Cognitive Behavioral Therapy Skills Research Articles

Integrating Mobile Technology and Social Support with Cognitive Behavioral Therapy for Anger in Veterans with PTSD: A Pilot Study

We conducted a pilot study incorporating mobile technology and social support into cognitive behavioral therapy (CBT) for anger in veterans with posttraumatic stress disorder (PTSD). N = 26 veterans with PTSD were administered standard 12-weekly session CBT for anger. Veterans randomized to an experimental group additionally received an app (“Connectd”) enabling CBT skills use and anger self-assessment while their family/friends received a supporter’s version of the same app providing PTSD resources/psychoeducation. Experimental participants readily used Connectd, found it valuable, and were more likely to practice CBT skills compared to control participants. Findings show feasibility and potential of a novel approach to treating anger in veterans with PTSD.

Improving Positive Life Event Predictions through Cognitive Behavioral Therapy

Depression is characterized by a tendency to overestimate the probability of negative life events and underestimate the probability of positive events. Although cognitive behavioral therapy (CBT) targets overly negative future expectations, research has yet to examine how such expectations change relative to one’s experiences. We examined the relation between predictions and event occurrence for positive and negative life events (i.e., informativeness of predictions [IoP]) among patients in CBT for depression. We examined how IoP changed over the course of CBT and whether these changes were related to CBT skill acquisition or symptom reduction. At intake and posttreatment, 67 patients were asked to estimate the probability of 40 events in the following week; patients later reported whether the events occurred. IoP improved for positive but not negative events across treatment. IoP for positive (but not negative) events were also associated with symptoms at intake and therapist-rated CBT skills at posttreatment. However, neither positive nor negative event IoP changes were associated with symptom improvement over the course of CBT. These findings suggest changes in the informativeness of predictions of positive life events may uniquely change and be important to the development of skills in CBT for depression.

Initial testing of a computer-based simulation training module to support clinicians' acquisition of CBT skills for substance use disorder treatment

Cognitive behavioral therapy (CBT) is one of the most common and effective treatments for substance use disorders (SUD); however, effective delivery of CBT depends on a wide variety of nuanced skills that require practice to master. We created a computer-based simulation training system to support the development of necessary skills for student trainees to be able to apply CBT effectively for clients with SUDs. CBT: Introducing Cognitive Behavioral Therapy is an interactive, role-play simulation that provides opportunities for clinician trainees to hone their skills through repeated practice and real-time feedback before application in a clinical setting. This is the first study that tests whether such a simulation improves trainee skills for the treatment of clients with SUDs. Graduate students (N = 65; social work, clinical psychology) completed standardized patient (SP) interviews, were randomized to the simulation training program or manual comparison condition (Project MATCH manual), and completed SP interviews three months post-baseline. Using general linear models, results indicated a significant time x group effect, with students assigned to the simulation training program showing greater improvement in “extensiveness” and “skillfulness” ratings across three skill categories: general agenda setting (p = .03), explaining CBT concepts (p = .007), and understanding of CBT concepts (p = .001). However, manual comparison participants showed greater improvement than simulation trainees in “assessing primary drug use” (prange = .013–.024). No changes in extensiveness or skillfulness of motivational interviewing (MI) style were observed. This pilot test of CBT: Introducing Cognitive Behavioral Therapy offers support for use of this novel technology as a potential approach to scale up CBT training for students, and perhaps clinicians, counseling people with SUDs.

A239 INFLAMMATORY BOWEL DISEASE PSYCHOTHERAPY PROTOCOL: GUT-DIRECTED COGNITIVE BEHAVIOURAL THERAPY, CLINICAL HYPNOSIS, AND EMOTION REGULATION COPING SKILLS DEVELOPMENT

Abstract Background IBD patients have a heightened risk for mental health illness, but general psychotherapy has shown mixed results. This psychotherapy protocol specialized for IBD patients uses recommended mental health therapies to treat specific chronic mental health illness. Therapy focuses on practicing CBT, clinical hypnosis, and emotion regulation healthy coping skills to self-manage chronic mental health symptoms. Standard therapies for acute mental illness, e.g. anxiety, depression, and suicidality, should be used as appropriate. Aims Aims of psychotherapy in IBD include improvement of mental health, symptoms management, quality of life (QOL), and adherence to medical treatments. Cognitive behavioural therapy (CBT) changes maladaptive coping behaviours and thinking. Clinical hypnosis improves somatic symptoms, e.g. chronic pain, nausea, and cramping. Emotion regulation improves ability to process stressful emotions, and has been shown to be affected by chronic diseases, including moderate to severe Crohn’s disease. Methods Patients learn to self-manage chronic mental health symptoms with healthy coping skills. CBT allows patients to identify maladaptive coping behaviours and thinking. Healthy coping behaviours and thinking patterns are chosen, supported, and adapted to. Clinical hypnosis uses relaxation techniques, e.g. progressive muscle relaxation, visualizations, and positive suggestions as a complimentary therapy for somatic symptoms. Emotion regulation develops tolerance and healthy processing of stressors. Results Therapy effectiveness is evaluated by improvements in patients’ mental health, symptoms management, QOL, and adherence to medical treatments. Mental health improvement, QOL, and emotion regulation are monitored by patient self-report, e.g. questionnaires. Maladaptive coping behaviours and thinking changed using CBT are individual to each patient. Somatic symptoms improved using clinical hypnosis are determined by monitoring or patient self-report. Adherence to medical treatments, as appropriate, is monitored. Conclusions This IBD psychotherapy protocol uses gut-directed CBT, clinical hypnosis, and emotion regulation therapies, designed to improve mental health, symptoms management, QOL, and adherence to medical treatments. Healthy coping skills treat maladaptive coping behaviours and thinking, somatic symptoms, and emotion dysregulation. Chronic mental health illness associated with IBD, is treated using this specialized psychotherapy. Funding Agencies None

Validation of a Self-Assessment Scale for Therapists’ Perception of Cognitive Behavioural Therapy Skills in China: A Mixed Method

Cognitive behavioural therapy (CBT) is a first-line psychotherapy in Western countries, yet there have been limited studies examined the required skills based on perception of CBT therapists in the context of Western countries, and there has been no such research in China. Currently, there is no exist of a selfassessment scale to evaluate the required competence perceived by CBT therapists in China. This study used both qualitative and quantitative method to develop a self-assessment tool by CBT therapist to provide their perception about required skills in the treatment of mental disorders in China. Qualitative research used semistructured behavioural event interviews to identify the essential competences perceived by CBT therapists in China. Based on the qualitative research results, quantitative research was further used to develop a self-rated instrument with 52 questions. Three-hundred therapists who were conducting CBT therapy for clients with mental disorders were invited to participate in the study, 278 of which answered the survey. Among 25 therapists in the qualitative research, three key themes relating to the success of treatment using CBT were extracted from the interview. These themes including generic psychotherapy competencies, common CBT theory, mastering basic CBT techniques are essential skills in the effective application of CBT treatment. Another two themes on challenges and difficulties in the application of CBT include formulating clients’ problems and plans and using CBT techniques properly. Among 52 questions, 44 questions were analysed, which identified four CBT competence related factors: 1. generic psychotherapy competencies; 2. mastering CBT theory and skills; 3. using CBT techniques properly; 4. formulating clients’ problems and plans. The reliability using Cronbach’s α and half-reliability coefficient analysis showed that the therapist competence self-assessment scale had a high level of reliability of 0.94. The content validity, convergent validity and discriminant validity were high, and the structure of the instrument was reasonable. The self-assessment scale may provide a reliable and valid tool to self-assess the required competence and skills perceived by CBT therapists in China, and provide useful information for CBT training curriculum and program in China.

Pain management in bleeding disorders care: perspectives of Canadian Social Workers in Hemophilia Care

Abstract Background Pain associated with bleeding disorders has been demonstrated to have an impact on patients’ and families’ quality of life. Both acute and chronic pain are common experiences and require attention by professionals working in haemophilia treatment centres (HTCs). The benefits of psychological pain management strategies such as cognitive behaviour therapy and self-management skills training are well documented; however, it is not well understood how Canadian social workers involved in haemophilia care perceive and provide pain management support to patients. Aims To explore the current understanding of pain management and practice as well as the education needs of members of Canadian Social Workers in Hemophilia Care (CSWHC). Method Twelve semi-structured qualitative interviews were conducted with members of CSWHC. Transcribed interviews were coded with NVivo software and thematically analysed. Results The four key themes reflecting the experiences of social workers are: 1) Limited comprehension of key issues related to pain; 2) Conditioning to push through pain; 3) Expanding pain knowledge to enhance practice; 4) How we practice social work and choose to step in. Conclusion The current practice of CSWHC members aligns with literature in three main areas including assessment, instrumental services, and counselling. Social workers support the development of pain education and practical resources for patients with haemophilia who experience pain. While formal education, advocacy, and policy development of pain assessment and management are recognised, these areas require further research and development.

Validation of a Self-Assessment Scale for Therapists’ Perception of Cognitive Behavioural Therapy Skills in China: A Mixed Method

Background: There is limited information on outcomes of adult patients with pulmonary atresia with intact ventricular septum (PA-IVS) due to the low incidence of disease and the large variation of surgical histories. Methods: Among 58 patients with repaired PA-IVS, a total of 32 patients aged ≥16 years and who were followed at our institution between January 2003 and December 2018 were reviewed. Surgical history, clinical outcomes, and laboratory, echocardiographic and electrocardiographic data were obtained by chart review. Results: Follow-up was from the age of 16 years and the median age at the latest follow-up was 23.7 years. Twenty-four patients had undergone biventricular repair (BVR), 3 had undergone one-and-a half ventricular repair (1.5VR), and 5 had undergone univentricular repair. Over a median follow-up period of 7.7 years (interquartile range: 4.1–11.0 years), 1 BVR patient died suddenly and 7 patients had heart failure. Arrhythmias were present in 5 patients. Ten patients underwent surgical re-interventions, including 4 BVR take-downs with conversion to 1.5VR and 3 Fontan conversions. Overall survival, heart failure-free, arrhythmia-free, and surgical re-intervention-free rates at 5 years and 10 years from the age of 16 years were 96.2% (95% confidence interval [CI], 77.2–99.4) and 96.2% (95% CI, 77.2– 99.4), 81.4% (95% CI, 62.1–92.1) and 74.6% (95%CI, 52.3–88.7), 88.7% (95% CI, 70.1–96.3) and 75.9% (95% CI, 51.7–90.2), and 80.7% (95% CI, 60.8–91.8) and 70.8% (95% CI, 49.7–85.7), respectively. Conclusion: Adults with PA-IVS have preserved long-term survival regardless of the early operative strategy, while they are at risk for heart failure, arrhythmia, and surgical re-intervention. Thus, detailed and continued follow-up is mandatory for all PA-IVS patients from childhood to adulthood.

One-Year follow-up effects of a cognitive behavior therapy-based transdiagnostic program for emotional problems in young children: A school-based cluster-randomized controlled trial

BackgroundThe present study examined the long-term efficacy of a transdiagnostic prevention program, Super Skills for Life (SSL), among young children with emotional problems. SSL is based on the principles of cognitive behavioral therapy, behavioral activation, and social skills training. MethodsOne-hundred and twenty-three Spanish-speaking children, aged 6 to 8 years, and their parents participated in the study. They were recruited from ten schools. Schools were randomly allocated to either the intervention (IG) or waiting-list control (WLC) groups. The children's parent completed a set of questionnaires to measure their child's anxiety and depressive symptoms, general difficulties and positive attributes, and psychosocial impairment. Parent's assessment at baseline and at a 12-month follow-up was assessed using an intent-to-treat approach. ResultsThe IG, compared to WLC group, showed significant baseline-to-follow-up reductions in anxiety and depressive symptoms, as well as in behavioral difficulties and psychosocial impairment in various life domains. LimitationsThe small sample size and the reliance on parental reports were the major limitations of this study. ConclusionsThis study provides initial evidence of the long-term effects of SSL, suggesting that it is a promising indicated preventive intervention for young children with emotional problems.

Gamifying CBT to deliver emotional health treatment to young people on smartphones

mHealth interventions promise the economic delivery of evidence-based mental health treatments like cognitive behavioural therapy (CBT) to populations that struggle to access health services, such as adolescents and in New Zealand, Māori and Pasifika youth. Unfortunately engagement with digital therapies is poor; modularisation and gamification have potential to increase their appeal. Gamifying CBT involves selecting suitable interventions, adapting them to a digital format while applying gamification principles. We describe the design and development of Quest - Te Whitianga, an app that encourages the user to learn CBT skills via a series of activities and games. A variety of approaches including consultation with clinicians, reference to best-practice literature, focus groups and interactive workshops with youth were used to inform the co-design process. Clinicians worked iteratively with experienced game designers to co-create a youth CBT digital intervention. The Quest modular app is set on an ocean and the user travels between islands to learn six evidence-based skills. These include a relaxation/mindfulness activity, activity planning, a gratitude journal plus problem solving and communication skills training. We describe the theoretical and design aspects of each module detailing the gamified features that aim to increase user engagement. In the near future we will be testing the app and the principles discussed in this paper via a randomised-controlled trial.

Resilience Against Depression Disparities (RADD): a protocol for a randomised comparative effectiveness trial for depression among predominantly low-income, racial/ethnic, sexual and gender minorities

IntroductionDepression is the leading cause of adult disability and common among sexual and gender minority (SGM) adults. The current study builds on findings showing the effectiveness of depression quality improvement...

A COMPARISON OF TWO METHODS FOR REDUCING TEST-ANXIETY AND IMPROVING ACADEMIC PERFORMANCE

This study examined the effectiveness of cognitive behavioral therapy (CBT) and study skills training (SST) in reducing test-anxiety and improving academic performance. Eighty one high test-anxious male students in the tenth grade were randomly assigned to three groups: CBT, SST and waiting-list control (WLC). CBT aimed to help participants become aware of the anxiety-producing self-statements they emitted both before and during exams, and to train them to develop positive self-statements that would facilitate task attending; whereas SST aimed to teach participants the skills necessary for effective learning, namely SQ3R method of studying, techniques of time management, note-taking methods, test preparation techniques and test-taking techniques. All participants receiving treatment met for a total of six 50-minute treatment sessions spanning over six weeks. The data was analyzed using one-way ANOVA and one way MANOVA. The results indicated that both treatment groups made significant improvements from pretest to posttest in test-anxiety when compared to the WLC group. However, only the CBT group was superior to the WLC group in improving academic performance. Overall, the results were interpreted as giving support to the interference model of the debilitating effect of anxiety on performance.

Training and Clinical Impact of Cognitive Behaviour Therapy Workshops in a Teaching Hospital in North India.

Background:Cognitive behaviour therapy (CBT) is an empirically supported psychotherapy with applications across psychiatric disorders. The demand for nonpharmacological interventions is increasing in the developing world. Unfortunately, existing resources are unable to cater to treatment and training needs.Methods:The aim of the current paper is to provide a description of the format of a series of CBT training workshops and their clinical impact in a psychiatric tertiary care center in north India. Over a period of nine years, nine training workshops were conducted. CBT concepts and skills sets were inculcated in faculty and student participants, using teaching strategies based on adult learning techniques.Results:The workshops resulted in a tremendous increase in the number of patients taken up for CBT. While therapeutic and training outcomes were not systematically assessed, the naturalistic outcomes (60 out of 85 patients completed therapy; improvement reported by >90% of the completers) are encouraging and showcase capacity building by means of CBT training in these workshops.Conclusions:CBT training workshops are an effective way to impart CBT skills and, therefore, to build CBT expertise in a resource-poor setting.

Implementing evidence-based mental health practices in schools: Feasibility of a coaching strategy

PurposeMood and anxiety disorders affect 20–30 percent of school-age children, contributing to academic failure, substance abuse, and adult psychopathology, with immense social and economic impact. These disorders are treatable, but only a fraction of students in need have access to evidence-based treatment practices (EBPs). Access could be substantially increased if school professionals were trained to identify students at risk and deliver EBPs in the context of school-based support services. However, current training for school professionals is largely ineffective because it lacks follow-up supported practice, an essential element for producing lasting behavioral change. The paper aims to discuss these issues.Design/methodology/approachIn this pilot feasibility study, the authors explored whether a coaching-based implementation strategy could be used to integrate common elements of evidence-based cognitive behavioral therapy (CBT) into schools. The strategy incorporated didactic training in CBT for school professionals followed by coaching from an expert during co-facilitation of CBT groups offered to students.FindingsIn total, 17 school professionals in nine high schools with significant cultural and socioe-conomic diversity participated, serving 105 students. School professionals were assessed for changes in confidence in CBT delivery, frequency of generalized use of CBT skills and attitudes about the utility of CBT for the school setting. Students were assessed for symptom improvement. The school professionals showed increased confidence in, utilization of, and attitudes toward CBT. Student participants showed significant reductions in depression and anxiety symptoms pre- to post-group.Originality/valueThese findings support the feasibility and potential impact of a coaching-based implementation strategy for school settings, as well as student symptom improvement associated with receipt of school-delivered CBT.

Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders

Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40%–50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9–14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At posttreatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at 2-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.

Cognitive versus behavioral skills in CBT for depressed adolescents: Disaggregating within-patient versus between-patient effects on symptom change.

Despite a growing body of research supporting the efficacy of cognitive-behavioral therapy (CBT) for depressed adolescents, few studies have investigated the role of the acquisition and use of CBT skills in accounting for symptom improvement. The present study examined the role of cognitive versus behavioral skills in predicting symptom improvement in depressed youth. Analyses considered different raters of patient skills (patient vs. therapist) as well as disaggregated between-patient versus within-patient effects. Data were derived from a 12-week clinical trial of CBT for depressed adolescent females (N = 33; ages 13-18 years; 69.7% White). Both therapist-report and patient-report measures of CBT skills (skills of cognitive therapy) were acquired at 5 time points throughout therapy: Sessions 1, 3, 6, 9, and 12. Depressive symptoms (Beck Depression Inventory-II) were assessed at every session. Therapist and patient ratings of CBT skills showed small to moderate associations (rs = .20-.38). Intraclass correlation coefficients indicated that the majority of the variance in skills scores (61-90%) was attributable to within-patient variance from session to session, rather than due to between-patient differences. When disaggregating within-patient and between-patient effects, and consistent with a causal relationship, within-patient variability in both patient-rated (b = -2.55; p = .025) and therapist-rated (b = -2.41; p = .033) behavioral skills predicted subsequent symptom change. Analyses highlight the importance of the acquisition and use of behavioral skills in CBT for depressed adolescents. Findings also underscore the importance of disentangling within-patient from between-patient effects in future studies, an approach infrequently used in process-outcome research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluating the real-world effectiveness of a cognitive behavior therapy-based transdiagnostic program for emotional problems in children in a regular school setting

BackgroundThe present study examined the real-world effectiveness of a transdiagnostic prevention program, Super Skills for Life (SSL), among children with emotional problems in regular school settings. SSL is based on the principles of Cognitive Behavior Therapy (CBT), behavioral activation, and social skills training. MethodsParticipants were 205 children, aged 8–12 years, who were referred by their teachers as having significant emotional problems. All the children completed measures of emotional and behavioral problems and self-esteem, both before and after participating in SSL, and at six months after the intervention. The children's parents and class teachers also completed a questionnaire that measures children's general difficulties and positive attributes. Children also gave a 2-minute speech task in front of the video in sessions 1 and 8. ResultsThere was agreement among self, parent, and teacher report, showing significant decreases of emotional symptoms from pretest to posttest and pretest to follow-up. Main effect of gender was significant for anxiety symptoms, emotional symptoms peer problems, and prosocial behavior. Video analysis of the 2-minute speech task showed significant improvement in length of eye gaze, vocal quality, length of speech, manifestation of comfort, and conversational flow. However, hypothesized increases in self-esteem did not act as a mediator of change in pre- to post-anxiety symptoms or social phobia subscale scores. LimitationsThe present study used an open clinical trial design. ConclusionsThis study provides initial support for the effectiveness of the manual-guided CBT for emotional problems in regular school settings when delivered by school services staff.

Towards an improved access to psychiatric rehabilitation: availability and effectiveness at 1-year follow-up of psychoeducation, cognitive remediation therapy, cognitive behaviour therapy and social skills training in the FondaMental Advanced Centers of Expertise-Schizophrenia (FACE-SZ) national cohort.

Psychosocial Interventions (PIs) have shown positive effects on clinical and functional outcomes of schizophrenia (SZ) in randomized controlled trials. However their effectiveness and accessibility remain unclear to date in "real world" schizophrenia. The objectives of the present study were (i) to assess the proportion of SZ outpatients who benefited from PIs between 2010 and 2015 in France after an Expert Center Intervention in a national multicentric non-selected community-dwelling sample; (ii) to assess PIs' effectiveness at 1-year follow-up. 183 SZ outpatients were recruited from FondaMental Advanced Centers of Expertise for Schizophrenia cohort. Baseline and 1-year evaluations included sociodemographic data, current treatments, illness characteristics and standardized scales for clinical severity, adherence to treatment, quality of life, a large cognitive battery, and daily functioning assessment. Only 7 (3.8%) received a PI before the evaluation, and 64 (35%) have received at least one PI during the 1-year follow-up. Having had at least one PI during the follow-up has been associated in multivariate analyses with significantly higher improvement in positive and negative symptoms (respectively p=0.031; p=0.011), mental flexibility (TMT B, p=0.029; C-VF, p=0.02) and global functioning (p=0.042). CBT and SST were associated with higher cognitive improvements, while CRT was associated with clinical improvement. These results have not been demonstrated before and suggest that the effect of each PI is larger than its initial target. The present study has confirmed the PIs' effectiveness in a large sample of community-dwelling SZ outpatients at 1 year follow-up. Efforts to improve access to PI should be reinforced in public health policies.

Dissemination of computer-assisted cognitive-behavior therapy for depression in primary care

Computer-assisted cognitive-behavior therapy (CCBT) for depression in primary care will be evaluated in a trial with 240 patients randomly assigned to CCBT or treatment as usual (TAU). The study will disseminate a therapy method found to be effective in psychiatric settings into primary care – a setting in which there have been significant problems in the delivery of adequate, evidence-based treatment for depression. The study will include a high percentage of disadvantaged (low-income) patients – a population that has been largely ignored in previous research in CCBT. There have been no previous studies of CCBT for depression in primary care that have enrolled large numbers of disadvantaged patients. The form of CCBT used in this study is designed to increase access to effective therapy, provide a cost-effective method, and be a sustainable model for wide-spread use in primary care. In order to deliver therapy in a practical manner that can be replicated in other primary care practices, patients with significant symptoms of depression will receive treatment with an empirically supported computer program that builds cognitive-behavior therapy skills. Support for CCBT will be provided by telephone and/or e-mail contact with a care coordinator (CC) instead of face-to-face treatment with a cognitive-behavior therapist. Outcome will be assessed by measuring CCBT completion rate, comprehension of CBT concepts, and satisfaction with treatment, in addition to ratings of depressive symptoms, negative thoughts, and quality of life. The cost-effectiveness analysis and exploration of possible predictors of outcome should help clinicians, health care organizations, and others plan further dissemination of CCBT in primary care.

Using cognitive behavioural therapy techniques in COPD

It is estimated that by 2020 chronic obstructive pulmonary disease is likely to become the fourth leading cause of death. People living with this condition may experience symptoms that can be managed with cognitive behavioural therapy, says Karen Heslop-Marshall Chronic obstructive pulmonary disease (COPD) is a term oftened used to describe two lung conditions in particular: chronic bronchitis and/or emphysema. Patients with COPD often experience symptoms of breathlessness, anxiety, panic and depression, and practice nurses are ideally placed to address these symptoms. This article looks at the use of cognitive behavioural therapy (CBT) techniques in symptom management, describes methods to assess the psychological impact of breathlessness, and outlines common techniques evaluated in a COPD CBT study by Heslop-Marshall et al (2018) . Research found that respiratory nurses were able to learn and deliver CBT techniques to patients with COPD and improved their symptoms of anxiety, depression, quality of life and reduced their use of healthcare resources. Self-management in primary care can be improved with CBT skills and practice nurses could improve self-management by incorporating CBT techniques.

Efficacy of exposure-based cognitive behaviour therapy for post-traumatic stress disorder in emergency service personnel: a randomised clinical trial.

Although emergency service personnel experience markedly elevated the rates of post-traumatic stress disorder (PTSD), there are no rigorously conducted trials for PTSD in this population. This study assessed the efficacy of cognitive behaviour therapy (CBT) for PTSD in emergency service personnel, and examined if brief exposure (CBT-B) to trauma memories is no less efficacious as prolonged exposure (CBT-L). One hundred emergency service personnel with PTSD were randomised to either immediate CBT-L, CBT-B or wait-list (WL). Following post-treatment assessment, WL participants were randomised to an active treatment. Participants randomised to CBT-L or CBT-B were assessed at baseline, post-treatment and at 6-month follow-up. Both CBT conditions involved 12 weekly individual sessions comprising education, CBT skills building, imaginal exposure, in vivo exposure, cognitive restructuring and relapse prevention. Imaginal exposure occurred for 40 min per session in CBT-L and for 10 min in CBT-B. At post-treatment, participants in WL had smaller reductions in PTSD severity (Clinician Administered PTSD Scale), depression, maladaptive appraisals about oneself and the world, and smaller improvements on psychological and social quality of life than CBT-L and CBT-B. There were no differences between CBT-L and CBT-B at follow-up on primary or secondary outcome measures but both CBT-L and CBT-B had large baseline to follow-up effect sizes for reduction of PTSD symptoms. This study highlights that CBT, which can include either long or brief imaginal exposure, is efficacious in reducing PTSD in emergency service personnel.