaluated with the scales of positive and negative symptoms of Kay, Fiszbein, and Opler (1986) and difficulties in emotional regulation by Gratz and Roemer (2004) in the baseline, intervention, and follow-up phases. The treatment sessions were planned based on the CBT protocol developed by Laura Smith, Paula Nathan, Uta juniper, Patrick Kingsep, and Louella Lim (2003). Non-overlap of all pairs (NAP), percentage of non-overlapping data (PND), percentage of all non-overlapping data (PAND), percentage of data points exceeding the median (PEM), Cohen’s d effect size, and improvement percentages were used to analyze the data, and visual graphs were used for data presentation. Results The outcomes showed that in the intervention phase, compared to the baseline phase, the effect sizes of the positive and negative symptoms in the first to fifth participants were 1.6, 3.1, 3.2, 1.9, and 2.4, respectively. Only the effect sizes of the second and third participants were large. The effect sizes of the emotional regulation factor in the first to fifth participants were 2.8, 1.2, 1.1, 2.2, and 1.9, respectively. The effect size of the second participant was large, and the rest were average. The findings of this study showed that during the post-therapy and follow-up stages, while patients who had received CBT still experienced positive and negative symptoms of psychosis and difficulties in emotional regulation; these symptoms decreased in comparison with the baseline phase. Furthermore, their improvement percentages were not significant. Conclusion Data analysis showed that although CBT is effective in reducing positive and negative psychotic symptoms and improving the emotional regulation of patients, the data obtained from Cohen’s d effect size and recovery indices showed that the results are not clinically significant. In other words, although the patients who received CBT showed a slight improvement in psychotic symptoms and difficulty in emotional regulation, they could not maintain the therapeutic gains in the follow-up phase.