Cognitive Behavioral Therapy Research Articles

Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep

Direct-to-patient interventions enabling transitions from long-term benzodiazepine receptor agonist (BZRA) use to cognitive behavioral therapy for insomnia (CBTI) by older adults has the potential to reduce BZRA use and related harms while improving sleep outcomes without requiring prearranged clinician involvement. To compare 2 direct-to-patient behavior change interventions with treatment as usual (TAU) on BZRA use, sleep, and other health outcomes, and uptake of CBTI techniques. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study was a 3-arm, pragmatic, open-label, minimum-contact, randomized clinical trial. The study began November 2020 and ended June 2022. Participants were randomly allocated to 1 of 3 groups, including 2 different mailed behavior change interventions or no intervention (TAU). Participants were from communities across the province of New Brunswick, Canada, and included adults 65 years and older living independently with long-term use of BZRAs and current or past insomnia. The Sleepwell package (YAWNS-1) consisted of a cover letter and 2 booklets ("How to Stop Sleeping Pills" and "How to Get Your Sleep Back"). The other package (YAWNS-2) included updated versions of the 2 booklets ("You May Be at Risk" and "How to Get a Good Night's Sleep Without Medication") used in the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) study. BZRA use at 6 months was the primary measure. Secondary measures included CBTI use, sleep, insomnia, daytime sleepiness, safety, anxiety, frailty, and quality of life. A total of 1295 individuals expressed interest in the study, and 565 (43.6%) completed a baseline assessment. Participants had a mean (SD) age of 72.1 (5.7) years, a mean (SD) BZRA use duration of 11.4 (9.1) years, and 362 (64.1%) were female. Discontinuations and dose reductions of 25% or greater were highest with YAWNS-1 (50 of 191 [26.2%]; 39 of 191 [20.4%]; total, 46.6%) compared with YAWNS-2 (38 of 187 [20.3%]; 27 of 187 [14.4%]; total, 34.8%, P = .02) and TAU (14 of 187 [7.5%]; 24 of 187 [12.8%]; total, 20.3%, P < .001). YAWNS-1 also demonstrated better uptake of CBTI techniques and sleep outcomes compared with YAWNS-2 (new CBTI techniques: 3.1 vs 2.4; P =.03; sleep efficiency change: 4.1% vs -1.7%; P =.001) and reduced insomnia severity and daytime sleepiness compared with TAU (insomnia severity index change: -2.0 vs 0.3; P <.001; Epworth Sleepiness Scale change: -0.8 vs 0.3; P =.001). Results of the YAWNS NB randomized clinical trial show that, as a simple, scalable, direct-to-patient intervention, YAWNS-1 substantially reduced BZRA use and improved sleep outcomes. It could be implemented to transform insomnia care for older adults at the population level. ClinicalTrials.gov Identifier: NCT04406103.

A Reinforcement Learning-Based Approach for Promoting Mental Health Using Multimodal Emotion Recognition

This research aims to enhance mental well-being by addressing symptoms of anxiety and depression through a personalized, culturally specific multimodal emotion prediction system. It employs an emotionally aware Reinforcement Learning (RL) agent to suggest tailored Cognitive Behavioral Therapy (CBT) activities. The study focuses on developing precise, individualized emotion prediction models using facial expressions, vocal tones, and text, and integrates these models with the RL agent for emotionally aware CBT recommendations. The mHealth approach combines deep learning models with RL, achieving accuracies of 72% for facial expressions, 73% for vocal tones, and 86% for text, all fine-tuned for the Sri Lankan context. Validation through real-world use and user feedback consistently demonstrated that each model exceeds 70% accuracy, fulfilling the objective of precise emotion prediction. A weighted algorithm was introduced to refine the emotion prediction experience and personalize forecasts across the three modalities to enhance mental well-being. The RL-enabled agent suggests CBT activities approved by mental health professionals, tailored based on predicted emotions, and delivered through the same mHealth application. The effectiveness of these interventions was assessed using the DASS-21 questionnaire, revealing significant reductions in depression scores (from 21.08 to 13.54) and anxiety scores (from 19.85 to 10.46) in the study group compared to the control group. The study concludes that integrating multimodal emotion prediction models with RL-based CBT suggestions positively impacts mental well-being and contributes to personalized mental health interventions.

Telehealth-delivered cognitive behavioral therapy - a potential solution to improve sleep quality and normalize the salience network in fibromyalgia: a pilot randomized trial.

Our study investigated the associations between the clinical benefits of telehealth-delivered cognitive behavioral therapy for insomnia (tele-CBT-I) and the salience network in fibromyalgia (FM). Thirty-five FM patients with comorbid insomnia were recruited and assigned into two groups: the tele-CBT-I group (n = 17) or the treatment-as-usual (TAU) group (n = 18). At baseline and post-treatment, clinical status was assessed using standardized scales, including the Insomnia Severity Index (ISI), Brief Pain Inventory, Numeric Pain Rating scale, Beck Depression Intervention version II, Beck Anxiety Intervention, Situational Fatigue Scale, and Fibromyalgia Impact Questionnaires. Resting-state functional magnetic resonance imaging was collected. We compared within- and between-group differences in clinical changes and functional connectivity (FC) of the salience network. A factor analysis of significant FCs was performed. Correlation analyses between clinical symptoms and salience FCs were conducted. The tele-CBT-I group showed sleep quality improvements after treatment that were greater than those in the TAU group (p-value = 0.038). After treatment, tele-CBT-I decreased FCs of cortical regions and increased FCs of subcortical regions compared to the TAU group. Additionally, factor analysis grouped the significant FCs into cortical factors and subcortical factors. The cortical factor value, representing the involvement of specific cortical regions of the salience network by the factor analysis, was significantly associated with ISI scores in the tele-CBT-I group (p-value = 0.0002). In conclusion, tele-CBT-I might be an adjuvant approach to improve sleep quality and normalize cortical and subcortical functions of the salience network in FM patients with comorbid insomnia.

Transformative approaches to chronic mood disorders: a comparative evaluation of cognitive-behavioral therapy and allegorical schema modes

Transformative approaches to chronic mood disorders: a comparative evaluation of cognitive-behavioral therapy and allegorical schema modes

A hospital and community-based violence intervention program for Black & Latino youth and their caregivers.

Black and Latino youth are disproportionately affected by trauma from community violence, but to date, few data support the benefit of evidence-based treatments for these youth or of including peer support to engage these youth in mental health services. From 2018 until 2020, a hospital and community-based violence intervention program in Philadelphia pilot tested the integration of home and community-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with peer services and case management for youth impacted by community violence. This study describes the implementation of this intervention. Data was gathered by querying the program's database. The Child Post Traumatic Stress Symptom Severity Scale (CPSS-SR-5) and the Short Mood and Feelings Questionnaire (SMFQ) were utilized to evaluate the participants' pre- and post-intervention assessment of PTSD and depression. The sample (N = 50) consisted of Black and Latino youth, mean age 14. Twenty-nine (58%) completed TF-CBT, and 82% met peer and case management goals. Youth who completed therapy showed significant improvement in both PTSD and depression symptoms at post-test. To our knowledge, this is the first study describing the implementation of home and community-based TF-CBT with peer support and case management. The study's limitations and need for further research are discussed.

The relationship between perfectionism and self-esteem in adults: a systematic review and meta-analysis.

Perfectionism dimensions, including perfectionistic strivings and perfectionistic concerns, have a significant positive association with psychopathology. Clinical perfectionism is defined as when an individual's self-esteem is excessively reliant on meeting high standards despite negative consequences. Numerous studies have found that higher perfectionistic concerns correlate with lower self-esteem; however, evidence for the association with perfectionistic strivings has been mixed. The focus of this systematic review and meta-analysis was to inform theoretical understanding of the relationships between perfectionism dimensions and self-esteem in adults. A systematic literature search was conducted in Medline, PsycINFO, PsychARTICLES, ProQuest Central, and Scopus on 31 May 2023. There were 83 articles included, with 32,304 participants (Mage=∼24.66 years). There was a significant negative moderate pooled association between self-esteem and perfectionistic concerns, r=-.42, 95% CI [-0.47 to -0.38]. A significant negligible positive pooled association was found between self-esteem and perfectionistic strivings, r=.06, 95% CI [0.01 to 0.11]. Results indicate higher perfectionistic concerns is associated with lower self-esteem, providing indirect support for the cognitive-behavioural model of clinical perfectionism. Future research should compare cognitive behaviour therapy for perfectionism to treatments for low self-esteem on outcomes of perfectionistic concerns and psychopathology.

Trends, advances and directions in cognitive-behavioral therapy for adolescent anxiety.

Trends, advances and directions in cognitive-behavioral therapy for adolescent anxiety.

Augmented Reality as an Aid to Behavior Therapy for Anxiety Disorders: A Narrative Review.

Anxiety disorders are among the most common mental disorders worldwide. These conditions are characterized by excessive anxiety that is difficult to control. In most anxiety disorders, symptoms are triggered by exposure to specific objects or situations. This leads sufferers to avoid such exposures, leading to impaired social and occupational functioning and reduced quality of life. Therapies based on behavioral principles, either alone or in combination with cognitive techniques, are the most effective psychological interventions for anxiety disorders. However, the effectiveness of these therapies may be limited due to a lack of generalization from clinic to real-world settings. Augmented reality (AR) is a technology that provides an interactive experience by superimposing computer-generated content, often in multiple sensory modalities, on the real world. Emerging evidence suggests that AR may be useful in treating a broad range of mental disorders, including anxiety disorders. This review examines the evidence for the use of AR-based techniques as an aid to behavioral or cognitive-behavioral therapies for anxiety disorders. The available evidence suggests that this method may offer significant advantages over conventional therapies, particularly in the case of specific phobias, but also in social anxiety disorder. AR can also be combined with other novel technologies to monitor psychophysiological markers of anxiety and its reduction over the course of treatment. The advantages of AR could be related to its combination of real and simulated content, allowing for better generalization of the benefits of conventional exposure-based therapy. Though the safety, efficacy, and cost-effectiveness of this method need to be confirmed in larger samples, it could lead to a paradigm shift in the way behavioral therapies for anxiety disorders are conceptualized and delivered.

Nursing Interventions in Primary Care for the Management of Maladaptive Grief: A Scoping Review.

Grief is a natural and self-limited adaptation process to a new reality that emerges after a significant loss (whether real or perceived), with a broad variety of manifestations that exert an impact on a grieving person's health. The study aim was to synthesize the evidence available about the interventions carried out by Primary Health Care nurses, by means of an individual approach to reduce maladaptive grief or maladaptive grief risk. A scoping review was conducted (November and December 2023) through searches in Medline, Cinahl, Web of Science, ProQuest and Scopus using MeSH terms combined with Booleans. Primary research of any design in adult people undergoing grief situations and receiving professional assistance by nurses in the primary, home and community care contexts published after 2009 in English, Spanish or Portuguese languages were included. Excluded publications were those conducted in in-hospital clinical settings and which did not correspond to research designs or the gray literature. The screening process was carried out by two reviewers using the appropriate JBI critical appraisal tools for each design and discrepancies were resolved by a third reviewer. A total of n = 10 studies were included (n = 4 qualitative, n = 2 RCTs, n = 1 quasi-experimental, n = 2 cross-sectional observational, and n = 2 mixed methods). The qualitative studies identified topics and subtopics of professionals' and families' experiences of grief. The observational studies analyzed symptoms and factors associated with the grieving process. Interventions consisted of cognitive-behavioral therapies delivered by psychological specialists who assessed the severity of grief in a range of cultural contexts using different instruments. The evidence retrieved from the studies that address the reduction in maladaptive grief or maladaptive grief risk is not conclusive. There is a need to increase both the number and the methodological quality of studies assessing the effectiveness of Nursing care in Primary Health Care for individuals experiencing maladaptive grief or maladaptive grief risk. Further research should focus on experimental studies, developing specific interventions conducted by nurses to address individual's grief and prevent maladaptive grief.

Clinical Considerations for Integrating Ethical Principles of Beneficence in the Development of Evidence-Based Interventions: The case of Pediatric Misophonia.

Misophonia is a condition involving decreased tolerance and intense responses to specific sounds, often those that are human-generated and repetitive in nature. Misophonia frequently onsets during childhood and is associated with significant distress, impairment, and diminished quality of life. While misophonia research remains nascent and no definitive practice guidelines exist at present, extant studies offer several promising potential avenues in intervention development for adults with misophonia. However, such research is comparatively limited for youth. Before widespread adoption of promising treatments, it is important to consider the potential for harm or non-beneficence that may arise from the mis-informed application of such treatments. In this article, we identify several potential pitfalls within intervention development for pediatric misophonia and provide recommendations to circumvent them. To that end, we focus on the following three topic areas: (a) challenges arising when psychological mechanisms are not considered in intervention development, (b) importation of a cognitive-behavior therapy (CBT) framework for obsessive-compulsive spectrum disorders without nuanced tailoring to misophonia, and (c) neglecting to include individuals with lived experience in the process of intervention development research. Considering these key areas within misophonia intervention development will be critical for upholding beneficence and minimizing harm in treatment of misophonia across the lifespan.

The Indirect Effect of an Internet-Based Intervention on Third-Party Disability for Significant Others of Individuals with Tinnitus.

This study aimed to investigate whether Internet-based cognitive behavioural therapy intervention (ICBT) for individuals with tinnitus had an indirect effect on the third-party disability noticed by significant others (SOs). Significant Others Questionnaire (CTSOQ). Individuals with tinnitus completed standardized self-reported outcome measures for tinnitus severity, anxiety, depression, insomnia, hearing-related quality of life, tinnitus cognitions, hearing disability, and hyperacusis. In total, 194 pairs of individuals with tinnitus and their SOs participated. The impact of third-party disability experienced by SOs was significantly reduced after individuals with tinnitus undertook the ICBT intervention (d = 0.41). This reduced SOs with severe difficulties from 52% to 35%. The remaining impact was mild for 30% and moderate for 35%. SOs with higher baseline difficulties and SOs who were partners (e.g., spouses) were less likely to notice indirect benefits from intervention undertaken by their family members. There was a moderate positive correlation between the post-intervention CTSOQs and the clinical variables of tinnitus severity and depression. Third-party disability may be reduced as an indirect effect of individuals with tinnitus undertaking ICBT. Including SOs of individuals with tinnitus within the rehabilitation process may add additional benefits, and such involvement should be encouraged.

Effect of cognitive behavioral therapy for insomnia on sleep quality among college students: the role of hyperarousal and dysfunctional beliefs

ABSTRACT Background Although cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment for sleep disorders, little is known about the role of hyperarousal (especially trait arousal) in CBT-I interventions. Therefore, this study investigated the role of trait arousal in the maintenance of sleep problems using cross-sectional and longitudinal methods. Methods Study 1, 1209 Chinese university students (63.9% female) completed the Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), Pre-sleep Arousal Scale (PSAS), Arousal Predisposition Scale (APS), and Pittsburgh Sleep Quality Index (PSQI). The study calculated the moderating role of trait arousal in the relationship between dysfunctional beliefs about sleep and sleep quality. In study two, 89 participants completed the questionnaire used in Study 1 during pre-and post-treatment. A within-subjects mediation analysis examined the indirect effects of dysfunctional beliefs about sleep pre-sleep arousal (cognitive and somatic) on sleep quality. A within-subjects moderation analysis was used to investigate whether baseline trait arousal moderated sleep quality. Results Cross-sectional findings indicated that pre-sleep cognitive arousal mediated the effects of dysfunctional beliefs about sleep on sleep quality and that trait arousal moderated the first half of the mediating pathway described above; longitudinal analyses indicated that changes in dysfunctional beliefs about sleep and pre-sleep cognitive arousal mediated changes in sleep quality, and that, in addition, trait arousal moderated changes in sleep quality. Conclusion Trait arousal correlates with the maintenance of sleep problems, and participants with higher trait arousal benefited less from CBT-I. Enhancement programs that incorporate mindfulness may be a direction for future research.

Classification of suicidal ideation severity from Twitter messages using machine learning

Depression has become a major mental health problem in Thailand and can lead to suicidal ideation. As suicidal ideation may vary in intensity and lead to suicide attempts, early detection of suicidal ideation severity should be implemented. This research presents text classification models for the prediction of suicidal ideation severity. A dataset of Twitter messages in Thai was used to develop several classification models. A web application prototype was also developed to predict suicidal ideation severity and introduce self-therapy based on Cognitive Behavioral Therapy to its users for managing negative automatic thoughts. The application prototype received satisfactory feedback during the user experience assessment. The results of this research highlight the importance and need for socio-technical systems to help with early suicidal ideation detection and early therapy in the social environment where mental health support is inadequate.

Homework adherence in mindfulness-based cognitive interventions for female sexual dysfunction: a scoping review.

Mindfulness-based cognitive therapy (MBCT) includes regular home practice of mindfulness exercises as a key means of cultivating mindfulness. Although there are instruments available for measuring homework adherence following cognitive behavioral therapy (CBT), little is known about measuring homework practice in MBCT studies for sexual dysfunction. In this review we sought to investigate which items and instruments are the most used for the assessment of homework adherence in studies evaluating MBCT for the treatment of female sexual dysfunction (FSD). We also investigated the types of homework used in these interventions. Five databases (PubMed, Scopus, PsycINFO, Embase, and Web of Science) were searched and a total of 30 articles were included in this review. Our main findings revealed that there was no gold standard instrument used to assess homework adherence in patients using MBCT interventions for FSD, and that most of the reported studies did not provide information on how they assess homework adherence. Six of the 9 studies for which the articles reported how homework was assessed used only ad hoc measures. Only 3 studies used psychometrically validated instruments. We also found that mindfulness, psychoeducation, and CBT exercises were the most prescribed homework. This review uniquely integrates homework adherence measures with studies on FSD that evaluate mindfulness, finding no gold standard for assessing adherence. However, limitations including both MBCT and CBT interventions, limiting generalization to MBCT alone, the predominance of Western-based studies, and the lack of reporting on instruments used to assess adherence, indicating a gap in the field. Further studies should consider adapting existing instruments that assess homework adherence in studies of CBT for other psychopathologies or seek to develop new psychometrically validated instruments for MBCT interventions that assess homework adherence.

Hair cortisol and psychiatric symptomatology in children; outcomes of group CBT

The associations between hair cortisol concentration (HCC), a biomarker of chronic stress, and behavior and sleep disturbance symptoms have not been studied in children with psychiatric disorders. While cognitive behavioral therapy (CBT) has proven effective in treating psychiatric symptoms in children, its potential biological implications as determined by HCC have not been investigated. We explored associations between HCC, behavior and sleep disturbance symptoms, and different diagnostic groupings (depression/anxiety, ADHD, or other types of psychiatric disorders) in clinician-diagnosed 6-12-year-old children (n = 100) with mixed psychiatric disorders and comorbidities. In addition, we examined whether group CBT led to changes in HCC, behavior symptoms, and sleep disturbance symptoms and whether any fluctuations in HCC levels were associated with potential symptom change. We collected data on HCC, internalizing and externalizing symptoms (The Spence Children's Anxiety Self-Report, Child Behavior Checklist, and Teacher Report Form), and sleep disturbance symptoms (The Sleep Disturbance Scale for Children) at three time points (baseline, post-treatment, and seven-month follow-up). Baseline HCC was not associated with behavior or sleep disturbance symptoms, whereas behavior and sleep disturbance symptoms were mutually correlated. No changes in HCC levels were observed with group CBT. Moreover, potential variations in HCC levels over the course of the study did not appear to be associated with behavior symptom relief after group CBT. Our findings suggest that HCC may not be a methodologically relevant biomarker of behavior or sleep disturbance symptoms in children with diverse psychiatric disorders.

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.

Applying Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) to Severe and Longstanding Eating Disorders (SEED) Paper 1: I am no longer a SEED patient

This autobiographical paper recounts the recovery journey of Lorna Collins, a survivor of severe and enduring anorexia nervosa (SE-AN). Her story begins with a traumatic brain injury at the age of 18, leading to a complex eating disorder that persisted for over two decades. Despite over 30 hospital admissions and various treatment modalities, her condition only worsened, compounded by other mental health challenges. The paper describes these multifaceted struggles, including mistreatment in healthcare, self-harm, further trauma and near-fatal illness. The author aims to culminate her story in an uplifting manner, by highlighting the pivotal role that integrated cognitive behaviour therapy, artistic expression, and a renewed connection with her family have made on her recovery. Collins’ account is not only a personal testimony but also offers critical insights into the shortcomings of traditional eating disorder treatments and the importance of personalised, holistic approaches in mental health care. Lorna’s story aims to bring hope, challenge the concept of SEED and form part of a growing evidence-base that recovery is possible irrespective of duration or eating disorder severity.

A - 27 Case Study Approach to Initial Exploration of Adaptations of Cognitive Behavioral Therapy (CBT) for Non-Epileptic Seizures (NES) in the Context of Cognitive Impairment

Abstract Objective The following case study seeks to review implementation of CBT for NES, discuss psychotherapeutic adaptations and outcomes while balancing treatment fidelity, and offer preliminary recommendations for expansion of psychotherapeutic modalities for individuals with cognitive impairment. Methods 49-year-old Hispanic male with a history of mixed epileptic (non-lesional frontal lobe medically refractory) and non-epileptic events. Neurological workup included video EEG, which captured seven events without EEG correlate and an unremarkable brain MRI. Neuropsychological evaluation indicated mild cognitive impairment due to epilepsy with deficits in processing speed, executive functioning, and confrontation naming with borderline to low average core visual and verbal abilities. The patient participated in manualized CBT for PNES. Results Treatment adaptations included extending treatment sessions from 12–19 sessions and including the patient’s sister. They read the chapters together and practiced strategies outside of session. She participated in helping him notice patterns of manifestations of fear and anger and their influence on somatic symptoms. Omission of treatment elements with higher cognitive demand (i.e., thought chart). Outcomes included increased awareness of emotions, triggers, and warnings but not episode reduction in the context of increased epileptic seizures. Conclusions Feasibility of treatment may be limited for individuals with mixed epileptic and NES episodes, particularly if there is cognitive impairment and difficulty differentiating between the two. Psychotherapeutic techniques that are concrete and behaviorally based will = be beneficial for individuals with cognitive impairment. Episode reduction in isolation is likely reductionistic when considering treatment effectiveness. Ability to self-manage episodes, quality of life, functional status, and self-efficacy are valuable markers of improvement.

Making the most out of timeseries symptom data: A machine learning study on symptom predictions of internet-based CBT

ObjectivePredicting who will not benefit enough from Internet-Based Cognitive Behavioral (ICBT) Therapy early on can assist in better allocation of limited mental health care resources. Repeated measures of symptoms during treatment is the strongest predictor of outcome, and we want to investigate if methods that explicitly account for time-dependency are superior to methods that do not, with data from (a) only two pre-treatment timepoints and (b) the pre-treatment timepoints and three timepoints during initial treatment. MethodsWe use 1) commonly used time-independent methods (i.e., Linear Regression and Random Forest models) and 2) time-dependent methods (i.e., multilevel model regression, mixed-effects random forest, and a Long Short-Term Memory model) to predict symptoms during treatment, including the final outcome. This is done with symptom scores from 6436 ICBT patients from regular care, using robust multiple imputation and nested cross-validation methods. ResultsThe models had a 14 %–12 % root mean squared error (RMSE) in predicting the post-treatment outcome, corresponding to a balanced accuracy of 67–74 %. Time-dependent models did not have higher accuracies. Using data for the initial treatment period (b) instead of only from before treatment (a) increased prediction results by 1.3 % percentage points (12 % to 10.7 %) RMSE and 6 % percentage points BACC (69 % to 75 %). ConclusionTraining prediction models on only symptom scores of the first few weeks is a promising avenue for symptom predictions in treatment, regardless of which model is used. Further research is necessary to better understand the interaction between model complexity, dataset length and width, and the prediction tasks at hand.

A - 142 Exploratory Analysis of the Cognitive Outcomes of Cognitive Behavioral Therapy for Insomnia (CBT-I) in Patients with Primary Brain Tumor

Abstract Objective Patients with primary brain tumor (PBT) experience declines in cognitive functioning and frequently endorse sleep disturbance. Our single-arm proof-of-concept trial of Cognitive Behavioral Therapy for Insomnia (CBT-I) in patients with PBT demonstrated clinically significant improvements in self-reported insomnia symptoms. The present study explored changes in patients’ subjective and objective cognitive functioning following completion of the six-week CBT-I intervention. Methods Participants with PBT and clinical insomnia (N = 35; Mage = 51.6 ± 11 years; 54.03 female) enrolled in a 6-week group-based telehealth CBT-I intervention. Participants completed pre-post-intervention subjective and objective cognitive assessments (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30]; Hopkins Verbal Learning Test–Revised [HVLT-R], Oral Trail Making Test-B [OTMT-B], and Controlled Word Association Test [COWAT]). Within-group cognitive change was examined using established minimally important differences and reliable change indices. Results All participants demonstrated clinically stable subjective cognitive functioning from pre-to-post intervention. Individual analyses showed that 32 participants (91.4%) demonstrated clinically stable or improved verbal memory, 30 participants (85.7%) demonstrated clinically stable or improved divided attention, and all participants (100%) demonstrated clinically stable or improved phonemic fluency. Few participants demonstrated clinically significant decline in verbal memory (n = 2, 5.7%) or divided attention (n = 5, 14.3%). Conclusions Changes in both subjective and objective cognitive functioning were predominantly positive following a behavioral intervention for insomnia (CBT-I) among patients with PBT; however, these results should be viewed as preliminary. We will more thoroughly examine cognitive outcomes with a longer follow-up period in an upcoming randomized pilot trial of CBT-I in PBT.